grand rounds 8 4-2011
TRANSCRIPT
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Early Diagnosis of Skin Tumors
Daniel B. Allen, MDAssociate Professor of Surgery
UCSF East BayGrand Rounds – August 4, 2011
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ABC’s OF MELANOMA
AsymmetryBorder IrregularityColor VariegationDiameter often > 6mm
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CHARACTERISTICS OF PIGMENTED LESIONS
BenignMalignant
Size Smaller LargerColor Uniform
VariegatedBorder Regular IrregularSurface Regular Irregular
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Nodular Basal Cell Carcinoma
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Morpheaform Basal Cell Carcinoma
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Pigmented Basal Cell Carcinoma
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BASAL CELL CARCINOMA
Incidence in United States 146/100,000
Incidence in Australia 788/100,000
85% of basal cell carcinomas occur in the head and neck region
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PRS, Oct. 2010pp. 1222-1231
Margin Recurrence Clear Margins
5 mm 0.39% 85%
4 mm 1.62% 85%
3 mm 2.56% 85%
2 mm 3.96% 82%
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Approach to the patient with skin
lesions
I don’t know what it is.
Would you like this to be removed?
Your lesion may not be completely excised; in that event additional treatment could be needed.
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All reported cases of positive margins treated
by observation since 1965
Recurrence rate 27%
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Management of the Positive Margin
Nonmelanoma Skin Lesion The best prediction of recurrence: location histology
Most patients will not recur, but observation is not right for everyone
Talk to the patient and document the plan
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Dermatofibroma Benign Most common on lower extremities Rarely > 2cm
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Bowen’s Disease
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Keratoacanthoma
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Keratoacanthoma of the hand. Note resemblance to
a SCC
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Marjolin’s Ulcer
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Lentigo Maligna Melanoma- melanoma in situTX: Surgical Excision with 5mm margins
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Lentigo Maligna Melanoma
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Acral Lentiginous
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Subungual Melanoma
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Invasive Melanoma
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Melanoma
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Melanoma
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Superficial Spreading Melanoma
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Nodular Melanoma
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Dermatofibrosarcoma protuberans- Hard, protuberant mass- Arises from the dermis- Trunk or thighs most common- Extremely locally aggressive
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5/21/2009
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5/21/2009
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5/27/2009
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5/27/2009
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5/27/2009
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7/1/2009
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7/1/2009
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7/1/2009
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10/7/2009
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10/7/2009
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10/7/2009
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10/7/2009
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3/3/2010
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4/30/2010
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4/30/2010
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