nonmelanoma skin tumor what are nonmelanoma skin tumors? basal cell carcinoma squamous cell...

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