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

Skin Cancer

Sarah Boyce Sawyer, MDDermatology & Laser of Alabama

Skin Cancer

Melanoma

Squamous cell carcinoma

Basal cell carcinoma

Statistics

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

BCCBCC SCC MM All other

1,000,000 350,000 55,000 1,285,000

CA 52(1):10, 2002.

Lifetime Risk of Developing Melanoma

Rigel DS, et al. NYU Melanoma Cooperative Group, 2001.

19351935 19601960 19801980 19851985 19931993 20012001

1:1,5001:1,500

1:6001:600

1:2501:250

1:1501:150

1:1001:100

1:711:71

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. 6th and 7th most common cancer in men

and women respectively.

Types of Melanoma

1) Superficial spreading-70% 2) Nodular-15% 3) Acral lentiginous-8% 4) Lentigo maligna-5% 5) Other-2%

Acral Lentiginous Melanoma

Nodular Melanoma

Melanoma

Therapy for Melanoma

Excision +/- LND Sentinel lymphoscintigraphy No effective adjuvant therapy

– Interferon alpha-2b– Radiation– Chemotherapy

Dysplastic Nevi

Non-melanoma skin cancer

Squamous cell carcinoma Basal cell carcinoma

Lifetime risk: 1 in 3 in Caucasians


Erythematous to skin-colored, hyperkeratotic, scaly papule/plaque +/- overlying crust or eschar, underlying induration, and ulceration.

Differentiation– Well– Moderate– Poor


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

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

Types of basal cell carcinoma

Nodulo-ulcerative or nodularSuperficial multifocalMorpheaform or sclerosingPigmentedFibroepithelioma

Noduloulcerative

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

Noduloulcerative basal cell carcinoma

Superficial multifocal type

Ill-defined, erythematous, scaling papule/plaque with minimal underlying induration

Superficial multifocal type

Morpheaform or sclerosing type

Ill-defined, depressed, firm skin-colored to yellowish papule/plaque with rare ulceration

Morpheaform or sclerosing type

Pigmented basal cell carcinoma

Similar to nodular basal cell carcinoma but has pigment

Melanoma in differential diagnosis

Pigmented basal cell carcinoma

Fibroepithelioma

• Fibroepithelioma– Pedunculated, skin-colored to

erythematous papules 1o on the trunk

Fibroepithelioma

Treatment

Shave ED & C

Excision

Mohs micrographic surgery

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

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