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