Skin Cancer Diagnoses and Treatments

Aims NICE/IOG Use of the dermatoscope Pre malignant lesions BCC SCC Melanoma ‘quiz’

Reasons for referral

Diagnoses

Biopsies 2008

NICE guidance Issued Feb 2006 Low risk BCCs, AKs primary care High risk BCCs, SCC, melanoma, ? diagnosis refer BCCs should not be referred via 2 week wait Guidelines are being revised. GPSI with interest in skin cancer NB accreditation

Skin surgery Send all specimens for pathology Accurate information on pathology form, eg site, clinical description One specimen, one pot

Let there be light !

Types of dermatoscope

Lesion ‘turned black’

Distinguish vascular lesions from pigmented ones Distinguish melanocytic lesions from seb warts Adjunct to diagnosis If in doubt refer

Diagnosis ?

Management of pre- malignant non pigmented lesions Diagnostic biopsy Curettage Efudix PDT excision

~ 100 000 non melanoma skin cancers / year 80% NMSC occur > 60 years of age 95 % survival in NMSC overall ~ 10 000 melanomas / year Incidence doubling every 10 years

SCC - prognosis Lip Ear Immunocompromised pt Higher recurrence rates

Treatments for NMSC Excision Radiotherapy Mohs surgery

Mohs surgery Microscpoically controlled Margins examined Precise removal of tumour Used in cosmetically important areas Tissue sparing

Malignant melanoma Commonest cancer in 15 -34 age group Commoner than cervical cancer in women Average 20 years loss of life for each death Positive correlation with affluence

Advice on sun /UV exposure

Types of melanoma