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

2. Skin Cancer Melanoma Squamous cell carcinoma Basal cell carcinoma

3. Statistics BCCSCCMMAll other 1,000,000 350,00055,0001,285,000 CA 52(1):10, 2002.

4. Lifetime Risk of Developing Melanoma Rigel DS, et al. NYU Melanoma Cooperative Group, 2001. 193519601980198519932001 1:1,500 1:600 1:250 1:150 1:100 1:71

5. 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. 6 th and 7 th most common cancer in men and women respectively.

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

7. Acral Lentiginous Melanoma

8. Nodular Melanoma

9. Melanoma

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

15. Dysplastic Nevi

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

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

19. 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

20. Squamous cell carcinoma

23. 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

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

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

26. Noduloulcerative basal cell carcinoma

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

29. Superficial multifocal type

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

32. Morpheaform or sclerosing type

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

34. Pigmented basal cell carcinoma

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

36. Fibroepithelioma

37. Treatment Shave ED & C Excision Mohs micrographic surgery