Icm Ii Dermatology 8B

Front 1

Basal Cell Carcinoma Epidemiology

Back 1

Epidemiology
Most common cancer in the United States

Approximately 900,000 cases annually occur in the United States

Incidence has continued to rise over the last decade

Front 2

Basal Cell Carcinoma Clinical Features –Risk Factors

Back 2

Clinical Features –Risk Factors

fair skin
sun (i.e., ultraviolet) exposure
family history
radiation therapy
arsenic

Front 3

Basal Cell Carcinoma Appearance of lesions

Back 3

Appearance of lesions

Classically, the lesions are pink dome-shaped papules which have pearly, rolled borders and telangiectasias; the lesions are normally found on sun-exposed areas such as the face and arms. However, it is important to remember that not all BCC’s will share all of these characteristics.

Front 4

Basal Cell Carcinoma Diagnosis

Back 4

Diagnosis

Skin biopsy is the only way to definitively diagnose a BCC (or almost any skin disease).
Although biopsies of lesions which are suspicious for BCC are routinely performed, one can often accurately diagnose a BCC by physical examination alone.

Front 5

Basal Cell Carcinoma Course/Prognosis

Back 5

Course/Prognosis

BCC’s very rarely metastasize (<1 per 4000 cases), thus they rarely cause death. BCC’s which do metastasize are normally related to very large primary tumors that remain untreated for years.
 
Untreated BCC’s will become very large and disfiguring, so their early detection and removal is of great importance.

Front 6

Actinic Keratosis Epidemiology

Back 6

Epidemiology

Very common, affects over 50% of elderly, fair-skinned persons in hot, sunny climates

Front 7

Actinic Keratosis Clinical Features

Back 7

Clinical Features

Risk factors
-fair skin
-history of significant UV exposure
-family history
-immunocompromised individuals

Front 8

Actinic Keratosis Appearance of lesions

Back 8

Appearance of lesions

dry, red, scaly, hyperkeratotic papules and macules which are most commonly found on the face, scalp,and arms

Front 9

Actinic Keratosis Diagnosis

Back 9

Diagnosis

Biopsy is definitive. In practice, actinic keratoses
are generally diagnosed by physical examination
alone. However, if one suspects evolution into a
SCC, then biopsy is indicated

Front 10

Actinic Keratosis Pathology

Back 10

Pathology

Actinic keratoses are benign epidermal tumors which are best thought of as pre-cancerous lesions (a slight oversimplification). The percentage of AK’s which will become squamous cell carcinomas if untreated is somewhat controversial, but the actual figure is almost certainly less than 10% .

Front 11

Squamous Cell Carcinoma Epidemiology

Back 11

Epidemiology


Approximately 200,000 new cases every year
incidence continues to rise

Front 12

Squamous Cell Carcinoma Clinical Features

Back 12

Clinical Features

Risk Factors
fair skin
Sun (i.e., ultraviolet) exposure
family history
Arsenic
Hydrocarbons
Heat
Radiation
Scars
Uncircumcised Males (penile SCC)
Alcohol and Tobacco – together they have a synergistic effect (oral SCC)
HPV

Front 13

Squamous Cell Carcinoma Appearance of lesions

Back 13

Appearance of lesions

There is much variation in the appearance of SCC’s,but classically they are described as small, red, hard, scaly papules and plaques.

Front 14

Squamous Cell Carcinoma Diagnosis

Back 14

Diagnosis

Skin biopsy is definitive, but many SCC’s can be reliably diagnosed by physical exam alone.

Front 15

Squamous Cell Carcinoma Prognosis/Course

Back 15

Prognosis/Course

Metastasis of SCC is uncommon, but not as rare as metastasis of BCC. Approximately 5% of cutaneous SCC’s metastasize. As is the case with BCC, tumors which are large and untreated for long periods of time are the most likely to metastasize.

Front 16

Squamous cell carcinoma in situ

Back 16

Squamous cell carcinoma in situ (i.e., entire tumor is confined to the epidermis without invasion into the dermis) is called Bowen’s Disease.This form of SCC appears as a characteristic red, slightly scaly patch or plaque. Bowen’s disease (not unexpectedly) has a much better prognosis than invasive SCC.

Front 17

Melanoma Epidemiology

Back 17

Epidemiology


Approximately 60,000 new cases a year in the United States
Accounts for about 4% of skin cancer cases, but 79% of skin cancer deaths
incidence is rising faster than any other cancer

Front 18

Melanoma Risk Factors

Back 18

Risk Factors

intermittent sun exposure appears to be more predisposing to melanoma than chronic sun exposure
fair-skinned patients who sunburn easily
genetic factors (defective p16 tumor suppressor gene increases risk of melanoma)
family history
congenital nevi (risk increases with size)
dysplastic nevi
immunosuppression

Front 19

Melanoma Appearance

Back 19

Like all skin cancers, melanomas have many different appearances.
Characteristics which might suggest that a pigmented lesion is a melanoma include
Asymmetry
Border Irregularity
Color Variegation
Diameter > 5 mm
Enlargement

Lesions which itch, burn, are tender, bleed or ulcerate should also raise a clinician’s index of suspicion for melanoma.

Front 20

Melanoma Diagnosis

Back 20

Diagnosis


Skin biopsy is only way to make a diagnosis of melanoma.. The diagnosis of melanoma is sometimes difficult to make on physical exam alone (for early lesions). This is because the high mortality rate of melanoma mandates early detection in order to increase the chances of a cure. At their earliest stages, melanomas probably will not exhibit all of the above classical features. Sometimes dermatologists will employ a magnifying device known as a dermatoscope to increase their diagnostic accuracy. Any lesion that is even minimally suspicious for melanoma should be biopsied.

The need to increase diagnostic accuracy has also fostered the development of new modalities such as ultrasound, mole mapping, and digital image analysis to aid in the detection of melanoma. To date, none of them are widely used.

Front 21

Melanoma Prognosis

Back 21

Prognosis

Unlike, BCC’s and SCC’s, the prognosis of melanoma is relatively poor. This is because of its much greater potential for metastasis, and the lack of effective treatment for metastatic disease. The prognosis of melanoma is strongly correlated with the depth of the tumor (i.e., the deeper the tumor, the poorer the prognosis). The presence of ulceration and nodal disease are also poor prognostic indicators.