London Dermatology Centre and St Mary’s...
Transcript of London Dermatology Centre and St Mary’s...
Dr Ien Chan MD FRCP
Consultant Dermatologist London Dermatology Centre
and St Mary’s Hospital
Pre- skin cancers
Non-Melanoma Skin Cancers
! Pre-cancers
" Actinic (solar) keratosis
" Bowen’s disease (squamous cell carcinoma in-
situ)
! Basal cell carcinoma
! Squamous cell carcinoma
Non-Melanoma Skin Cancers
• Sun beds
• Depletion of ozone layer
• Ageing population
• Immunosuppressants
• Increase in outdoor activities (leisure, holidays)
• Skin type
Risk factors:
Non-Melanoma Skin Cancers
High risk exposed sites
Actinic keratosis
ACTINIC KERATOSIS
! Dry, scaly plaques on sun-exposed areas
! Usually < 10mm
! More common in middle-age and beyond
! Skin types I, II and III
! Outdoors workers and sports persons
Actinic keratosis
" Prevalence of AK varies with geography " UK prevalence - 5.9%-15.4% of population aged 40+
" Australian prevalence – 40% of the population
1. Memon et al. Br J Dermatol 2000; 142: 1154-1159 2. Green et al. J Am Acad Dermatol 1988; 19: 1045-1052
Actinic keratosis"
1. Adapted from Harvey I et al. Br J Cancer 1996; 74: 1302-1307"
"
ACTINIC KERATOSIS
! Pre-malignant
! Keratotic lesions occurring on chronically light-exposed adult skin
! Carry a risk of progression to squamous cell carcinoma (6-10% in 10 years)
! NICE recommends AKs can be treated in primary care
ACTINIC KERATOSIS
! Histopathology: epithelial dysplasia; focal areas of abnormal keratinocyte proliferation
! Rate of transformation into invasive SCC is very low (0.24% for each AK)
! 26% resolve without treatment over a 1-yr period
! Prevention: sunscreens, hats, self-examination, follow-up
ACTINIC KERATOSIS
Field damage: • mul,ple AK lesions present • underlying and surrounding area
of ac,nic damage likely • likely to be scalp or other sun-‐
damaged areas • extent of area of ac,nic damage
may not be evident visually or by physical examina,on.
ACTINIC KERATOSIS
Treatment:
Cryotherapy
Solaraze gel
Efudix (5-Fluorouracil 5%)
Actikerall (5-Fluorouracil 0.5% + 10% salicyclic acid)
Aldara (imiquimod 5%)
Zyclara (imiquimod 3.75%)
Picato (Ingenol mebutate)
Photodynamic therapy (PDT)
Surgical (curettage and cautery; excision)
ACTINIC KERATOSIS
Disease-related factors: • Duration
• Number
• Clinical course of lesions; localisation
• Extent of disease
Patient profile: • Age
• Co-morbidities
• Other risk factors, e.g. immunosuppression
• Pre-existing skin cancer
• History of treatments for AK
• Tolerability
• Long term outcome
• Personal preference of the patient
Healthcare system: • Cost
• Physician’s familiarity
• Clinic facilities
The presentation of AK"
A few superficial “thin” AKs Many small but visible AKs, which may be palpated
Multiple “thicker” AKs many of which are quite hyperkeratotic
Pre and post Efudix treatment
Bowen’s Disease
BOWEN’S DISEASE
! Solitary lesion, on a
sun-exposed area
! Typically: lower leg of
elderly patient
! Slowly enlarging
erythematous scaly
plaque with well-
defined boundaries
BOWEN’S DISEASE
Bowen’s Disease
BOWEN’S DISEASE
! Histopathology: SCC in situ
! Rate of malignant transformation: 5 - 10%
! Spontaneous resolution does not occur
! Treatment: excision, curettage and cautery, Efudix, Aldara, PDT, cryotherapy, radiotherapy
Summary
" UV radiation may lead to a range of skin lesions, both
pre-cancerous and cancerous
" Early diagnosis & intervention essential
" AKs can be managed in primary care
" Other lesions (SCC, BCC, melanoma) to be referred to
dermatologist
Date of preparation: April 2005 " " " " "036/0181"