Skin Cancers Flashcards
What is the 2 year recurrence rate of SCC in a patient with h/o of SCC
40%
What is the prevalence of SCC
1 in 3 people (33%)
What is the prevalence of BCC?
1 in 4 people gets BCC (sun and genetics)
What is the prevalence of Melanoma in AZ?
1 in 50 people in AZ
Cause: sun and genetics
When scheduling pt for cancer excision surgery, what questions must ask that pt?
Do you have any artificial joints, valves?
If a patient has an artificial heart valve, what is done before surgery
Take Keflex or Clindamycin (1 hour before?) Doxy ok but prefer those 2
In which cancer are negative margins not definitive?
Superficial BCC - it can reoccur because cancer cells skip around like pebbles (or loaf of bread with figs)
What is the risk of developing melanoma in a patient with h/o of any skin cancer?
4x risk of developing MM
How to treat SCCis (Bowens) to BASE in LE
MOHS
If not to base on LE, ok to excise
Not to use in breastfeeding
Rogaine
Gabapentin
Topical class 1 steroids
Dermasmooth ok
IL kenalog OK
Normal to lose hair after pregs x 6 months because of Telogen Effluvium
LPP associated pain tx
Can use gabapentin (not if breast feeding)
LPP can regrow if caught early, scars after hair falls out several times (IL kenalog is more effective)
Can use dermasmooth in breast feeding
NP with h/o MM
What color was it?
Any FH of MM?
ANy FH of any other cancers (kidney, pancreas, breast cancer is the highest RF for MM)
For genetic saliva test need 3 - either 3 MM on self or 3 among family members
Superficial BCC - how to tx
Always EDC but excise if large? (even if positive margins, even if to base)
How to tx Nodular BCC with negative margins
Always EDC
Nodular BCC with positive margins tx
Excision preferred if pos margins
Can EDC if pos margins and to base!!!
Ok to EDC back leg arm
NEVER EDC ON FACE - face goes to MOHS (+ or - margins))
Small Nodular BCC to base tx
Can excise or EDC
Ulcerated nodular BCC
EXCISE
Nodular BCC tx areas to avoid
Post auricular to base - ok to excise, not MOHS
AVOID: neck and Supra auricular (can cause numbness)
SCM muscle - CNXI Spinal Accessory nerve
Which BCC never to EDC
Micro Nodular (>7 mm): excise or MOHS Invasive (always MOHS if LIza) but can excise if arm or leg
SCCis (BOWENS) to base
Excise or Mohs
To base on face or Finger - Mohs
>2 cm - Mohs
SCC T1 is how many risk factors and how Tx
0 risk factors
Tx: if WELL differentiated - EXCISE with 4 mm margins
If moderately differentiated = MOHS
All other SCC T2 T3 T4 - must MOHS
When to refer for urgent MOHS
SCC that’s MODERATELY differentiated AND (or OR?) in low immunity pt (CLL, HIV, transplant, on biological?)
Top 3 Mets to head
MM
Breast cancer
Renal cancer
Percent of risk for SCC to metastasize
4%
Tell pts with melanoma to do what once per year
Have eyes checked
What can be used instead of FUDEX for AKs
Solarace x 3 months (more gentle but less effective)
Aldabra (imiquimod) QD 2 wks on, 1 wk off, 2 wks on
But can cause flu sx
Blue light not effective - gets red x1 week bs 2 weeks on FUDEX
