SKIN CANCER

SKIN CANCER PowerPoint PPT Presentation


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Skin Cancer. Skin cancer is a major health problem in AustraliaThe most common skin cancer is the Basal Cell Carcinoma (BCC)The next most common is the Squamous Cell Carcinoma (SCC)The least common is the Melanoma (MM)BCC and SCC are often grouped together as non-melanoma skin cancer (NMSC)Skin cancer dose not kill many Australians but treating cancers causes considerable morbidity..

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SKIN CANCER

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1. SKIN CANCER Dr. D. Czarnecki MD MBBS

2. Skin Cancer Skin cancer is a major health problem in Australia The most common skin cancer is the Basal Cell Carcinoma (BCC) The next most common is the Squamous Cell Carcinoma (SCC) The least common is the Melanoma (MM) BCC and SCC are often grouped together as non-melanoma skin cancer (NMSC) Skin cancer dose not kill many Australians but treating cancers causes considerable morbidity.

3. Skin Cancer Not all races have an equal risk of developing skin cancer Skin cancers overwhelmingly develop in white people The following slide has the incidences of NMSC in different races in different parts of the world The highest incidence found was in white Australian men living in tropical Queensland The incidence in coloured people was lower, even when they lived in the tropics.

5. Skin Cancer A BCC – nodular type. Most of these occur on the head. BCCs slowly grow BCCs rarely metastasize – about 1 in 100,000 It is often difficult to tell BCCs from SCCs on clinical grounds

6. Skin Cancer A BCC – superficial type This is now the most common type of BCC and most occur on the back It is pink, well demarcated, and slightly scaly There is a small area of ulceration

8. BCC Treatment of BCCs: Surgery has the lowest recurrence rate (5-8%) Radiotherapy has a 12% recurrent rate Imiquimod fails in 20-40% (higher failure rate in thicker tumours) Photodynamic therapy fails in 40% after 4 years of follow up Cryotherapy has a high failure rate and should not be used unless a thermocouple is used (to measure skin temperature at a set depth)

9. Skin Cancer An SCC on the forehead SCCs are most often found on the head or hands SCCs metastasize in about 5% of cases The regional lymph node is the most common site of metastasis

10. SCC The average age for an SCC to develop in Melbourne is 71. This means that many patients die of other causes before metastases are obvious. The Metastatic rate could be higher. The risk factors for metastasis are Thickness > 4 mm male sex located on the ear a recurrent SCC perineural spread is present the patient is immunosuppressed

11. SCC An SCC on the nose There are metastases in the submental lymph nodes The patient had chronic lymphocytic leukaemia and died shortly after of the leukaemia

12. SCC A recurrent SCC in front of the ear. The initial pathology report stated that it was incompletely excised A wider, deeper excision is mandatory

13. Skin Cancer A safety margin is needed A 4 mm margin of normal looking tissue is recommended for BCCs (not morphoeic) and SCCs A 4 mm margin will give a 95% chance of removing the tumour For morphoeic BCCs a 10 mm margin is recommended

14. Skin Cancer You must review the patient Overall – 2/3rds will develop a new skin cancer within 5 years The risk is higher the greater the number of skin cancers a patient has had removed Patients with skin cancer have an increased risk of developing non-Hodgkins lymphoma Regular review enables the doctor examine for cancers and to re- inforce the message about protection from sunburn.

16. Melanoma Melanomas are the least common skin cancers. There were fewer than 10,000 invasive melanomas registered in Australia in 2003. There were about 40% more melanomas-in-situ. In 2003 there were about 14,000 melanomas removed from Australians About 1000 Australians die each year of melanoma. This is fewer than commit suicide or die in car accidents.

18. Melanoma Not all races are at risk of melanoma. The disease is overwhelmingly one of white people. The main risk factors for a melanoma are (in decreasing order of importance: A previous melanoma A previous BCC or SCC More than 150 moles A skin that sun burns easily and tans poorly A first degree relative with a melanoma Immunosuppression

19. The incidence of melanoma in different countries (cases per 100,000)

20. Melanoma Had a melanoma? – 10% get another A family history (FH) increases the risk 1 first degree relative – doubles the risk 2 first degree relatives – 5 times the risk 3 first degree relatives – 35 to 70 times the risk Had a BCC or SCC? – greater risk than a +ve FH x 8 for men x 4 for women

21. Melanoma A typical melanoma It is asymmetrical The A B of melanoma: A – asymmetry B – biopsy asymmetrical pigmented lesions

22. Melanoma When you see a pigmented lesion Draw a line down the middle If one half does not look like the other half - TAKE A BIOPSY

23. Melanoma Taking a punch biopsy or a shave biopsy Will not increase the risk of metastases Studies have found no risk if such a biopsy is taken and the definitive surgery is carried out within two weeks Punch or shave biopsies are not encouraged because thickness is the main prognostic factor and a biopsy may miss the thickest area However, if unsure, and you do not wish to excise the lesion, take a biopsy

24. Melanoma This melanoma is thick – at the inferior end It is ulcerated Thickness and ulceration are the two most important prognostic factors

25. Melanoma If you think the lesion is a melanoma – excise it Guides lines Excise with a 2 mm margin, await the pathology report, and if it is a melanoma, carry out a wider excision Margins Melanoma-in-situ – 5 mm margin Melanoma < 1 mm thick – 1 cm margin Melanoma > 1 mm thick – 2 cms margin

26. Melanoma Prognostic factors (a worse prognosis) Thickness Ulceration Male sex Site – ear, palms, soles Old age Level IV in thin melanomas

27. Melanoma This melanoma developed on the toe. The patient had many naevi and had had a BCC. Melanomas on the feet are uncommon. You need to examine the entire body.

28. Melanoma

29. Melanoma

30. Melanoma

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