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Premium member Presentation Transcript Skin Cancer: Skin Cancer Carlos Garcia MD Dermatology at OUHSC No conflicts of interest to discloseObjectives : 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 Precancerous skin lesions : Precancerous skin lesions Actinic keratoses Dysplastic melanocytic neviActinic keratoses: Actinic keratoses 10% risk of malignant transformationHypertrophic AK’s: Hypertrophic AK’sActinic cheilitis : Actinic cheilitis Treatment of AK’s: Liquid nitrogen cryotherapy Topical therapies 5-FU (Efudex) Imiquimod (Aldara) Curettage for hypertrophic lesions Treatment of AK’sSlide8: Residual hypopigmentation Blister formation Liquid nitrogen CryotherapyTopical therapies: Topical therapies Efudex or Aldara * 3-5 times per week * 6-8 weeksDysplastic nevi: Dysplastic nevi Precursors for melanoma Markers for melanomaTreatment of dysplastic nevi: Treatment of dysplastic neviSlide14: Non-melanoma skin cancers (NMSC) Basal cell carcinoma Squamous cell carcinoma Keratoacanthoma Risk factors for development of BCC and SCC: 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, tarBasal cell carcinoma: Basal cell carcinomaBCC- clinical types: BCC- clinical types Nodular Pigmented Infiltrative Superficial Morpheaform Nodular BCC: Nodular BCC Chronic lesion Easy bleeding Pearly border Surface telangiectasias Head and neck, trunk, and extremities Pigmented BCC: Pigmented BCC Similar to nodular but with black discoloration Melanin deposits Pigmented races Face, trunk, and scalpSuperficial BCC: Superficial BCC Erythematous scaly plaque Slow growth Asymptomatic Trunk, extremities, faceMorpheaform BCC: Morpheaform BCC Resembles scar Asymptomatic and slow growing Ill-defined margins Marked subclinical extensionSlide22: 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: Treatment of BCC Curettage electrodessication (ED/C) Surgical excision Traditional Mohs surgery Radiation therapy Topical therapy imiquimod 95% Cure Rate 50-75% Cure RateSquamous cell carcinoma : Squamous cell carcinoma SCC types: SCC types In-situ Bowen’s disease Erythroplasia of Queyrat Invasive SCC Keratoacanthoma Bowen’s disease: Bowen’s disease In-situ SCC Arsenic, HPV 16, radiation Erythroplasia of Queyrat: Erythroplasia of Queyrat In-situ SCC Uncircumcised men May progress to invasive SCCInvasive SCC: Invasive SCC Erythematous nodule Indurated lesion Sun-exposed skin Men > women Slow growthInvasive SCC: Invasive SCCKeratoacanthoma : Keratoacanthoma Low grade SCC Rapid growth over weeks Trauma, sun exposure, HPV 11 and 16 May progress to invasive SCC Slide32: SCC is locally invasive and destructive Metastases in 1-3% of cases To lymph nodes 50-73% survival Distant sites (lungs) Incurable Treatment of SCC: Bowen’s disease Erythroplasia of Queyrat Efudex or aldara Liquid nitrogen cryotherapy Radiation therapy Curettage electrodessication (ED/C) Surgical excision Treatment of SCCSlide34: Invasive squamous cell carcinoma Surgical excision Traditional Mohs surgery Radiation therapyMalignant Melanoma (MM): Malignant Melanoma (MM)Risk factors- MM: Risk factors- MM Fair skin, red hair, and blue eyes Intermittent sun exposure Sunburns Tanning beds Freckles and melanocytic nevi Family history of melanomaClinical types- MM: Clinical types- MM Superficial spreading melanoma Lentigo maligna melanoma Acral lentiginous melanoma Nodular melanomaABCD of Melanoma: ABCD of Melanoma Asymmetry Border irregularity Color variegation Diameter >6mm Prognostic features- MM: Prognostic features- MM Good prognosis Breslow < 1mm Intermediate prognosis Breslow 1-4mm Bad prognosis Breslow >4mmTreatment of MM: Treatment of MM Surgical excision In situ = 5 mm margin Invasive= 1-3 cm depending on Breslow’s depthSentinel lymph node biopsy- MM: 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 patientsSlide44: Thank you You do not have the permission to view this presentation. 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SkinCancerMS yilmar Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 939 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: January 02, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Skin Cancer: Skin Cancer Carlos Garcia MD Dermatology at OUHSC No conflicts of interest to discloseObjectives : 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 Precancerous skin lesions : Precancerous skin lesions Actinic keratoses Dysplastic melanocytic neviActinic keratoses: Actinic keratoses 10% risk of malignant transformationHypertrophic AK’s: Hypertrophic AK’sActinic cheilitis : Actinic cheilitis Treatment of AK’s: Liquid nitrogen cryotherapy Topical therapies 5-FU (Efudex) Imiquimod (Aldara) Curettage for hypertrophic lesions Treatment of AK’sSlide8: Residual hypopigmentation Blister formation Liquid nitrogen CryotherapyTopical therapies: Topical therapies Efudex or Aldara * 3-5 times per week * 6-8 weeksDysplastic nevi: Dysplastic nevi Precursors for melanoma Markers for melanomaTreatment of dysplastic nevi: Treatment of dysplastic neviSlide14: Non-melanoma skin cancers (NMSC) Basal cell carcinoma Squamous cell carcinoma Keratoacanthoma Risk factors for development of BCC and SCC: 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, tarBasal cell carcinoma: Basal cell carcinomaBCC- clinical types: BCC- clinical types Nodular Pigmented Infiltrative Superficial Morpheaform Nodular BCC: Nodular BCC Chronic lesion Easy bleeding Pearly border Surface telangiectasias Head and neck, trunk, and extremities Pigmented BCC: Pigmented BCC Similar to nodular but with black discoloration Melanin deposits Pigmented races Face, trunk, and scalpSuperficial BCC: Superficial BCC Erythematous scaly plaque Slow growth Asymptomatic Trunk, extremities, faceMorpheaform BCC: Morpheaform BCC Resembles scar Asymptomatic and slow growing Ill-defined margins Marked subclinical extensionSlide22: 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: Treatment of BCC Curettage electrodessication (ED/C) Surgical excision Traditional Mohs surgery Radiation therapy Topical therapy imiquimod 95% Cure Rate 50-75% Cure RateSquamous cell carcinoma : Squamous cell carcinoma SCC types: SCC types In-situ Bowen’s disease Erythroplasia of Queyrat Invasive SCC Keratoacanthoma Bowen’s disease: Bowen’s disease In-situ SCC Arsenic, HPV 16, radiation Erythroplasia of Queyrat: Erythroplasia of Queyrat In-situ SCC Uncircumcised men May progress to invasive SCCInvasive SCC: Invasive SCC Erythematous nodule Indurated lesion Sun-exposed skin Men > women Slow growthInvasive SCC: Invasive SCCKeratoacanthoma : Keratoacanthoma Low grade SCC Rapid growth over weeks Trauma, sun exposure, HPV 11 and 16 May progress to invasive SCC Slide32: SCC is locally invasive and destructive Metastases in 1-3% of cases To lymph nodes 50-73% survival Distant sites (lungs) Incurable Treatment of SCC: Bowen’s disease Erythroplasia of Queyrat Efudex or aldara Liquid nitrogen cryotherapy Radiation therapy Curettage electrodessication (ED/C) Surgical excision Treatment of SCCSlide34: Invasive squamous cell carcinoma Surgical excision Traditional Mohs surgery Radiation therapyMalignant Melanoma (MM): Malignant Melanoma (MM)Risk factors- MM: Risk factors- MM Fair skin, red hair, and blue eyes Intermittent sun exposure Sunburns Tanning beds Freckles and melanocytic nevi Family history of melanomaClinical types- MM: Clinical types- MM Superficial spreading melanoma Lentigo maligna melanoma Acral lentiginous melanoma Nodular melanomaABCD of Melanoma: ABCD of Melanoma Asymmetry Border irregularity Color variegation Diameter >6mm Prognostic features- MM: Prognostic features- MM Good prognosis Breslow < 1mm Intermediate prognosis Breslow 1-4mm Bad prognosis Breslow >4mmTreatment of MM: Treatment of MM Surgical excision In situ = 5 mm margin Invasive= 1-3 cm depending on Breslow’s depthSentinel lymph node biopsy- MM: 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 patientsSlide44: Thank you