Skin Cancer: No Conflicts of Interest To Disclose

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

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
Precancerous skin lesions
Actinic keratoses
Dysplastic melanocytic nevi

Actinic keratoses
10% risk of malignant transformation

Hypertrophic AK’s
Actinic cheilitis
Treatment of AK’s
 Liquid nitrogen cryotherapy
 Topical therapies
 5-FU (Efudex)
 Imiquimod (Aldara)
 Curettage for hypertrophic lesions

Liquid nitrogen
Cryotherapy Residual hypopigmentation
Blister formation
Topical therapies
Efudex or Aldara
* 3-5 times per week

* 6-8 weeks
Dysplastic nevi
•Precursors for
melanoma
•Markers for
melanoma
Treatment of dysplastic nevi
 Non-melanoma skin cancers
(NMSC)
 Basal cell carcinoma
 Squamous cell carcinoma
 Keratoacanthoma
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
Basal cell carcinoma
BCC- clinical types
 Nodular
 Pigmented
 Infiltrative
 Superficial
 Morpheaform
Nodular BCC
 Chronic lesion
 Easy bleeding
 Pearly border
 Surface telangiectasias
 Head and neck, trunk,

and extremities
Pigmented BCC
 Similar to nodular but

with black discoloration
 Melanin deposits
 Pigmented races
 Face, trunk, and scalp

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

Morpheaform BCC
 Resembles scar
 Asymptomatic and slow

growing
 Ill-defined margins
 Marked subclinical
extension
 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
Treatment of BCC
 Curettage electrodessication (ED/C)
 Surgical excision
95% Cure Rate
 Traditional
 Mohs surgery
 Radiation therapy
 Topical therapy 50-75% Cure Rate

 imiquimod
Squamous cell carcinoma
SCC types
 In-situ
 Bowen’s disease
 Erythroplasia of Queyrat
 Invasive SCC
 Keratoacanthoma
Bowen’s disease
 In-situ SCC
 Arsenic, HPV 16,

radiation
Erythroplasia of Queyrat
 In-situ SCC
 Uncircumcised men
 May progress to
invasive SCC
Invasive SCC
 Erythematous nodule
 Indurated lesion
 Sun-exposed skin
 Men > women
 Slow growth
Invasive SCC
Keratoacanthoma
 Low grade SCC
 Rapid growth over

weeks
 Trauma, sun exposure,

HPV 11 and 16
 May progress to
invasive SCC
 SCC is locally invasive and
destructive
 Metastases in 1-3% of
cases
 To lymph nodes
 50-73% survival
 Distant sites (lungs)

 Incurable
Treatment of SCC
 Efudex or aldara
 Bowen’s disease  Liquid nitrogen

cryotherapy
 Erythroplasia of  Radiation therapy

Queyrat
 Curettage
electrodessication
(ED/C)
 Invasive
 Traditional
squamous cell
 Mohs surgery
carcinoma
 Radiation therapy
Malignant Melanoma
(MM)
Risk factors- MM
 Fair skin, red hair, and blue eyes
 Intermittent sun exposure

 Sunburns
 Tanning beds
 Freckles and melanocytic nevi
 Family history of melanoma

Clinical types- MM
Superficial spreading melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma Nodular melanoma

ABCD of Melanoma
 Asymmetry
 Border irregularity
 Color variegation
 Diameter >6mm
Prognostic features- MM
 Good prognosis
 Breslow < 1mm
 Intermediate prognosis
 Breslow 1-4mm
 Bad prognosis
 Breslow >4mm
Treatment of MM
 In situ = 5 mm margin
 Invasive=1-3 cm depending on
Breslow’s depth
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
Thank you

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Skin Cancer

No conflicts of interest to disclose

 Common skin cancers

 Define risk factors for development of skin

 Choose appropriate methods for diagnosis

Dysplastic melanocytic nevi

10% risk of malignant transformation

 Curettage for hypertrophic lesions

* 3-5 times per week

 Basal cell carcinoma

 Squamous cell carcinoma

 Chronic sun exposure

 Head and neck, trunk,

 Similar to nodular but

 Face, trunk, and scalp

 Trunk, extremities, face

 Asymptomatic and slow

 Metastases are rare

 Topical therapy 50-75% Cure Rate

 Arsenic, HPV 16,

 Rapid growth over

 Trauma, sun exposure,

 Distant sites (lungs)

 Bowen’s disease  Liquid nitrogen

 Erythroplasia of  Radiation therapy

 Intermittent sun exposure

 Freckles and melanocytic nevi

 Family history of melanoma

Superficial spreading melanoma

Lentigo maligna melanoma

Acral lentiginous melanoma Nodular melanoma

 It does not affect

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