Skin Cancer

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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 of
• Precancerous lesions
• Common 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 AKs
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Actinic cheilitis
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Treatment of AKs

• Liquid nitrogen cryotherapy
• Topical therapies
• 5-FU (Efudex)
• Imiquimod (Aldara)
• Curettage for hypertrophic lesions

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Liquid nitrogen Cryotherapy
Residual hypopigmentation
Blister formation
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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 (Fitzpatricks 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 (
• 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
• Bowens disease
• Erythroplasia of Queyrat
• Invasive SCC
• Keratoacanthoma

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Bowens 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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Treatment of SCC

• Bowens disease
• Erythroplasia of Queyrat

• Efudex or aldara
• Liquid nitrogen cryotherapy
• Radiation therapy
• Curettage electrodessication (ED/C)
• Surgical excision

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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
• 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 Breslows 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