Skin Cancer

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Skin Cancer

• Burton L. Hayes M.D.

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• 30 year old white male presents to your office
  with a mole he believes has increased in size.

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(No Transcript)
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What should you do?

• A. Reassure the patient that he has a benign
  solar lentigo and no further evaluation is
  needed.
• B. Ask the patient to return for re-examination
  in 6 months
• C. Measure the lesion and biopsy if diameter is
  greater than 6 mm.
• D. Biopsy and/or refer to dermatology

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D. Biopsy and/or refer to Dermatology

• Melanoma is the sixth most common cancer in the
  United States.
• 7900 deaths per year in the United States.
• The overall survival of patients with melanoma
  has increased from 50 percent in 1950, to 80
  percent between 1974 and 1976, to 90 percent in
  1992 to 1999.

Malignant Melanoma
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Risk Factors

• Sun-sensitive skin type
• Immunosuppression
• Xeroderma pigmentosum
• Family history of melanoma
• Dysplastic mole syndrome
• Multiple common or atypical nevi

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Melanoma subtypes

• Superficial spreading melanoma
• Nodular melanoma
• Acral lentiginous melanoma
• Lentigo maligna melanoma

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Superficial spreading melanoma

• 70 of melanomas
• Radial growth for 1 to 5 years before vertical
  (invasive) growth occurs
• Once the lesion has begun to spread vertically,
  the tumor has greater potential to metastasize
  because it can access dermal lymphatics and blood
  vessels.
• SSM can arise in a preexisting nevus as a focal
  area of deep pigmentation that can be subtle and
  difficult to detect.

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Nodular melanoma

• 15 to 30 percent of all melanomas
• A discrete nodule with dark black pigmentation is
  typical clinically, but amelanotic melanomas are
  also commonly nodular
• The absence of a radial growth phase can make
  identification of these lesions clinically
  difficult.

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Acral letiginous melanoma

• 5 percent of melanomas
• Most common subtype found in dark-skinned
  individuals
• Melanoma location on the hands or feet has been
  independently associated with a poorer prognosis.

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Lentigo maligna melanoma

• 5 percent of melanomas
• arises from in situ melanoma on sun-damaged skin,
  usually on the head and neck
• The in situ form, termed lentigo maligna, may be
  present for years before a vertical growth phase
  develops

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ABCDEs of Melanoma

• Asymmetry
• Border irregularities
• Color variegation (ie, different colors within
  the same region)
• Diameter greater than 6 mm
• Enlargement

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Enlargement may be most important

• If the patient notices an increase in size of a
  mole, it is likely to have increased in size by
  30
• If you are highly suspicious, primary complete
  excision is preferred, but punch biopsy does NOT
  worsen prognosis.

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68 y/o landscaper presents with the following
lesion. Which of the following are risk factors
for developing this lesion?

• A. Sunburn as a child
• B. Treatment for Hodgkins lymphoma
• C. Steroid dependent asthma
• D. All the above

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D. All the above

• Rodent-ulcer variant of Nodular Basal Cell
  Carcinoma (BCC)

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Basal Cell Carcinoma

• 70 of an estimated 1.5 million non-melanoma skin
  cancers in the U.S. yearly
• Risk Factors
• UV light exposure
• Ionizing radiation exposure
• Chronic immunosuppression

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Types of Basal Cell Carcinoma

• Nodular BCC
• Sclerosing morpheaform BCC
• Superficial BCC

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Nodular BCC

• Most common
• Head and neck are most common sites
• Well circumscribed nodule with pearly sheen
• Telangiectasias present

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Sclerosing BCC

• Whitish firm plaque
• More aggressive growth pattern
• Fibrosis or sclerosis on palpation
• Margins are indistinct

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Superficial BCC

• Commonly on back
• Erythema and scaling
• Thread-like border demarcates for normal skin
• May be mistaken for patch of dermatitis

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Basal Cell Carcinoma

• Punch biopsy, shave biopsy, or primary excision
  preferred for diagnosis
• 90 of cases can be managed with surgical
  excision
• Mohs surgery or radiation for difficult cases

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What minimum SPF suncreen would you recommend to
help prevent this lesion?

• A. SPF 2
• B. SPF 8
• C. SPF 15
• D. SPF 30

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C. SPF 15 (at a minimum)

• Squamous Cell Carcinoma
• Hyperkeratosis is key feature do distinguish from
  BCC
• Sun-exposed skin mostly
• HPV possible in non-exposed areas

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Squamous cell carcinoma

• Cure rates of 90 with simple excision
• 97 with Mohs surgery
• Radiation therapy possible for lesions not
  amenable to surgery