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

Skin Cancer Melanoma Squamous cell carcinoma Basal cell carcinoma

Statistics BCCSCCMMAll other 1,000, ,00055,0001,285,000 CA 52(1):10, 2002.

Lifetime Risk of Developing Melanoma Rigel DS, et al. NYU Melanoma Cooperative Group, :1,500 1:600 1:250 1:150 1:100 1:71

Melanoma Facts (2002) 6/7 skin cancer deaths. More common than any other nonskin cancer in women years old. Lifetime risk was 1/71 in the year person dies of melanoma every hour. 6 th and 7 th most common cancer in men and women respectively.

Types of Melanoma 1) Superficial spreading-70% 2) Nodular-15% 3) Acral lentiginous-8% 4) Lentigo maligna-5% 5) Other-2%

Acral Lentiginous Melanoma

Nodular Melanoma

Melanoma

Therapy for Melanoma Excision +/- LND Sentinel lymphoscintigraphy No effective adjuvant therapy – Interferon alpha-2b – Radiation – Chemotherapy

Dysplastic Nevi

Non-melanoma skin cancer Squamous cell carcinoma Basal cell carcinoma Lifetime risk: 1 in 3 in Caucasians

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

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 > 2.0 cm

Squamous cell carcinoma

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

Types of basal cell carcinoma Nodulo-ulcerative or nodular Superficial multifocal Morpheaform or sclerosing Pigmented Fibroepithelioma

Noduloulcerative Translucent, waxy papule/plaque with “rolled- edge” border +/- central ulceration and telangiectasia

Noduloulcerative basal cell carcinoma

Superficial multifocal type Ill-defined, erythematous, scaling papule/plaque with minimal underlying induration

Superficial multifocal type

Morpheaform or sclerosing type Ill-defined, depressed, firm skin-colored to yellowish papule/plaque with rare ulceration

Morpheaform or sclerosing type

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

Pigmented basal cell carcinoma

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

Fibroepithelioma

Treatment Shave ED & C Excision Mohs micrographic surgery