1. SKIN CANCER
KARINA PARR, MD
RONALD GRIMWOOD, MD
KARA KENNEY

2. Over 3.5 million cases per year BCC – 80%, SCC – 16%, Melanoma – 4%
SKIN CANCER
More new cases last year than breast, colon, lung, and prostate cancer combined
Over 3.5 million cases per year
BCC – 80%, SCC – 16%, Melanoma – 4%
Expected deaths from skin cancer this year
Melanoma: > 9700, Non-Melanoma: >4,000

3. Non-Melanoma Skin Cancer
> 3.5 million cases in > 2 million people per year
BCC > 2.8 million
SCC > 700,000
Lifetime risk is 1 in 5 overall
Fair skin, fair colored hair, light eye color
Chronic sun exposure/tanning bed use
Expected deaths

4. Basal Cell Carcinoma
Most common skin carcinoma in US
Almost exclusively in hair-bearing skin, especially face
40% dx w/ BCC will have another w/in 10 years
Metastasis rate %

5. Basal Cell Carcinoma
Nodular
Pigmented
Cystic
Morpheaform
Superficial

6. Squamous Cell Carcinoma Precursors
Actinic Keratosis
Bowen’s Disease
Arsenical Keratosis

7. Treatment of Actinic Keratosis
Cryotherapy with Liquid Nitrogen
5 – fluorouracil cream (Efudex or Carac)
Chemical Peels
Photodynamic therapy
Dermabrasion
Curettage
Immune response therapy – Aldara
Diclofenac Sodium 3% gel – Solaraze
Topical Retinoids
Lasers

8. Mucous membranes can be involved
Bowen’s Disease
SCC in situ
Can become invasive
Mucous membranes can be involved

9. Treatment of Bowen’s Disease
Excision
Topical 5-fluorouracil
Mohs surgery (depends on the site and size)

10. Squamous Cell Carcinoma
May occur anywhere on skin including mucous membranes
Most commonly arises on sun damaged skin
Overall, rate of metastasis is 2-3%
SCC lower lip approx 11% metastasis
SCCs in areas of chronic inflammation (burns, radiation tx, osteomyelitis) also have higher rate of metastasis

11. SCC Factors Associated w/Local Recurrence & Metastasis
Size > 2.0 cm
Depth > 0.4 cm (into deep dermis or fat)
Histology – poorly differentiated
Perineural involvment

12. SCC Factors Associated w/Local Recurrence & Metastasis
Sites – ear, lip (lower), scar, non-sun exposed skin
Recurrent tumor
Immunosuppression – transplant patients

13. Treatment for Non-Melanoma Skin Cancer
Cryotherapy
Electrodessication & Curettage (ED & C)
Radiation therapy
Surgical Excision
Mohs Micrographic Surgery

14. Clinically ill-defined margins Aggressive histological growth patterns
Indications for Mohs
Clinically ill-defined margins
Aggressive histological growth patterns
Tumor size
Perineural involvement
Uncommon tumors that are locally aggressive w/high recurrence rate (MAC, DFSP, Atypical fibroxanthoma, malignant fibrous histiocytoma

15. Indications for Mohs
High risk anatomic locations (medial canthus, nasal ala, nasal tip, external auditory canal, temple, eyelids, lower lip)
Young patients – often have aggressive histology, in areas of high recurrence rate, cosmetic concerns

16. Skin Cancer Update 2014 for Melanoma
Number of new invasive cases – 76,100
Men - 43,890, Women - 32,210
Deaths – 9710
Highest mortality rate in white, older men
Lifetime risk of developing melanoma
Invasive = 1 in 62
Invasive + in-situ = 1 in 34

17. Risk Factors for Developing Malignant Melanoma
Lentigo Maligna
Red or blond hair
Actinic Keratosis
Marked freckling
> 3 blistering sunburns as a teenager
> 3 yrs with outdoor summer job as a teenager

18. Risk Factors for Developing Malignant Melanoma
Type I & II skin types
Excessive sun exposure
Immunosuppression
Family hx of melanoma
Personal hx of melanoma
Dysplastic nevi

19. Superficial spreading 65 - 70% Nodular 15 - 30%
Melanoma Types
Superficial spreading %
Nodular %
Lentigo Maligna Melanoma %
Acral Lentiginous %
Still seems accurate based on:

20. Appropriate Management of Pts w/ Early Melanoma (<1mm depth)
Ask about personal or family history of MM
Total body skin exam
Palpation of regional lymph nodes
Surgical excision w/ 1.0 cm margins
SLN biopsy if >0.75 mm

21. Melanoma 10 yr Survival Rate
Tumor thickness (mm)
No Ulceration
With Ulceration T
95%
86% T
67%
57% T
68%
43%
T4 > 4.00
10-15%

22. How to protect your skin
Seek shade
Wear protective clothing
Generously apply a broad-spectrum sunscreen with a Sun Protective Factor (SPF) of at least 30 to all exposed skin
Use extra caution near water, snow, and sand
AVOID TANNING BEDS
Consult your physician for any new or changing skin lesions

23. Further reading
"Skin Cancer Facts." SkinCancer.Org. The Skin Cancer Foundation, 4 June Web. 27 Aug
Skin Cancer section from the American Academy of Dermatology website 23