MEDICAL MANAGEMENT OF SKIN CANCER

1. MEDICAL MANAGEMENT OF SKIN CANCER MAHMUD ALI DERMATOLOGIST EAST SUSSEX NHS TRUST 2011

2. MEDICAL MANAGMENT OF SKIN CANCER • Pre-cancerous skin conditions (Solar keratosis, Bowen’s disease) • Basal cell carcinoma (BCC) • Squamous cell carcinoma (SCC) • Malignant melanomas

3. SKIN TYPES SKINN TYPE TANNING ABILITY SKIN TYPE I Always burns, does not tan SCANDINAVIAN & CELTIC SKIN TYPE II Burns easily, tans poorly (CAUCASAINS) SKIN TYPE III Tans after initial burn (CENTRAL EUROPE) SKIN TYPE IV Burns minimally, tans easily MEDITERANEAN AND SOUTH AMERICANS SKIN TYPE V Rarely burns, tans darkly easily MIDDLE EAST, ASIAN AND AFRO AMERICANS SKIN TYPE VI Never burns, always tans darkly AFRICANS AND AFRO AMERICANS

4. RELATIVE RISK OF SUN DAMAGE • Skin type x total sun exposure + decades • Cumulative exposure causes AK, BCC, SCC and melanomas in the genetically susceptible. • Short sharp exposures as sun burn in youth may increase risk of melanomas.

5. ACTINIC(SOLAR) KERATOSIS • AK is common pre-malignant skin tumours displaying different clinical morphological features and histological configuration. • AK means thickened scaly growth(keratosis) caused by sun light(Actinic/Solar) • Due to cumulative rather than acute sun exposure

6. I NCIDENCE AND PREVALENCE OF AK • Number of people varies geographically • UK incidence is 6-15% of population aged more than 40 • Australian incidence is 40-60% of the population • Second most common skin complaint treated by dermatologist s in the US • Prevalence in UK is 20% in those 40+ and 50% in those aged more than 70

7. Solar keratosis or early SCC • 3 outcomes for AK 1- Progress into invasive SCC. The risk is 15 to 20% 2- Spontaneous clearance 3- May persist • Not always easy to tell which one will progress to SCC • Earle treatment of all lesions of SK is essential

8. CLINICAL FEATURES OF SK • Middle aged to elderly patients with fair skin • Sites; sun exposed parts of the body • Rough, small/ large spots which are easy to feel than to see.

9. SOLAR KERATOSIS

10. SK

11. SK

12. SK

13. SK

14. SK

16. SK

17. BOWEN’S DISEASE • I t is squamous cell carcinoma in situ ( Intra epithelial) with potential lateral spread. • Affects male and females equally and it’s commoner in whites • Frequency in USA is about 140/100,000 • Less than 5% of Bowen’s could advance to SCC

18. BOWEN’S DISEASE • Affects sun exposed parts of the body(head and neck and limbs) • Can affect genitalia; Erytheroplasia of Queyrat • Causes: chronic UV radiation, Human papiloma virus, Genetic factors, X ray radiation.

19. BOWEN’S DISEASE Clinical features: • Single lesion in about 2/3 of cases • Varies in size from 2 mm to several cm • Sharply demarcated, erythematous, psoriasiform irregular patch or plague, which could be scaly, crusted fissured or ulcerated

20. BOWEN’S DISEASE

21. BOWENS DISEASE

22. BOWENS DISEASE

23. BOWENS DISEASE

24. BASAL CELL CARCINOMA(BCC) • BCC is a malignant skin tumour which has varying morphology and histological configurations. • Slowly growing tumour(years) and very rarely metastasizes • It is the most common form of skin cancer • The neoplastic cells originating in the pluropotental primordial cells in the skin basal cell layer

25. BCC • Annual incidence in USA is 900,000(more in males) • Life time risk of BCC in white people is 35 -40 % in men and 20-30% in women • Causes of BCC 1- UV radiation, most common cause, due to short wave length(UVB), latent period 20-30 years between the UV damage and clinical onset of BCC

26. BCC • Causes: • 2- X ray • 3- Arsenic exposure • 4- immunosuppression • 5- Xerodermapigmentosum • 6- Gorlins syndrome

27. BCC Clinical signs and types 1- Nodular BCC Waxy papule or nodule with central depression, pearly appearance, rolled out edges and telangiectasia. With secondary changes

28. BCC

29. BCC 2- Superficial spreading multifocal BCC: Scaly erythemayous, thread like lesion with raised borders More common in the trunk and limbs little tendency to become invasive

30. BCC 3-Morpheic/ infiltrative BCC The most aggressive type, sclerotic plaque or nodule, ill defined border and often extend beyond clinical margins diagnosed as a scar

31. BCC 4- Pigmented BCC Nodular lesion with pearly appearance, rolled edges and black to brown pigmentation.

32. BCC Skin tension test

33. PRIMARY CUTANEOUS SQUAMOUS CELL CARCINOMA • Second most common form of skin cancer. • Arise from the keratinising cells of the epidermis or the appendages. • Locally invasive and capable of metastasize • Due to chronic UV exposure

34. SCC • Can be caused be: ionising radiation, arsenic, Chronic wounds, burns, scars, immunocompromised patients and Human papiloma virus infection • Common in sun exposed parts of the body • Fair skinned individuals • More in Males

35. SCC • The incidence of SCC is rising • The incidence in USA is 107/ 100,000 and 1300/100.000 in Australia, 10,000 yearly in UK (1 in every 6 BCC) • The overall risk of spread is 2-6% • Once spread to lungs is incurable

36. SCC Clinical features • Raised, firm, pink to flesh lesion • Warty, Keratotic, papule, nodule or plaque • Sun exposed parts of the body • Secondary changes

41. MALIGNANT MELANOMA • Least common, causes most deaths • Incidence quadrupled since 1960s (3% of skin cancers in UK is MM ) • Currently about 9,000 cases a year with about 2000 deaths • Can spread to any organ • Survival is entirely dependant on early diagnosis and adequate excision

42. 5 year survival rates for melanomas • In situ----------------------------Close to 100% • Less than 1mm-----------------93% • Between 1 and 3.5 mm--------67% • More than 3.5 mm-------------31% • Metastatic-----------------------Close to zero

43. M M • Sites affected

44. M M • Clinical features: ABCD • Asymmetry • Borders • Colour • Diameter

45. TYPES OF MM 1- SPUERFICAL SPREADING MM

46. 2- Nodular MM

47. 3- Lentigo Maligna /Melanoma

48. 4- Acral lentiginous

49. 5- AMELANOTIC MM

50. MANAGING SKIN CANCERS Management of skin cancer include: A- General measures B- Medical treatment C- Surgical treatment