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
45.7%

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
13.7%

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