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
 Treatment of AK’s
 Liquid nitrogen cryotherapy

 Topical therapies

 5-FU (Efudex)

 Imiquimod (Aldara)

 Curettage for hypertrophic lesions

Liquid nitrogen
Cryotherapy Residual hypopigmentation

Blister formation
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
95% Cure Rate
 Traditional

 Mohs surgery

 Radiation therapy

 Topical therapy 50-75% Cure Rate

 imiquimod
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
 Treatment of SCC

 Efudex or aldara

 Bowen’s disease  Liquid nitrogen

cryotherapy

 Erythroplasia of  Radiation therapy

Queyrat
 Curettage
electrodessication
(ED/C)

 Surgical excision
  Surgical excision
 Invasive
 Traditional
squamous cell
 Mohs surgery
carcinoma

 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 melanoma Nodular melanoma

ABCD of Melanoma

 Asymmetry

 Border irregularity

 Color variegation

 Diameter >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