london dermatology centre and st mary’s...
TRANSCRIPT
![Page 1: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/1.jpg)
Dr Ien Chan MD FRCP
Consultant Dermatologist London Dermatology Centre
and St Mary’s Hospital
Pre- skin cancers
![Page 2: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/2.jpg)
Non-Melanoma Skin Cancers
! Pre-cancers
" Actinic (solar) keratosis
" Bowen’s disease (squamous cell carcinoma in-
situ)
! Basal cell carcinoma
! Squamous cell carcinoma
![Page 3: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/3.jpg)
Non-Melanoma Skin Cancers
• Sun beds
• Depletion of ozone layer
• Ageing population
• Immunosuppressants
• Increase in outdoor activities (leisure, holidays)
• Skin type
Risk factors:
![Page 4: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/4.jpg)
Non-Melanoma Skin Cancers
High risk exposed sites
![Page 5: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/5.jpg)
Actinic keratosis
![Page 6: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/6.jpg)
ACTINIC KERATOSIS
! Dry, scaly plaques on sun-exposed areas
! Usually < 10mm
! More common in middle-age and beyond
! Skin types I, II and III
! Outdoors workers and sports persons
![Page 7: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/7.jpg)
Actinic keratosis
" Prevalence of AK varies with geography " UK prevalence - 5.9%-15.4% of population aged 40+
" Australian prevalence – 40% of the population
1. Memon et al. Br J Dermatol 2000; 142: 1154-1159 2. Green et al. J Am Acad Dermatol 1988; 19: 1045-1052
![Page 8: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/8.jpg)
Actinic keratosis"
1. Adapted from Harvey I et al. Br J Cancer 1996; 74: 1302-1307"
"
![Page 9: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/9.jpg)
ACTINIC KERATOSIS
! Pre-malignant
! Keratotic lesions occurring on chronically light-exposed adult skin
! Carry a risk of progression to squamous cell carcinoma (6-10% in 10 years)
! NICE recommends AKs can be treated in primary care
![Page 10: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/10.jpg)
ACTINIC KERATOSIS
! Histopathology: epithelial dysplasia; focal areas of abnormal keratinocyte proliferation
! Rate of transformation into invasive SCC is very low (0.24% for each AK)
! 26% resolve without treatment over a 1-yr period
! Prevention: sunscreens, hats, self-examination, follow-up
![Page 11: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/11.jpg)
ACTINIC KERATOSIS
Field damage: • mul,ple AK lesions present • underlying and surrounding area
of ac,nic damage likely • likely to be scalp or other sun-‐
damaged areas • extent of area of ac,nic damage
may not be evident visually or by physical examina,on.
![Page 12: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/12.jpg)
ACTINIC KERATOSIS
Treatment:
Cryotherapy
Solaraze gel
Efudix (5-Fluorouracil 5%)
Actikerall (5-Fluorouracil 0.5% + 10% salicyclic acid)
Aldara (imiquimod 5%)
Zyclara (imiquimod 3.75%)
Picato (Ingenol mebutate)
Photodynamic therapy (PDT)
Surgical (curettage and cautery; excision)
![Page 13: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/13.jpg)
ACTINIC KERATOSIS
Disease-related factors: • Duration
• Number
• Clinical course of lesions; localisation
• Extent of disease
Patient profile: • Age
• Co-morbidities
• Other risk factors, e.g. immunosuppression
• Pre-existing skin cancer
• History of treatments for AK
• Tolerability
• Long term outcome
• Personal preference of the patient
Healthcare system: • Cost
• Physician’s familiarity
• Clinic facilities
![Page 14: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/14.jpg)
The presentation of AK"
A few superficial “thin” AKs Many small but visible AKs, which may be palpated
Multiple “thicker” AKs many of which are quite hyperkeratotic
![Page 15: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/15.jpg)
![Page 16: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/16.jpg)
![Page 17: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/17.jpg)
![Page 18: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/18.jpg)
![Page 19: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/19.jpg)
![Page 20: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/20.jpg)
Pre and post Efudix treatment
![Page 21: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/21.jpg)
![Page 22: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/22.jpg)
Bowen’s Disease
![Page 23: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/23.jpg)
BOWEN’S DISEASE
! Solitary lesion, on a
sun-exposed area
! Typically: lower leg of
elderly patient
! Slowly enlarging
erythematous scaly
plaque with well-
defined boundaries
![Page 24: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/24.jpg)
BOWEN’S DISEASE
![Page 25: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/25.jpg)
Bowen’s Disease
![Page 26: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/26.jpg)
BOWEN’S DISEASE
! Histopathology: SCC in situ
! Rate of malignant transformation: 5 - 10%
! Spontaneous resolution does not occur
! Treatment: excision, curettage and cautery, Efudix, Aldara, PDT, cryotherapy, radiotherapy
![Page 27: London Dermatology Centre and St Mary’s Hospitaconnect-bma.public-i.tv/document/Ien_Chen_presentation.pdf · London Dermatology Centre and St Mary’s Hospita Pre- skin cancers](https://reader033.vdocuments.mx/reader033/viewer/2022060522/6050b42f153589328552e5bf/html5/thumbnails/27.jpg)
Summary
" UV radiation may lead to a range of skin lesions, both
pre-cancerous and cancerous
" Early diagnosis & intervention essential
" AKs can be managed in primary care
" Other lesions (SCC, BCC, melanoma) to be referred to
dermatologist
Date of preparation: April 2005 " " " " "036/0181"