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Nonmelanoma Skin Tumor. What are nonmelanoma skin tumors?. Basal Cell carcinoma Squamous cell carcinoma. Basal Cell Carcinoma. Epidemiology. Occur at any age More after age 40. Risk factor for BCC?. Sun exposure 1/3 not in sun exposure areas Prior history of BCC or SCC
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What are nonmelanoma skin tumors? • Basal Cell carcinoma • Squamous cell carcinoma
Epidemiology • Occur at any age • More after age 40
Risk factor for BCC? • Sun exposure • 1/3 not in sun exposure areas • Prior history of BCC or SCC • 3-year-accumulative risk – 44% for BCC • 3-year-accumulative risk – 43% for SCC
Common location? • Face • Uncommon in back of hands and forearms
Characteristic • Rarely metastasize • Need stroma to support the growth • Destruction by extension • Growth – unpredictable • Little growth for many years • Fast extension
Five histological types • Nodular – most common • Superficial • Micronodular • Infiltrative • Morpheaform
BCC • White pearly • Telangiectasia
BCC • Dome-shape • Central umbilication • Telangiectasia
BCC Crusting with extension
BCC Dome-shaped Scaling
BCC Telangiectasia on surrounding skin with tension
BCC - morpheaform Firm, flat Yellow or white Blend in normal skin Average of 7.2 mm subclinical extension
Diagnosis? Shave biopsy
Treatment • Histological type • Tumor size • Location • Risk of recurrence
Treatment • Methods • Curettage and electrodessication – small lesion • Simple surgical excision – large lesion • Mohs' micrographic surgery – large tumor, high recurrent site like nose, poorly-defined marging • Radiation – elderly, difficult area like eyelid • Imiquimod – superficial BCC
Risk factors? • Sun exposure - UVB • Immunosuppresion – 65x in transplant patients • Light skin
Actinic keratosis • AK is confined to epidermis • Extension beyond the epidermis = squamous cell carcinoma • May resolve spontaneously when sun exposure is removed • Risk of developing SCC 0.085% per lesion per year • 60% SCC came from AK
AK Yellow, brown scaly, adherent macule
Cutaneous horn Warts, SK, AK, and SCC may retain keratin and produce horns.
Keratoacanthoma Dome shape Rapid growth Central keratin plug Difficult to distinguish from SCC
Diagnosis? Shave biopsy
Treatment for AK • Cryotherapy • Electrodesiccation and curettage • CO2 laser – actinic cheilitis • 5-FU • Imiquimod • Diclofenac sodium gel