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Treatment of Common Skin Cancers Jon Paul Nielsen MD/MPH Candidate 2010 New York Medical College
[object Object],[object Object],[object Object],[object Object],[object Object],Types of Skin Lesions
[object Object],[object Object],[object Object],[object Object],Benign Skin Lesions Observe, no treatment necessary
Seborrheic Keratoses
Acanthosis Nigricans
Fibroepithelial Polyp, aka squamous papilloma, skin tag
Adnexal (appendage) tumors eg cylindroma
[object Object],[object Object],[object Object],[object Object],Precancerous Lesions Dysplastic Nevi = Melanoma precursor
Actinic Keratosis
[object Object]
Bowen’s Disease
[object Object]
Malignant Skin Cancer Prevalence
[object Object],[object Object],[object Object],Malignant Skin Cancer Mortality Rates
Skin Cancer Incidence and Mortality Source: Cancer Statistics 2000, American Cancer Society Nonmelanoma: (basal and squamous cell) Melanoma: 1,300,000 New Cases Deaths 47,700 7,700 Deaths New Cases Deaths 1,900
[object Object],[object Object],[object Object],Basal Cell Carcinoma Clinical Course
[object Object],[object Object],[object Object],[object Object],[object Object],Clinical Appearance of Basal Cell Carcinoma
[object Object]
[object Object],[object Object],[object Object],Clinical Course of Squamous Cell Carcinoma
[object Object],[object Object],[object Object],[object Object],Clinical Appearance of Squamous Cell Carcinoma
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Management of Nonmelanoma Skin Cancer
[object Object]
Medical Management ,[object Object],[object Object],[object Object]
Curettage and electrodessication ,[object Object],[object Object]
Mohs Microsurgery ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Risk of Developing Second Nonmelanoma Skin Cancer
Melanoma Projected 2000 1996 1992 1985 1980 1960 1935 Adapted from: Rigel, et al. J. Am. Derm. 34: 839-47, 1996. Lifetime Risk of Malignant Melanoma Rate / 100,000 1:1500 1:600 1:250 1:150 1:105 1:87 1:75
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Risk Factors for Malignant Melanoma
[object Object],[object Object],[object Object],[object Object],[object Object],Previous Skin Cancers as a Risk Factor for Melanoma
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Precursor Lesions as a Risk Factor for Melanoma
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Establishing Prognosis in Melanoma
Clark Levels 1 2 3 4 5
Melanoma Staging
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Malignant Melanoma: Relative Survival According to Stage
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Malignant Melanoma: Relative Survival According to Stage Swetter, Susan M., MD. “Malignant Melanoma.”  eMedicine Journal  2.5 (2001).  12 Jun. 2001  <http://www. emedicine .com/ derm /topic257. htm > .
[object Object],[object Object],Clinical Course of Melanoma
[object Object],[object Object],[object Object],Treatment for Malignant Melanoma
[object Object],[object Object],[object Object],Biopsy for Malignant Melanoma
[object Object],[object Object],[object Object],[object Object],Sentinel Node Biopsy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Surgical Excision for Malignant Melanoma
Medical adjuvant therapy for melanoma ,[object Object],[object Object],[object Object]
[object Object],What is it? – Basal cell carcinoma. How is it diagnosed?  - Full thickness biopsy at the edge of the lesion (punch or knife). Treatment: Surgical excision with clear margins, but conservative width.
A blond, blue eyed, 69 year old sailor has a non-healing, indolent 1.5 cm. ulcer n the lower lip, that has been present, and slowly enlarging for the past 8 months.  He is a pipe smoker, and he has no other lesions or physical findings. What is it?  - Squamous cell carcinoma. How is the diagnosis made?  - Biopsy, as described before. Treatment: he will need surgical resection with wider  (about 1 cm.) clear margins .  Local radiation therapy is another option.
A red headed 23 year old lady who worships the sun, and who happens to be full of freckles, consults you for a skin lesion on her shoulder that concerns her.  She has a pigmented lesion that is asymetrical, with irregular borders, of different colors within the lesion, and measuring 1.8 cms. What is it? – The classical ABCD that alerts you to melanoma or a forerunner (dysplastic nevus). Management: full thickness biopsy at the edge of the lesion, .5 cm local excision if superficial melanoma (Clarks’ levels one or two, or under 0.75 mm), wide local excision with 2 or 3 cm. margin if deep melanoma.
 

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Skin Cancer

  • 1. Treatment of Common Skin Cancers Jon Paul Nielsen MD/MPH Candidate 2010 New York Medical College
  • 2.
  • 3.
  • 6. Fibroepithelial Polyp, aka squamous papilloma, skin tag
  • 8.
  • 10.
  • 12.
  • 13. Malignant Skin Cancer Prevalence
  • 14.
  • 15. Skin Cancer Incidence and Mortality Source: Cancer Statistics 2000, American Cancer Society Nonmelanoma: (basal and squamous cell) Melanoma: 1,300,000 New Cases Deaths 47,700 7,700 Deaths New Cases Deaths 1,900
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28. Melanoma Projected 2000 1996 1992 1985 1980 1960 1935 Adapted from: Rigel, et al. J. Am. Derm. 34: 839-47, 1996. Lifetime Risk of Malignant Melanoma Rate / 100,000 1:1500 1:600 1:250 1:150 1:105 1:87 1:75
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35. Clark Levels 1 2 3 4 5
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46. A blond, blue eyed, 69 year old sailor has a non-healing, indolent 1.5 cm. ulcer n the lower lip, that has been present, and slowly enlarging for the past 8 months. He is a pipe smoker, and he has no other lesions or physical findings. What is it? - Squamous cell carcinoma. How is the diagnosis made? - Biopsy, as described before. Treatment: he will need surgical resection with wider (about 1 cm.) clear margins . Local radiation therapy is another option.
  • 47. A red headed 23 year old lady who worships the sun, and who happens to be full of freckles, consults you for a skin lesion on her shoulder that concerns her. She has a pigmented lesion that is asymetrical, with irregular borders, of different colors within the lesion, and measuring 1.8 cms. What is it? – The classical ABCD that alerts you to melanoma or a forerunner (dysplastic nevus). Management: full thickness biopsy at the edge of the lesion, .5 cm local excision if superficial melanoma (Clarks’ levels one or two, or under 0.75 mm), wide local excision with 2 or 3 cm. margin if deep melanoma.
  • 48.