Dr. Sunil Chopra The London Dermatology Centre
Transcript of Dr. Sunil Chopra The London Dermatology Centre
Topics Covered
! Solar Keratoses (aka Actinic Keratoses)
! Squamous Cell Carcinoma
! Basal Cell Carcinoma
! Dysplasia of epidermal cells.
! Precancerous.
! Multiple flat or thickened, scaly or warty, skin
colored or reddened.
! May develop into a cutaneous horn.
! Exposure to sun
! Dorsa of hands, face - nose, cheeks, upper lip,
temples and forehead.
! Lips - actinic cheilitis.
What are Solar Keratoses?
" Fair-skinned
" Worked outdoors
" Sun-damaged skin is also dry, discolored
and wrinkled.
Patient Characteristics
! Uncomfortable and unsightly.
! Squamous Cell Carcinoma.
! More than ten solar keratoses - 10 to 15%.
Are Solar Keratoses Dangerous?
! Blistering and shedding of the sun damaged
skin.
! Face - peel off after about 10 days
! Hands - 3 weeks
! Legs - 12 weeks to heal.
Cryotherapy
! Thicker keratoses
! Pathological examination.
! Heals over a few weeks, leaving a small
scar.
Curettage & Cautery
! Multiple keratoses on the face.
! Twice daily for two to four weeks.
! Treated areas become red, raw and uncomfortable.
5 – Fluorouracil Cream
! Ensures lesion has been completely
removed, confirmed by pathological
examination.
! Permanent scar.
Excision
! Immune response modifier
! Three times weekly for four to sixteen
weeks.
! Inflammatory reaction - maximal at three
weeks.
Imiquimod
! Extract of a common plant, petty spurge or
milk weed (Euphorbia peplus).
! Specifically grown in Queensland
Ingenol Mebutate Gel (Picato)
! Refrigerated.
! Face and scalp- 0.015% OD 3/7
! Trunk and extremities- 0.05% OD 2/7
Ingenol Mebutate Gel (Picato)
! Dry for 15 minutes
! Do not touch for 6 hours
! Avoid excessive sweating
! Treated areas become inflamed, often
crusted, and then heal over a few days.
! Moisturise after skin peels off.
Ingenol Mebutate Gel (Picato)
" Solar keratoses may be prevented by
protecting skin from ultraviolet radiation.
" Polypodium Leucotomos ?
Prevention of Keratoses
" Prevention is better than cure!
" Treat early with topical treatment
" Refer those that need cryotherapy or any
further invasive Rx
" Beware AKs on lips and ears
Conclusions
! Ultraviolet radiation
! Inherited predisposition to skin cancer.
! Smoking – especially SCC of the lip.
! Thermal burn scars.
! Longstanding leg ulcers.
! Immunosuppression
! Infection with human papillomavirus (HPV)
SCC Causes
! Rodent ulcer and basalioma.
! keratinocytic
! Most common type of cancer in humans
! Rarely a threat to life.
Basal Cell Carcinoma
! Younger patients
! Multiple
! Upper trunk and shoulders
! Pink or red scaly irregular plaques
! Slowly grow
Superficial BCC
! Sclerosing BCC
! Mid-facial sites
! Skin-coloured, waxy, scar-like
! Prone to recur after treatment
! May infiltrate cutaneous nerves (perineural
spread)
Morphoeic BCC
! Avoid sunburn in childhood
! Sun protection lifelong
! Nicotinamide (vitamin B3) 500 mg twice
daily
! Polypodium Leucotomos ?
Prevention
! Shave
! Curettage, & cautery
! Small
! Well-defined
! Nodular
! Superficial BCCs
! No stitches.
Superficial Skin Surgery
! 70 to 80% of small superficial BCCs
! Good cosmetic result
! Avoid high risk sites
Photodynamic Therapy
! Three to five times each week
! Six to sixteen weeks
! 70 to 80% of small superficial BCCs
! Long term follow up
Imiquimod Cream
! Superficial small
! 12 weeks
! Twice daily
! Cure rates lower than with imiquimod cream.
Fluorouracil Cream