1. Skin Cancer Carlos Garcia MD Dermatology at OUHSC No conflicts of interest to disclose

2. Objectives Identify clinical characteristics of Precancerous lesions Common skin cancers Define risk factors for development of skin cancer Choose appropriate methods for diagnosis and treatment

3. Precancerous skin lesions Actinic keratoses Dysplastic melanocytic nevi

4. Actinic keratoses 10% risk of malignant transformation

5. Hypertrophic AK’s

6. Actinic cheilitis

7. Liquid nitrogen cryotherapy Topical therapies 5-FU (Efudex) Imiquimod (Aldara) Curettage for hypertrophic lesions Treatment of AK’s

8. Residual hypopigmentation Blister formation Liquid nitrogen Cryotherapy

9. Topical therapies Efudex or Aldara * 3-5 times per week * 6-8 weeks

11. Dysplastic nevi Precursors for melanoma Markers for melanoma

12. Treatment of dysplastic nevi

14. Non-melanoma skin cancers (NMSC) Basal cell carcinoma Squamous cell carcinoma Keratoacanthoma

15. Risk factors for development of BCC and SCC Fair skin (Fitzpatrick’s types I-III) Blue eyes Red hair Family history Genetic syndromes Chronic sun exposure Old age Arsenic, tar

16. Basal cell carcinoma

17. BCC- clinical types Nodular Pigmented Infiltrative Superficial Morpheaform

18. Nodular BCC Chronic lesion Easy bleeding Pearly border Surface telangiectasias Head and neck, trunk, and extremities

19. Pigmented BCC Similar to nodular but with black discoloration Melanin deposits Pigmented races Face, trunk, and scalp

20. Superficial BCC Erythematous scaly plaque Slow growth Asymptomatic Trunk, extremities, face

21. Morpheaform BCC Resembles scar Asymptomatic and slow growing Ill-defined margins Marked subclinical extension

22. BCC is the most frequent skin cancer (80%) BCC is 4x more frequent than SCC Metastases are rare (<1% of cases) Local destruction of tissue

23. Treatment of BCC Curettage electrodessication (ED/C) Surgical excision Traditional Mohs surgery Radiation therapy Topical therapy imiquimod 95% Cure Rate 50-75% Cure Rate

25. Squamous cell carcinoma

26. SCC types In-situ Bowen’s disease Erythroplasia of Queyrat Invasive SCC Keratoacanthoma

27. Bowen’s disease In-situ SCC Arsenic, HPV 16, radiation

28. Erythroplasia of Queyrat In-situ SCC Uncircumcised men May progress to invasive SCC

29. Invasive SCC Erythematous nodule Indurated lesion Sun-exposed skin Men > women Slow growth

30. Invasive SCC

31. Keratoacanthoma Low grade SCC Rapid growth over weeks Trauma, sun exposure, HPV 11 and 16 May progress to invasive SCC

32. SCC is locally invasive and destructive Metastases in 1-3% of cases To lymph nodes 50-73% survival Distant sites (lungs) Incurable

33. Bowen’s disease Erythroplasia of Queyrat Efudex or aldara Liquid nitrogen cryotherapy Radiation therapy Curettage electrodessication (ED/C) Surgical excision Treatment of SCC

34. Invasive squamous cell carcinoma Surgical excision Traditional Mohs surgery Radiation therapy

36. Malignant Melanoma (MM)

37. Risk factors- MM Fair skin, red hair, and blue eyes Intermittent sun exposure Sunburns Tanning beds Freckles and melanocytic nevi Family history of melanoma

38. Clinical types- MM Superficial spreading melanoma Lentigo maligna melanoma Acral lentiginous melanomaNodular melanoma

39. ABCD of Melanoma A symmetry B order irregularity C olor variegation D iameter >6mm

41. Prognostic features- MM Good prognosis Breslow < 1mm Intermediate prognosis Breslow 1-4mm Bad prognosis Breslow >4mm

42. Treatment of MM Surgical excision In situ = 5 mm margin Invasive= 1-3 cm depending on Breslow’s depth

43. Sentinel lymph node biopsy- MM Recommended for MM with Breslow 1-4mm Lymphadenectomy for positive nodes Powerful prognostic feature for disseminated disease It does not affect survival of patients

44. Thank you