Skin Cancer Carlos Garcia MD Dermatology at OUHSC No conflicts of interest to disclose

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 Actinic keratoses Dysplastic melanocytic nevi

Actinic keratoses 10% risk of malignant transformation

Hypertrophic AK’s

Actinic cheilitis

Liquid nitrogen cryotherapy Topical therapies 5-FU (Efudex) Imiquimod (Aldara) Curettage for hypertrophic lesions Treatment of AK’s

Residual hypopigmentation Blister formation Liquid nitrogen Cryotherapy

Topical therapies Efudex or Aldara * 3-5 times per week * 6-8 weeks

Dysplastic nevi Precursors for melanoma Markers for melanoma

Treatment of dysplastic nevi

Non-melanoma skin cancers (NMSC) Basal cell carcinoma Squamous cell carcinoma Keratoacanthoma

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, tar

Basal cell carcinoma

BCC- clinical types Nodular Pigmented Infiltrative Superficial Morpheaform

Nodular BCC Chronic lesion Easy bleeding Pearly border Surface telangiectasias Head and neck, trunk, and extremities

Pigmented BCC Similar to nodular but with black discoloration Melanin deposits Pigmented races Face, trunk, and scalp

Superficial BCC Erythematous scaly plaque Slow growth Asymptomatic Trunk, extremities, face

Morpheaform BCC Resembles scar Asymptomatic and slow growing Ill-defined margins Marked subclinical extension

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 Curettage electrodessication (ED/C) Surgical excision Traditional Mohs surgery Radiation therapy Topical therapy imiquimod 95% Cure Rate 50-75% Cure Rate

Squamous cell carcinoma

SCC types In-situ Bowen’s disease Erythroplasia of Queyrat Invasive SCC Keratoacanthoma

Bowen’s disease In-situ SCC Arsenic, HPV 16, radiation

Erythroplasia of Queyrat In-situ SCC Uncircumcised men May progress to invasive SCC

Invasive SCC Erythematous nodule Indurated lesion Sun-exposed skin Men > women Slow growth

Invasive SCC

Keratoacanthoma Low grade SCC Rapid growth over weeks Trauma, sun exposure, HPV 11 and 16 May progress to invasive SCC

SCC is locally invasive and destructive Metastases in 1-3% of cases To lymph nodes 50-73% survival Distant sites (lungs) Incurable

Bowen’s disease Erythroplasia of Queyrat Efudex or aldara Liquid nitrogen cryotherapy Radiation therapy Curettage electrodessication (ED/C) Surgical excision Treatment of SCC

Invasive squamous cell carcinoma Surgical excision Traditional Mohs surgery Radiation therapy

Malignant Melanoma (MM)

Risk factors- MM Fair skin, red hair, and blue eyes Intermittent sun exposure Sunburns Tanning beds Freckles and melanocytic nevi Family history of melanoma

Clinical types- MM Superficial spreading melanoma Lentigo maligna melanoma Acral lentiginous melanomaNodular melanoma

ABCD of Melanoma A symmetry B order irregularity C olor variegation D iameter >6mm

Prognostic features- MM Good prognosis Breslow < 1mm Intermediate prognosis Breslow 1-4mm Bad prognosis Breslow >4mm

Treatment of MM Surgical excision In situ = 5 mm margin Invasive= 1-3 cm depending on Breslow’s depth

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 patients

Thank you