Basal Cell Ca, Squamous Cell Ca, and Melanoma

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Basal Cell Ca, Squamous Cell Ca, and Melanoma

• Jeanette Prante, MS3

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Normal Skin Histology
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Basal Cell CA

• Older individuals
• Sun-exposed areas
• Irregular exposure to sun
• Small, well-circumscribed pearly tan-gray papule
  with telangiectasia
• Enlarges
• Ulcerates (rat tooth)

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Nevoid BCC Syndrome/BC Nevus Syndrome/Gorlin
Syndrome

• AD (PTCH)
• Multiple BCCs
• lt20 years
• Other tumors
• Ovarian fibromas
• Medulloblastomas
• Cleft lip/palate, rib/vertebral abnormalities
• Pits soles, palms

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Diagnosis BCC

• Shave bx
• Excisional bx
• Small lesion
• Multiple skin cancers

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Melton J. Dec 1996. Loyola University Dermatology
Education Website. lthttp//www.meddean.luc.edu/lum
en/MedEd/medicine/dermatology/melton/content1.htmgt
Assessed Mar 2007.
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Treatment BCC

• Surgical
• Primary excision
• Mohs surgery
• Destructive
• Electrodessication/curretage
• Cryosurgery
• Laser phototherapy
• Medical
• Radiotherapy

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Metastasis

• RARE!
• When happens, lesion advanced

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Squamous Cell Carcinoma

• Malignancy of epidermal keratinocytes
• Mengt60
• Sun-exposed areas
• Solitary, slowly enhancing indurated nodule
• Central ulceration

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Ray T. 2005 Sept. lthttp//tray.dermatology.uiowa.
edu/Home.htmlgt Assessed Mar 2007
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SCC Risk Factors

• Solar irradiation (UVA/B)
• Number of lifetime burns
• X-ray therapy
• Carcinogens (tars, oils)
• Hereditary diseases
• Xeroderma pigmentosa
• Albinism
• Actinic keratoses, HPV, burn scars

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Diagnosis SCC

• Shave bx
• Excisional bx
• Small lesion
• Multiple skin cancers

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UCSF School of Medicine Dermatology Glossary.
lthttp//missinglink.ucsf.edu/lm/DermatologyGlossar
y/squamous_cell_carcinoma.htmlgt Assessed March
2007.
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Treatment SCC

• Surgical
• Primary excision
• Mohs surgery
• Destructive
• Electrodessication/curretage
• Cryosurgery
• Laser phototherapy
• Medical
• Radiotherapy

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Metastasis

• More likely on ears, scalp, nostrils, extremities
• Overall 1-2
• More likely with larger (2 cm), deeper lesions (4
  mm)

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Malignant Melanoma

• Asymmetric, irregularly-pigmented lesions with
  ill-defined borders
• gt4 mm (gt10mm)
• MgtF
• Agegt50

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Ray T. 2005 Sept. lthttp//tray.dermatology.uiowa.
edu/Home.htmlgt Assessed Mar 2007
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Risk Factors

• UV light
• Sun lamps before age 25
• Light-colored skin
• Freckling
• Moles
• gt50
• h/o dysplastic
• Congenital
• Family history

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Growth Patterns

• Superficial spreading- MC
• Nodular- aggressive, vertical growth
• Lentigo Maligna- slow growth, rarely metastasize
• Acral Lentiginous- More common in non-Caucasians,
  soles/palms, subungal

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Conti I. Sept 2001. Histology.
lthttp//www.xiphophorus.org/pathology.htmgt
Assessed Mar 2007.
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Melanoma Staging/Dx

• Tumor thickness (Breslow)
• Ulceration
• Number of metastatic LNs
• DX with incisional/excisional bxs
• Sentinal node bx

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Treatment

• Narrow excisional bx
• Wide local excision
• Excision deep fascia inc. risk of mets
• Adjuvant- risk for distant mets
• Immunotherapy
• Chemotherapy

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Recurrence/Mets

• Most likely local recurrence
• Late recurrence gt10 yrs, 25
• Mets- MC skin, subcutaneous tissue, LNs
• ? Primary

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The BIG Picture

• Those at risk for all 3
• UV radiation- prevention key
• Basal Cell- Rarely metastasizes, nests of cells,
  MC skin cancer
• Squamous Cell- Can metastasize, Keratin pearls
• Melanoma- Late mets, great mimicker, no shave
  biopsy