Nonmelanoma Skin Tumor

What are nonmelanoma skin tumors? Basal Cell carcinoma Squamous cell carcinoma

Basal Cell Carcinoma

Epidemiology Occur at any age More after age 40

Risk factor for BCC? Sun exposure Prior history of BCC or SCC 1/3 not in sun exposure areas Prior history of BCC or SCC 3-year-accumulative risk – 44% for BCC 3-year-accumulative risk – 43% for SCC

Common location? Face Uncommon in back of hands and forearms

Characteristic Rarely metastasize Growth – unpredictable Need stroma to support the growth Destruction by extension Growth – unpredictable Little growth for many years Fast extension

Five histological types Nodular – most common Superficial Micronodular Infiltrative Morpheaform

BCC White pearly Telangiectasia

BCC Dome-shape Central umbilication Telangiectasia

BCC Crusting with extension

BCC Dome-shaped Scaling

BCC Telangiectasia on surrounding skin with tension

BCC

BCC - morpheaform Firm, flat Yellow or white Blend in normal skin Average of 7.2 mm subclinical extension

BCC - superficial

BCC - superficial

BCC - pigmented

Diagnosis? Shave biopsy

Treatment Histological type Tumor size Location Risk of recurrence

Treatment Methods Curettage and electrodessication – small lesion Simple surgical excision – large lesion Mohs' micrographic surgery – large tumor, high recurrent site like nose, poorly-defined marging Radiation – elderly, difficult area like eyelid Imiquimod – superficial BCC

Squamous cell carcinoma

Risk factors? Sun exposure - UVB Immunosuppresion – 65x in transplant patients Light skin

Actinic keratosis AK is confined to epidermis Extension beyond the epidermis = squamous cell carcinoma May resolve spontaneously when sun exposure is removed Risk of developing SCC 0.085% per lesion per year 60% SCC came from AK

AK Yellow, brown scaly, adherent macule

AK

AK - multiple

AK – small & scaly

AK - pigmented

SCC mimics AK

Cutaneous horn Treatment: cryotherapy, local scissor excision, or surgical excision. Warts, SK, AK, and SCC may retain keratin and produce horns.

AK vs. SCC AK mimics SCC

AK vs. SCC

SCC

SCC

SCC

SCC

Keratoacanthoma Dome shape Rapid growth Central keratin plug Difficult to distinguish from SCC

Keratoacanthoma vs. SCC

Risk of metastasis Depth Metastasis <2 mm None <4 mm 6.7% 4 mm 45.7%

Risk of metastasis Size Metastasis <2 cm 9.1% >2 cm 30.3%

Risk of metastasis Differentiation Metastasis Well differentiated 9.2% Poorly differentiated 32.2%

Risk of metastasis Location Metastasis Sun-exposured 5.2% Ear 11% Lip 13.7%

Diagnosis? Shave biopsy

Treatment for AK Cryotherapy Electrodesiccation and curettage CO2 laser – actinic cheilitis 5-FU Imiquimod Diclofenac sodium gel

5-FU

Treatment for SCC Radiation and chemotherapy in addition to surgery for large lesions. Excision to subcutaneous fate for lip or deep lesions.

Surgical margin Size Histological Grade Location Depth Surgical Margin <2 cm 1 Low risk Dermis 4 cm 2 cm 2,3,4 High risk SC 6 cm

The end