Skin Cancers Flashcards
Types of Skin Cancer
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
Malignant Melanoma: What is it?
- tumors arising from malignant transformation of melanocytes (pigment-producing cells)
- leading cause of death due to skin disease
- incidence has doubled over past 30 years
- tumor thickness is the single most important prognostic factor
- lymph node involvement and metastases decrease survival
Malignant Melanoma: Assessment
- use the ABCDE mnemonic
- be suspicious of any moles that look different than the others
- look on the hands, soles of feet, and nails of dark-skinned individuals
Malignant Melanoma: ABCDE
A - asymmetry of lesion
B - borders, irregular
C - color (blue/black or variegated)
D - diameter greater than 6 mm
E - elevation above skin level
** Refer immediately if suspected!!!
Malignant Melanoma: Diagnostic Tests
- clinical exam
- biopsy
Malignant Melanoma: Prevention
- sunscreen with at least 45 SPF
- wide brimmed hats
- long sleeves when in the sun
- avoid tanning bed use
- avoid sun exposure at peak hours (10-4)
- instruct to do a full body exam once per month and notify HCP of any changes
Malignant Melanoma: Treatment
- complete excision of the melanoma
- refer for sentinel lymph node biopsy, complete excision, and chemotherapy
- F/U every 3-6 months after treatment complete for skin reassessment
Squamous Cell Carcinoma: What is it?
- epithelial tumors arising from the keratinocytes of the epidermis
- may arise from actinic keratosis
Squamous Cell Carcinoma: Risk Factors
- fair skinned organ transplant patients
- smokers
- Same risk factors as other skin cancers
Squamous Cell Carcinoma: Assessment
- indistinct margins
- surface is firm, scaly, irregular
- may bleed easily
- may appear as a nonhealing ulcer or warty nodule
Squamous Cell Carcinoma: Prevention
- nicotinamide 500 mg PO BID can decrease the rate of development by 30% in high risk groups
- sunscreen with at least 45 SPF
- wide brimmed hats
- long sleeves when in the sun
- avoid tanning bed use
- avoid sun exposure at peak hours (10-4)
- instruct to do a full body exam once per month and notify HCP of any changes
Squamous Cell Carcinoma: Diagnostic Tests
- clinical exam
- biopsy
Squamous Cell Carcinoma: Treatment
- Preferred treatment for invasive SCC is excision or Mohs micrographic surgery
- SCC in situ can be treated with imiquimod
OR - 5-fluorouracil
OR - curettage and electrodessication
*** REFER
Squamous Cell Carcinoma: Follow-Ups
Complete skin assessment is needed every 3 months with careful examination of lymph nodes for a year, then twice yearly afterward
Basal Cell Carcinoma: What is it?
- tumors arising from the basal cell layer of the skin and skin appendages
- most common form of skin cancer
- metastasis is rare
- slow growing
- commonly found on the face, head, and neck
Basal Cell Carcinoma: Risk Factors
- more common in men
- common in 40 to 60 year olds
- same risk factors as other skin cancers
Basal Cell Carcinoma: Assessment
- waxy, pearly papule
- erythematous patch greater than 6 mm
- non healing ulcer in sun exposed areas
- history of bleeding
Basal Cell Carcinoma: Prevention
- nicotinamide 500 mg PO BID can decrease the rate of development by 20% in high risk groups
- sunscreen with at least 45 SPF
- wide brimmed hats
- long sleeves when in the sun
- avoid tanning bed use
- avoid sun exposure at peak hours (10-4)
- instruct to do a full body exam once per month and notify HCP of any changes
Basal Cell Carcinoma: Diagnostic tests
- clinical exam
- biopsy
Basal Cell Carcinoma: Treatment
** The histologic classification determines the therapy
1. imiquimod applied topically 5 nights per week for 6-10 weeks and 5-FU applied topically bid for up to 12 weeks for select patients with superficial BCC
2. superficial or nodular type lesions can be treated with curettage and electrodessication, excision, or Mohs micrographic surgery;
3. micronodular or infiltrative should be treated with excision or Mohs micrographic surgery.
