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Nonmelanoma Skin Tumor

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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Nonmelanoma Skin Tumor

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  1. Nonmelanoma Skin Tumor

  2. What are nonmelanoma skin tumors? • Basal Cell carcinoma • Squamous cell carcinoma

  3. Basal Cell Carcinoma

  4. Epidemiology • Occur at any age • More after age 40

  5. 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

  6. Common location? • Face • Uncommon in back of hands and forearms

  7. Characteristic • Rarely metastasize • Need stroma to support the growth • Destruction by extension • Growth – unpredictable • Little growth for many years • Fast extension

  8. Five histological types • Nodular – most common • Superficial • Micronodular • Infiltrative • Morpheaform

  9. BCC • White pearly • Telangiectasia

  10. BCC • Dome-shape • Central umbilication • Telangiectasia

  11. BCC Crusting with extension

  12. BCC Dome-shaped Scaling

  13. BCC Telangiectasia on surrounding skin with tension

  14. BCC

  15. BCC - morpheaform Firm, flat Yellow or white Blend in normal skin Average of 7.2 mm subclinical extension

  16. BCC - superficial

  17. BCC - superficial

  18. BCC - pigmented

  19. Diagnosis? Shave biopsy

  20. Treatment • Histological type • Tumor size • Location • Risk of recurrence

  21. 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

  22. Squamous cell carcinoma

  23. Risk factors? • Sun exposure - UVB • Immunosuppresion – 65x in transplant patients • Light skin

  24. 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

  25. AK Yellow, brown scaly, adherent macule

  26. AK

  27. AK - multiple

  28. AK – small & scaly

  29. AK - pigmented

  30. SCC mimics AK

  31. Cutaneous horn Warts, SK, AK, and SCC may retain keratin and produce horns.

  32. AK vs. SCC

  33. AK vs. SCC

  34. SCC

  35. SCC

  36. SCC

  37. SCC

  38. Keratoacanthoma Dome shape Rapid growth Central keratin plug Difficult to distinguish from SCC

  39. Keratoacanthoma vs. SCC

  40. Risk of metastasis

  41. Risk of metastasis

  42. Risk of metastasis

  43. Risk of metastasis

  44. Diagnosis? Shave biopsy

  45. Treatment for AK • Cryotherapy • Electrodesiccation and curettage • CO2 laser – actinic cheilitis • 5-FU • Imiquimod • Diclofenac sodium gel

  46. 5-FU

  47. Treatment for SCC

  48. Surgical margin

  49. The end

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