Transcript Non-Melanoma Skin Cancer

Actinic Keratosis
Rob Sheehan-Dare
Leeds Centre for Dermatology
Pre-Cancerous Lesions
 Actinic Keratoses
 Intra-epithelial Squamous Cell Carcinoma
 Lentigo maligna
Skin Cancer
 Basal Cell Carcinoma
 Squamous Cell Carcinoma
 Melanoma
 Lymphoma
What are Actinic keratoses?
Epidermal dysplasia
Associated with UV exposure
Sun exposed sites
Elderly
Outdoor occupations
Warmer climates
Lighter skin types
Immunosuppression
What are Actinic keratoses?
Histologically
Epidermal cell disorganisation
Acanthosis
Reduced granular layer
Parakeratosis
Hyperkeratosis
What is risk of malignancy?
?Less than 1:1000 per year
Increased by
Immunosuppression
Increased numbers of lesions
Co-factors (radiation, exposure to tar)
Prior Squamous cell carcinoma
Some lesions resolve spontaneously
Most SCC’s are well differentiated
What do they look like?
Clinically
Adherent scale (variable but always)
Erythema (often)
Light pigmentation (sometimes)
Merge with surrounding skin
Usually not indurated
Diagnostic difficulties
Cutaneous horn
Hypertrophic actinic keratoses
Inflammatory lesions
Often in immunosuppressed
What to treat
Lesions in immunosuppressed patients
Lesions at high risk sites (e.g. lip)
Where previous history of SCC
Inflamed Actinic keratoses
Lesions in younger age group
Symptomatic lesions
How to treat
Cryotherapy
Curettage & cautery
5-fluorouracil cream
Diclofenac gel
Imiquimod cream
Photodynamic therapy
Cryotherapy
 Destruction by cold injury
 Cotton bud or cryospray
 20-30 second freeze
 Moderate pain
 Immediate blistering
 Heals in 10 days
 Suitable for small/few lesions
 Suitable where compliance poor
Curettage and cautery
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Physical removal/thermal injury
Requires local anaesthesia
Moderate pain
Eschar
Heals in 10 days
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Suitable for solitary/few lesions
Suitable for cryo resistant lesions
Suitable for hyperkeratotic lesions
Suitable where histology required
5-fluorouracil cream
 Inhibits DNA synthesis by inactivating
thymidine synthase
 4 weeks treatment
 Inflammatory reaction (moderate-severe)
 Little pain
 Interrupted treatment may be required
 Suitable for multiple/extensive lesions
 Suitable for compliant patients
Diclofenac gel
 Inhibits Cyclo-oxygenase (COX-2)
 8 weeks treatment
 Mild-moderate inflammatory reaction
 No pain
 Long term benefits uncertain
 Suitable where intolerance to other treatment
Imiquimod cream
 Toll-like receptor 7 agonist induces apoptosis
 4-8 weeks treatment
 Inflammatory reaction (moderate-severe)
 Little pain
 Interrupted treatment may be required
 Suitable for multiple/extensive lesions
 Suitable for compliant patients
Photodynamic therapy
 ALA induced protoporphyrin IX synthesis
sensitizes cells to photodynamic effect
 1-2 prolonged treatments
 Moderate pain
 Inflammatory reaction (moderate-severe)
 Heals in 10 days
 Suitable for multiple/extensive lesions
 Suitable where compliance poor
Treatment summary
 Cryotherapy small/few lesions
 5-fluorouracil larger/multiple lesions
 Curettage for hyperkeratotic lesions
 Solaraze for patients with poor tolerance
 Imiquimod cream or PDT for resistant lesions
“They look benign , but keep out of the sun”