Nodular basal cell carcinoma
Download
Report
Transcript Nodular basal cell carcinoma
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
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
Superficial
Morpheaform
Nodular BCC
Chronic lesion
Easy bleeding
Pearly border
Surface telangiectasias
Head and neck, trunk,
and extremities
Pigmented BCC
Similar to nodular but
with black discoloration
Melanin deposits
Pigmented races
Face, trunk, and scalp
Superficial BCC
Erythematous scaly
plaque
Slow growth
Asymptomatic
Trunk, extremities, face
Morpheaform BCC
Resembles scar
Asymptomatic and slow
growing
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
In-situ SCC
Uncircumcised men
May progress to
invasive SCC
Invasive SCC
Erythematous nodule
Indurated lesion
Sun-exposed skin
Men > women
Slow growth
Invasive SCC
Keratoacanthoma
Low grade SCC
Rapid growth over
weeks
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)
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
Family history of melanoma
Clinical types- MM
Superficial spreading melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Nodular melanoma
ABCD of Melanoma
Asymmetry
Border irregularity
Color variegation
Diameter >6mm
Prognostic features- MM
Good prognosis
Breslow < 1mm
Intermediate prognosis
Breslow 1-4mm
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
Lymphadenectomy
for positive nodes
Powerful prognostic
feature for
disseminated disease
It does not affect
survival of patients
Thank you