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Nonmelanoma Skin Tumor What are nonmelanoma skin tumors? Basal Cell carcinoma Squamous cell carcinoma.

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Presentation on theme: "Nonmelanoma Skin Tumor What are nonmelanoma skin tumors? Basal Cell carcinoma Squamous cell carcinoma."— Presentation transcript:

1

2 Nonmelanoma Skin Tumor

3 What are nonmelanoma skin tumors? Basal Cell carcinoma Squamous cell carcinoma

4 Basal Cell Carcinoma

5 Epidemiology Occur at any age More after age 40

6 Risk factor for BCC? Sun exposure –1/3 not in sun exposure areas Prior history of BCC or SCC –3-year-accumulative risk – 44% for BCC –3-year-accumulative risk – 43% for SCC

7 Common location? Face Uncommon in back of hands and forearms

8 Characteristic Rarely metastasize –Need stroma to support the growth –Destruction by extension Growth – unpredictable –Little growth for many years –Fast extension

9 Five histological types Nodular – most common Superficial Micronodular Infiltrative Morpheaform

10 BCC White pearly Telangiectasia

11 BCC Dome-shape Central umbilication Telangiectasia

12 BCC Crusting with extension

13 BCC Dome-shaped Scaling

14 BCC Telangiectasia on surrounding skin with tension

15 BCC

16 BCC - morpheaform Firm, flat Yellow or white Blend in normal skin Average of 7.2 mm subclinical extension

17 BCC - superficial

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19 BCC - pigmented

20 Diagnosis? Shave biopsy

21 Treatment Histological type Tumor size Location Risk of recurrence

22 Treatment Methods –Curettage and electrodessication – small lesion –Simple surgical excision – large lesion –Mohs' micrographic surgery – large tumor, high recurrent site like nose, poorly-defined marging –Radiation – elderly, difficult area like eyelid –Imiquimod – superficial BCC

23 Squamous cell carcinoma

24 Risk factors? Sun exposure - UVB Immunosuppresion – 65x in transplant patients Light skin

25 Actinic keratosis AK is confined to epidermis Extension beyond the epidermis = squamous cell carcinoma May resolve spontaneously when sun exposure is removed Risk of developing SCC 0.085% per lesion per year 60% SCC came from AK

26 AK Yellow, brown scaly, adherent macule

27 AK

28 AK - multiple

29 AK – small & scaly

30 AK - pigmented

31 SCC mimics AK

32 Cutaneous horn Warts, SK, AK, and SCC may retain keratin and produce horns.

33 AK vs. SCC

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35 SCC

36 SCC

37 SCC

38 SCC

39 Keratoacanthoma Dome shape Rapid growth Central keratin plug Difficult to distinguish from SCC

40 Keratoacanthoma vs. SCC

41 Risk of metastasis DepthMetastasis <2 mmNone <4 mm6.7%  4 mm 45.7%

42 Risk of metastasis SizeMetastasis <2 cm9.1% >2 cm30.3%

43 Risk of metastasis DifferentiationMetastasis Well differentiated9.2% Poorly differentiated32.2%

44 Risk of metastasis LocationMetastasis Sun-exposured5.2% Ear11% Lip13.7%

45 Diagnosis? Shave biopsy

46 Treatment for AK Cryotherapy Electrodesiccation and curettage CO 2 laser – actinic cheilitis 5-FU Imiquimod Diclofenac sodium gel

47 5-FU

48 Treatment for SCC

49 Surgical margin SizeHistological Grade LocationDepthSurgical Margin <2 cm1Low riskDermis4 cm  2 cm 2,3,4High riskSC6 cm

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