Nonmelanoma Skin Tumor
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Transcript of Nonmelanoma Skin Tumor
Nonmelanoma Skin TumorNonmelanoma Skin Tumor
What are nonmelanoma skin What are nonmelanoma skin tumors?tumors?Basal Cell carcinomaSquamous cell carcinoma
Basal Cell CarcinomaBasal Cell Carcinoma
EpidemiologyEpidemiology
Occur at any ageMore after age 40
Risk factor for BCC?Risk factor for BCC?
Sun exposure– 1/3 not in sun exposure areas
Prior history of BCC or SCC– 3-year-accumulative risk – 44% for BCC– 3-year-accumulative risk – 43% for SCC
Common location?Common location?
FaceUncommon in back of hands and
forearms
CharacteristicCharacteristic
Rarely metastasize– Need stroma to support the growth– Destruction by extension
Growth – unpredictable– Little growth for many years– Fast extension
Five histological typesFive histological types
Nodular – most commonSuperficialMicronodularInfiltrativeMorpheaform
BCCBCC
White pearly Telangiectasia
BCCBCC
Dome-shape Central
umbilication Telangiectasia
BCCBCC
Crusting with extension
BCCBCC
Dome-shaped
Scaling
BCCBCC
Telangiectasia on surrounding skin with tension
BCCBCC
BCC - morpheaformBCC - morpheaform
Firm, flat
Yellow or white
Blend in normal skin
Average of 7.2 mm subclinical extension
BCC - superficialBCC - superficial
BCC - superficialBCC - superficial
BCC - pigmentedBCC - pigmented
Diagnosis?Diagnosis?
Shave biopsy
TreatmentTreatment
Histological typeTumor size Location Risk of recurrence
TreatmentTreatment
Methods– Curettage and electrodessication – small
lesion– Simple surgical excision – large lesion– Mohs' micrographic surgery – large tumor,
high recurrent site like nose, poorly-defined marging
– Radiation – elderly, difficult area like eyelid– Imiquimod – superficial BCC
Squamous cell carcinomaSquamous cell carcinoma
Risk factors?Risk factors?
Sun exposure - UVBImmunosuppresion – 65x in
transplant patientsLight skin
Actinic keratosisActinic keratosis
AK is confined to epidermisExtension beyond the epidermis =
squamous cell carcinomaMay resolve spontaneously when
sun exposure is removedRisk of developing SCC 0.085% per
lesion per year60% SCC came from AK
AKAK
Yellow, brown scaly, adherent macule
AKAK
AK - multipleAK - multiple
AK – small & scalyAK – small & scaly
AK - pigmentedAK - pigmented
SCC mimics AKSCC mimics AK
Cutaneous hornCutaneous horn
Warts, SK, AK, and SCC may retain keratin and produce horns.
AK vs. SCCAK vs. SCC
AK vs. SCCAK vs. SCC
SCCSCC
SCCSCC
SCCSCC
SCCSCC
KeratoacanthomaKeratoacanthoma
Dome shape
Rapid growth
Central keratin plug
Difficult to distinguish from SCC
Keratoacanthoma vs. SCCKeratoacanthoma vs. SCC
Risk of metastasisRisk of metastasis
Depth Metastasis
<2 mm None
<4 mm 6.7%
4 mm 45.7%
Risk of metastasisRisk of metastasis
Size Metastasis
<2 cm 9.1%
>2 cm 30.3%
Risk of metastasisRisk of metastasis
Differentiation Metastasis
Well differentiated 9.2%
Poorly differentiated 32.2%
Risk of metastasisRisk of metastasis
Location Metastasis
Sun-exposured 5.2%
Ear 11%
Lip 13.7%
Diagnosis?Diagnosis?
Shave biopsy
Treatment for AKTreatment for AK
CryotherapyElectrodesiccation and curettage CO2 laser – actinic cheilitis
5-FUImiquimodDiclofenac sodium gel
5-FU5-FU
Treatment for SCCTreatment for SCC
Surgical marginSurgical margin
Size Histological
Grade
Location Depth Surgical Margin
<2 cm 1 Low risk Dermis 4 cm
2 cm 2,3,4 High risk SC 6 cm