skin cancer carlos garcia md dermatology at ouhsc no conflicts of interest to disclose
TRANSCRIPT
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Skin Cancer
Carlos Garcia MD
Dermatology at OUHSC
No conflicts of interest to disclose
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Objectives
Identify clinical characteristics ofPrecancerous lesionsCommon skin cancers
Define risk factors for development of skin cancer
Choose appropriate methods for diagnosis and treatment
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Precancerous skin lesions
Actinic keratoses
Dysplastic melanocytic nevi
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Actinic keratoses
10% risk of malignant transformation
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Hypertrophic AK’s
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Actinic cheilitis
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Liquid nitrogen cryotherapy
Topical therapies
5-FU (Efudex)
Imiquimod (Aldara)
Curettage for hypertrophic lesions
Treatment of AK’s
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Residual hypopigmentation
Blister formation
Liquid nitrogenCryotherapy
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Topical therapies
Efudex or Aldara
* 3-5 times per week* 6-8 weeks
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Dysplastic nevi
•Precursors for melanoma
•Markers for melanoma
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Treatment of dysplastic nevi
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Non-melanoma skin cancers (NMSC)
Basal cell carcinoma
Squamous cell carcinoma
Keratoacanthoma
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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
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Basal cell carcinoma
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BCC- clinical types
Nodular Pigmented Infiltrative
Superficial
Morpheaform
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Nodular BCC
Chronic lesion
Easy bleeding
Pearly border
Surface telangiectasias
Head and neck, trunk, and extremities
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Pigmented BCC
Similar to nodular but with black discoloration
Melanin deposits
Pigmented races
Face, trunk, and scalp
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Superficial BCC
Erythematous scaly plaque
Slow growth
Asymptomatic
Trunk, extremities, face
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Morpheaform BCC
Resembles scar
Asymptomatic and slow growing
Ill-defined margins
Marked subclinical extension
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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
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Treatment of BCC
Curettage electrodessication (ED/C)
Surgical excision Traditional Mohs surgery
Radiation therapy
Topical therapy imiquimod
95% Cure Rate
50-75% Cure Rate
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Squamous cell carcinoma
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SCC types
In-situ Bowen’s disease Erythroplasia of Queyrat
Invasive SCC Keratoacanthoma
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Bowen’s disease
In-situ SCC
Arsenic, HPV 16, radiation
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Erythroplasia of Queyrat
In-situ SCC
Uncircumcised men
May progress to invasive SCC
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Invasive SCC
Erythematous nodule
Indurated lesion
Sun-exposed skin Men > women
Slow growth
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Invasive SCC
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Keratoacanthoma
Low grade SCC
Rapid growth over weeks
Trauma, sun exposure, HPV 11 and 16
May progress to invasive SCC
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SCC is locally invasive and destructive
Metastases in 1-3% of cases
To lymph nodes 50-73% survival
Distant sites (lungs) Incurable
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Bowen’s disease
Erythroplasia of Queyrat
Efudex or aldara
Liquid nitrogen cryotherapy
Radiation therapy
Curettage electrodessication (ED/C)
Surgical excision
Treatment of SCC
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Invasive squamous cell carcinoma
Surgical excision Traditional Mohs surgery
Radiation therapy
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Malignant Melanoma (MM)
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Risk factors- MM Fair skin, red hair, and blue eyes
Intermittent sun exposure Sunburns Tanning beds
Freckles and melanocytic nevi
Family history of melanoma
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Clinical types- MM
Superficial spreading melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma Nodular melanoma
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ABCD of Melanoma
Asymmetry
Border irregularity
Color variegation
Diameter >6mm
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Prognostic features- MM Good prognosis
Breslow < 1mm
Intermediate prognosis Breslow 1-4mm
Bad prognosis Breslow >4mm
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Treatment of MM
Surgical excision
In situ = 5 mm margin
Invasive= 1-3 cm depending on Breslow’s depth
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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
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Thank you