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Nonmelanoma Skin Tumor

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Presentation on theme: "Nonmelanoma Skin Tumor"— Presentation transcript:

1 Nonmelanoma Skin Tumor

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

3 Basal Cell Carcinoma

4 Epidemiology Occur at any age More after age 40

5 Risk factor for BCC? Sun exposure Prior history of BCC or SCC
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

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

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

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

9 BCC White pearly Telangiectasia

10 BCC Dome-shape Central umbilication Telangiectasia

11 BCC Crusting with extension

12 BCC Dome-shaped Scaling

13 BCC Telangiectasia on surrounding skin with tension

14 BCC

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

16 BCC - superficial

17 BCC - superficial

18 BCC - pigmented

19 Diagnosis? Shave biopsy

20 Treatment Histological type Tumor size Location Risk of recurrence

21 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

22 Squamous cell carcinoma

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

24 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

25 AK Yellow, brown scaly, adherent macule

26 AK

27 AK - multiple

28 AK – small & scaly

29 AK - pigmented

30 SCC mimics AK

31 Cutaneous horn Treatment: cryotherapy, local scissor excision, or surgical excision. Warts, SK, AK, and SCC may retain keratin and produce horns.

32 AK vs. SCC AK mimics SCC

33 AK vs. SCC

34 SCC

35 SCC

36 SCC

37 SCC

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

39 Keratoacanthoma vs. SCC

40 Risk of metastasis Depth Metastasis <2 mm None <4 mm 6.7% 4 mm

41 Risk of metastasis Size Metastasis <2 cm 9.1% >2 cm 30.3%

42 Risk of metastasis Differentiation Metastasis Well differentiated 9.2%
Poorly differentiated 32.2%

43 Risk of metastasis Location Metastasis Sun-exposured 5.2% Ear 11% Lip

44 Diagnosis? Shave biopsy

45 Treatment for AK Cryotherapy Electrodesiccation and curettage
CO2 laser – actinic cheilitis 5-FU Imiquimod Diclofenac sodium gel

46 5-FU

47 Treatment for SCC Radiation and chemotherapy in addition to surgery for large lesions. Excision to subcutaneous fate for lip or deep lesions.

48 Surgical margin Size Histological Grade Location Depth Surgical Margin
<2 cm 1 Low risk Dermis 4 cm 2 cm 2,3,4 High risk SC 6 cm

49 The end

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