Skin Cancer

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Skin Cancer
Diagnoses and Treatments
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Aims

• NICE/IOG
• Use of the dermatoscope
• Pre malignant lesions
• BCC
• SCC
• Melanoma
• quiz

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Reasons for referral
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Diagnoses
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Biopsies 2008
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NICE guidance

• Issued Feb 2006
• Low risk BCCs, AKs primary care
• High risk BCCs, SCC, melanoma, ? diagnosis refer
• BCCs should not be referred via 2 week wait
• Guidelines are being revised.
• GPSI with interest in skin cancer
• NB accreditation

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Skin surgery

• Send all specimens for pathology
• Accurate information on pathology form, eg site,
  clinical description
• One specimen, one pot

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Let there be light !
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Types ofdermatoscope
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Lesion turned black
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• Distinguish vascular lesions from pigmented ones
• Distinguish melanocytic lesions from seb warts
• Adjunct to diagnosis
• If in doubt refer

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Diagnosis ?
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Management of pre- malignant non pigmented lesions

• Diagnostic biopsy
• Curettage
• Efudix
• PDT
• excision

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• 100 000 non melanoma skin cancers / year
• 80 NMSC occur gt 60 years of age
• 95 survival in NMSC overall
• 10 000 melanomas / year
• Incidence doubling every 10 years

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SCC - prognosis

• Lip
• Ear
• Immunocompromised pt
• Higher recurrence rates

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Treatments for NMSC

• Excision
• Radiotherapy
• Mohs surgery

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Mohs surgery

• Microscpoically controlled
• Margins examined
• Precise removal of tumour
• Used in cosmetically important areas
• Tissue sparing

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Malignant melanoma

• Commonest cancer in 15 -34 age group
• Commoner than cervical cancer in women
• Average 20 years loss of life for each death
• Positive correlation with affluence

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• Advice on sun /UV exposure

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Types of melanoma