Skin Cancer

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Skin Cancer
Sarah Boyce Sawyer, MD Dermatology Laser of
Alabama
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Skin Cancer

• Melanoma
• Squamous cell carcinoma
• Basal cell carcinoma

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Statistics
1,000,000
350,000
55,000
1,285,000
BCC
SCC
MM
All other
CA 52(1)10, 2002.
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Lifetime Risk of Developing Melanoma
171
1100
1150
1250
1600
11,500
1935
1960
1980
1985
1993
2001
Rigel DS, et al. NYU Melanoma Cooperative Group,
2001.
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Melanoma Facts (2002)

• 6/7 skin cancer deaths.
• More common than any other nonskin cancer in
  women 25-29 years old.
• Lifetime risk was 1/71 in the year 2001.
• 1 person dies of melanoma every hour.
• 6th and 7th most common cancer in men and women
  respectively.

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Types of Melanoma

• 1) Superficial spreading-70
• 2) Nodular-15
• 3) Acral lentiginous-8
• 4) Lentigo maligna-5
• 5) Other-2

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Acral Lentiginous Melanoma
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Nodular Melanoma
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Melanoma
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Melanoma
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Melanoma
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Melanoma
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Melanoma
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Therapy for Melanoma

• Excision /- LND
• Sentinel lymphoscintigraphy
• No effective adjuvant therapy
• Interferon alpha-2b
• Radiation
• Chemotherapy

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Dysplastic Nevi
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Dysplastic Nevi
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Non-melanoma skin cancer

• Squamous cell carcinoma
• Basal cell carcinoma
• Lifetime risk 1 in 3 in Caucasians

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Squamous cell carcinoma

• Erythematous to skin-colored, hyperkeratotic,
  scaly papule/plaque /- overlying crust or
  eschar, underlying induration, and ulceration.
• Differentiation
• Well
• Moderate
• Poor

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Squamous cell carcinoma

• Higher risk for metastasis
• Lower lip (16)
• Osteomyelitic ulcer (31), an area of prior
  radiation (20), or burn scar (18)
• Modified skin, e.g., the glans penis, the
  vulva, or the oral mucosa
• The host is immunocompromised
• Diameter gt 2.0 cm

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Squamous cell carcinoma
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Squamous cell carcinoma
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Squamous cell carcinoma
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Basal Cell Carcinoma

• Most common skin cancer diagnosed
• Rarely metastatic (invades locally)
• Can be pearly papule or scaling macule/plaque
• From basal layer of epidermis

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Types of basal cell carcinoma

• Nodulo-ulcerative or nodular
• Superficial multifocal
• Morpheaform or sclerosing
• Pigmented
• Fibroepithelioma

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Noduloulcerative

• Translucent, waxy papule/plaque with
  rolled-edge border /- central ulceration and
  telangiectasia

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Noduloulcerative basal cell carcinoma
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Noduloulcerative basal cell carcinoma
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Superficial multifocal type

• Ill-defined, erythematous, scaling papule/plaque
  with minimal underlying induration

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Superficial multifocal type
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Superficial multifocal type
31
Morpheaform or sclerosing type

• Ill-defined, depressed, firm skin-colored to
  yellowish papule/plaque with rare ulceration

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Morpheaform or sclerosing type
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Pigmented basal cell carcinoma

• Similar to nodular basal cell carcinoma but has
  pigment
• Melanoma in differential diagnosis

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Pigmented basal cell carcinoma
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Fibroepithelioma

• Fibroepithelioma
• Pedunculated, skin-colored to erythematous
  papules 1o on the trunk

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Fibroepithelioma
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Treatment

• Shave ED C
• Excision
• Mohs micrographic surgery