Skin Caner Fernando Vega, M.D. 1 Skin Cancer Fernando Vega, MD Seattle Healing Arts nPrecancerous lesions nCommon skin cancers Clinical characteristics Precancerous skin lesions nActinic keratoses nDysplastic melanocytic nevi ACTINIC KERATOSIS n Common sun-induced premalignant neoplasm of the epidermis that occurs primarily on exposed skin n Consequence of cumulative long-term sun exposure n Prevalence ↑with ↑age n Men > women n Also genetic factors - ↑in fair skin and in genetic syndromes eg xeroderma pigmentosum NATURAL HISTORY n Some lesions (10%) spontaneously regress n Some (majority) remain unchanged n Others (1-10%) progress and develop into SCC – risk increased with continued sun exposure or concurrent immunosuppression CLINICAL FEATURES n Earliest evidence is a tiny red telangiectatic spot n Then dry, rough and adherent scale n Skin coloured/ red/ yellow/ brown n Usually multiple n Lesions on hands and forearms tend to be thicker n Actinic change on lips=actinic chelitis n Associated with other signs of sun damage – solar elastosis, wrinkled skin, solar lentigines
Transcript
Skin Caner
Fernando Vega, M.D. 1
Skin Cancer
Fernando Vega, MDSeattle Healing Arts
nPrecancerous lesionsnCommon skin cancers
Clinical characteristics
Precancerous skin lesionsnActinic keratoses
nDysplastic melanocytic nevi
ACTINIC KERATOSISn Common sun-induced
premalignant neoplasm of the epidermis that occurs primarily on exposed skin
n Consequence of cumulative long-term sun exposure
n Prevalence ↑with ↑age
n Men > women
n Also genetic factors - ↑in fair skin and in genetic syndromes eg xeroderma pigmentosum
NATURAL HISTORY
n Some lesions (10%) spontaneously regress
n Some (majority) remain unchanged
n Others (1-10%) progress and develop into SCC – risk increased with continued sun exposure or concurrent immunosuppression
CLINICAL FEATURESn Earliest evidence is a tiny red
telangiectatic spot
n Then dry, rough and adherent scale
n Skin coloured/ red/ yellow/ brown
n Usually multiple
n Lesions on hands and forearms tend to be thicker
n Actinic change on lips=actinic chelitis
n Associated with other signs of sun damage – solar elastosis, wrinkled skin, solar lentigines
Skin Caner
Fernando Vega, M.D. 2
Actinic keratoses Actinic keratoses
Actinic keratoses and SCC Actinic keratoses and SCC
Actinic keratoses and BCC Actinic keratoses
10% risk of malignant transformation
Skin Caner
Fernando Vega, M.D. 3
Hypertrophic AK’s Actinic cheilitis
n Liquid nitrogen cryotherapy
n Topical therapies
n 5-FU (Efudex)
n Imiquimod (Aldara)
n Curettage for hypertrophic lesions
Treatment of AK’sResidual hypopigmentation
Blister formation
Liquid nitrogenCryotherapy
Topical therapiesEfudex or Aldara
* 3-5 times per week* 6-8 weeks
Dysplastic nevi
•Precursors for melanoma•When to biopsy
Skin Caner
Fernando Vega, M.D. 4
Miller A and M ihm M. N Engl J Med 2006;355:51-65
Biologic Events and Molecular Changes in the Progression of Melanoma
Tsao H et al. N Engl J Med 2004;351:998-1012
Clinical Images of Pigmented Lesions
Non-melanoma skin cancers
nBasal cell carcinoma
nSquamous cell carcinoma
nKeratoacanthoma
Risk factors for development of BCC and SCC
n Fair skin (Fitzpatrick’s types I-III)n Blue eyesn Red hair
n Family historyn Genetic syndromes
n Chronic sun exposure
n Old age
n Arsenic, tar
Basal cell carcinoma
BCC- clinical types
n Nodular
n Superficial
n Morpheaform
Skin Caner
Fernando Vega, M.D. 5
Nodular BCCn Chronic lesion
n Easy bleeding
n Pearly border
n Surface telangiectasias
n Head and neck, trunk, and extremities
Skin Caner
Fernando Vega, M.D. 6
Superficial BCCn Erythematous scaly
plaque
n Slow growth
n Asymptomatic
n Trunk, extremities, face
Superficial BCC Morpheaform BCC
n Resembles scar
n Asymptomatic and slow growing
n Ill-defined margins
n Marked subclinical extension
n BCC is the most frequent skin cancer (80%)
n BCC is 4x more frequent than SCC
n Metastases are rare (<1% of cases)
n Local destruction of tissue
Treatment of BCCn Curettage electrodessication (ED/C)
n Surgical excisionn TraditionalnMohs surgery
n Radiation therapy
n Topical therapyn imiquimod
95% Cure Rate
50-75% Cure Rate
Skin Caner
Fernando Vega, M.D. 7
Squamous cell carcinoma
SCC types
n In-situnBowen’s diseasenErythroplasia of Queyrat
n Invasive SCCn Keratoacanthoma
Bowen’s disease
n In-situ SCC
n Arsenic, HPV 16, radiation
Invasive SCC
n Erythematous nodule
n Indurated lesion
n Sun-exposed skinn Men > women
n Slow growth
Invasive SCC Keratoacanthoma n Low grade SCC
n Rapid growth over weeks
n Trauma, sun exposure, HPV 11 and 16
n May progress to invasive SCC
Skin Caner
Fernando Vega, M.D. 8
n SCC is locally invasive and destructive
n Metastases in 1-3% of cases
n To lymph nodesn 50-73% survival
n Distant sites (lungs)n Incurable
Malignant Melanoma
Risk factorsn Fair skin, red hair, and blue eyes
n Intermittent sun exposuren Sunburnsn Tanning beds
