Skin Cancer Carlos Garcia MD Dermatology at OUHSC No conflicts of interest to disclose.
-
Upload
angela-lee -
Category
Documents
-
view
214 -
download
1
Transcript of Skin Cancer Carlos Garcia MD Dermatology at OUHSC No conflicts of interest to disclose.
Skin Cancer
Carlos Garcia MD
Dermatology at OUHSC
No conflicts of interest to disclose
Objectives
Identify clinical characteristics ofPrecancerous lesionsCommon skin cancers
Define risk factors for development of skin cancer
Choose appropriate methods for diagnosis and treatment
Precancerous skin lesions
Actinic keratoses
Dysplastic melanocytic nevi
Actinic keratoses
10% risk of malignant transformation
Hypertrophic AK’s
Actinic cheilitis
Liquid nitrogen cryotherapy
Topical therapies
5-FU (Efudex)
Imiquimod (Aldara)
Curettage for hypertrophic lesions
Treatment of AK’s
Residual hypopigmentation
Blister formation
Liquid nitrogenCryotherapy
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
Bowen’s disease
Erythroplasia of Queyrat
Efudex or aldara
Liquid nitrogen cryotherapy
Radiation therapy
Curettage electrodessication (ED/C)
Surgical excision
Treatment of SCC
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