Transcript Document

Skin Cancer
Carlos Garcia MD
Dermatology at OUHSC
No conflicts of interest to disclose
Objectives

Identify clinical characteristics of
 Precancerous lesions
 Common skin cancers

Define risk factors for development of skin
cancer

Choose appropriate methods for diagnosis
and treatment
Precancerous skin lesions
Actinic
Dysplastic
keratoses
melanocytic nevi
Actinic keratoses
10% risk of malignant transformation
Hypertrophic AK’s
Actinic cheilitis
Treatment of AK’s

Liquid nitrogen cryotherapy
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Topical therapies


5-FU (Efudex)

Imiquimod (Aldara)
Curettage for hypertrophic lesions
Liquid nitrogen
Cryotherapy
Residual hypopigmentation
Blister formation
Topical therapies
Efudex or Aldara
* 3-5 times per week
* 6-8 weeks
Dysplastic nevi
•Precursors for
melanoma
•Markers for
melanoma
Treatment of dysplastic nevi
 Non-melanoma
skin cancers
(NMSC)
 Basal
cell carcinoma
 Squamous
cell carcinoma
 Keratoacanthoma
Risk factors for development of
BCC and SCC

Fair skin (Fitzpatrick’s types I-III)
 Blue eyes
 Red hair

Family history
 Genetic syndromes

Chronic sun exposure

Old age

Arsenic, tar
Basal cell carcinoma
BCC- clinical types

Nodular
 Pigmented
 Infiltrative
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Superficial

Morpheaform
Nodular BCC
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Chronic lesion
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Easy bleeding
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Pearly border
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Surface telangiectasias
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Head and neck, trunk,
and extremities
Pigmented BCC

Similar to nodular but
with black discoloration
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Melanin deposits

Pigmented races
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Face, trunk, and scalp
Superficial BCC
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Erythematous scaly
plaque
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Slow growth
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Asymptomatic

Trunk, extremities, face
Morpheaform BCC

Resembles scar

Asymptomatic and slow
growing
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Ill-defined margins

Marked subclinical
extension

BCC is the most
frequent skin cancer
(80%)


BCC is 4x more
frequent than SCC
Metastases are rare
(<1% of cases)

Local destruction of
tissue
Treatment of BCC

Curettage electrodessication (ED/C)

Surgical excision
 Traditional
 Mohs surgery

Radiation therapy

Topical therapy
 imiquimod
95% Cure Rate
50-75% Cure Rate
Squamous cell carcinoma
SCC types



In-situ
 Bowen’s disease
 Erythroplasia of Queyrat
Invasive SCC
Keratoacanthoma
Bowen’s disease

In-situ SCC

Arsenic, HPV 16,
radiation
Erythroplasia of Queyrat
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In-situ SCC

Uncircumcised men

May progress to
invasive SCC
Invasive SCC

Erythematous nodule

Indurated lesion

Sun-exposed skin
 Men > women
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Slow growth
Invasive SCC
Keratoacanthoma

Low grade SCC

Rapid growth over
weeks
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Trauma, sun exposure,
HPV 11 and 16

May progress to
invasive SCC

SCC is locally invasive and
destructive

Metastases in 1-3% of
cases

To lymph nodes
 50-73% survival

Distant sites (lungs)
 Incurable
Treatment of SCC

Bowen’s disease

Erythroplasia of
Queyrat

Efudex or aldara

Liquid nitrogen
cryotherapy

Radiation therapy

Curettage
electrodessication
(ED/C)
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Surgical excision

Invasive
squamous cell
carcinoma

Surgical excision
 Traditional
 Mohs surgery

Radiation therapy
Malignant Melanoma
(MM)
Risk factors- MM

Fair skin, red hair, and blue eyes

Intermittent sun exposure
 Sunburns
 Tanning beds

Freckles and melanocytic nevi
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Family history of melanoma
Clinical types- MM
Superficial spreading melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Nodular melanoma
ABCD of Melanoma
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Asymmetry

Border irregularity
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Color variegation
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Diameter >6mm
Prognostic features- MM
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Good prognosis
 Breslow < 1mm
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Intermediate prognosis
 Breslow 1-4mm
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Bad prognosis
 Breslow >4mm
Treatment of MM

Surgical excision
 In
situ = 5 mm margin
 Invasive=
1-3 cm depending on
Breslow’s depth
Sentinel lymph node biopsy- MM

Recommended for MM
with Breslow 1-4mm
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Lymphadenectomy
for positive nodes
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Powerful prognostic
feature for
disseminated disease

It does not affect
survival of patients
Thank you