1. Common MMalignant Skin Tumours, M elanoma, Biopsy M ethods, Surgical
Therapy
Claire Temple MD MSc FRCSC Associate Professor, UW O Division of Plastic Surgery Hand and Upper Limb Centre

2. Skin Examination

4. Physical Examination
 Overall skin type
 Lesion description

5. Fitzpatrick classification
 I W hite  II W hite  III W hite
Always burns, never tans Always burns, little tan Slight burn, slow tan
 IV Pale brown  V Brown
Slight burn, fast tan Rarely burns, dark tan Never burns, dark tan
 VI Dark brown/black

6. Lesion description  Size in mm - two dimensions  Color
 Surface characteristics –  scale(excess keratin)  crust(dried serum)  excoriated/erosion/ulcer

7. Lesion description Macule/patch flat lesion<>1cm Papule/plaque
 NOUN
Macule/patch
flat lesion<>1cm
Papule/plaque
raised lesion <>1cm
Nodule/tumour
deep dermal lump <>1cm
Vesicle/bulla
elevated fluid filled lesion
<>1cm

8. If pigmented lesion, also describe:
 A asymmetry  B borders  C color
 D diameter  E elevation

12. Biopsy Techniques

13. Biopsy Techniques  Incisional  Shave  Punch
 Incisional ellipse  Excisional

14. Punch biopsy

15. Punch biopsy

16. Punch biopsy

18. Punch Biopsy

19. Incisional biopsy

20. Excisional Biopsy

21. Basal Cell Carcinoma

22. Etiology - MM ultifactorial
 UVR (Sun, tanning beds)
 Ionizing radiation
 Age >40
 Fitzpatrick I, II phenotype  Immunosuppression  Old, unstable scars  Genetic conditions
 Insecticides, hydrocarbons, arsenic

23. Basal Cell Carcinoma
 Malignant tumour arising from basal cell layer of epidermis
 90% of all skin cancers
 40% of North Americans will develop a BCC
 85% facial, 30% nose

24. Basal Cell Carcinoma  Nodular Form
 Telangiectatic papule  translucent
 pearly rolled border  Slow growing
 Rarely metastasizes

25. Variants  Nodular - 60%  Superficial  Pigmented
 Morpheaform or sclerosing

27. Nodular BCC

28. Rodent Ulcer

30. Sclerosing BCC

31. Somme Exammples to Practice

32. Pigmented Basal Cell Carcinoma

34. Superficial Basal Cell Carcinoma

35. Treatment  Prevention
 Electrodessication/Curettage  Surgical Excision with 4 mm margins
Mohs

36. Respect Basal Cell Carcinoma

42. Squamous Cell Carcinoma

43. Squamous Cell Cancer

44. Actinic Keratoses

45. SCC  Malignant lesion arising in epidermis  Age >40
 15% lifetime risk in Caucasians  Risk of metastases 0.5-6%
 Thickened, ulcerated, erythematous lesion  Examine nodal basins

49. SCC  Main treatment is surgical  6mm or wider margin  Radiation
 May recur along nerves  May metastasize