4b

1. Skin Cancer Diagnosis and
Management Continued

2. Photodynamic Therapy (PDT)
For superficial BCCs
Cream on for 3 hours
Illuminate 7 to 9
minutes
Repeat after 1 to 3
weeks
80% cure rate

3. PDT

4. Excisional Surgery

5. Mohs Surgery

6. Mohs Surgery

7. Squamous Cell Carcinoma
In Situ SCC (Bowens)
Hyperkeratotic SCC
Keratoacanthoma
Ulcerative SCC
Nodular (tumorous) SCC
Recurrent SCC

8. Squamous Cell Carcinoma
Metastatic rate (Rowe et al JAAD 1992)
Literature review >12000 cases
2.3% if reviewed up to 5 years
(mostly in first 2 yrs)
5.2% if reviewed longer than 5 years
(Range 0.1%to 9.9%)

9. Metastatic Cutaneous SCC
80%of metastases go to loco regional nodes
Treatment protocols debated
5yr survival 73% Sx and Xray vs 54%Sx
alone
(Veness et al Laryngoscope 2005)

10. Squamous Cell Carcinoma
Bowens (In Situ SCC) Well Differentiated Keratotic SCC
Ulcerated SCC
Ulcerated SCC

11. Squamous Cell Carcinoma
Ulcerated SCC Tumorous SCC
Tumorous SCC Tumorous SCC

12. Keratoacanthoma

13. Treatment Options
Efudix/Aldara (In Situ SCC)
Intralesional MTX, Bleo (KA)
Excision
Radiation Therapy

14. Pigmented Lesions and Melanoma
Benign Naevi
Lesions with potential to develop melanoma
- dysplastic naevi
- congenital naevi
-lentigo maligna(HMF)
Melanoma - in situ melanoma
- superficial spreading melanoma
- nodular melanoma
- lentigo maligna melanoma
- acral lentiginous melanoma

15. Benign Naevi
Junctional and Compound
naevi Dermal Naevus
Halo Naevus Blue Naevus

16. Potential for Melanoma
Dysplastic Naevi
HMF
Congenital Naevus

17. Congenital Naevi
Melanoma Risk
Risk for giant (>20cm) naevi is 5% – 7%
by age 60
Small (< 1.5cm) minimal risk
Intermediate (1.5cm to 20cm) (debated)
when it does it is usually after puberty

18. Melanoma
Incidence 10684 new cases (2005)
Deaths 1272 (2005)
(Australian Government DHA 2010)

19. Melanoma Clinical Variants
In situ
Superficial spreading
Nodular
Lentigo maligna melanoma
Amelanotic
Acral lentiginous
Subungal

20. Melanoma
In situ melanoma Superficial Spreading
Lentigo maligna melanoma
Nodular

21. Melanoma
Acral lentiginous melanoma Amelanotic HMF
Subungal Melanoma
Amelanotic SSM

22. Differential Diagnosis
Dysplastic naevus Ulcerated scc
Seborrhoeic Lentigo maligna
kerartosis
Dermatofibroma
Thrombosed
haemangioma
Pigmented bcc
Superficial bcc

23. Melanoma DD
Dysplastic Naevi In situ melanoma

24. Melanoma DD
Superficial BCC Amelanotic Melanoma

25. Melanoma DD
Seborrhoeic Keratoses

26. Melanoma DD
Dermatofibroma Seborrhoeic keratosis

27. Melanoma DD
Apocrine hydrocystoma Blue naevus

28. Melanoma DD
Pigmented BCC
Pigmented solar keratosis

29. Melanoma DD
Sole of the foot eccrine spiradenoma Ulcerated NMSC

30. Melanoma Treatment
In situ at least 5mm margin
<1mm at least 1 cm margin
>1mm 2cm margin plus sentinal lymph
node biopsy option

31. Melanoma Prognosis
In situ 98 – 100%
< 1mm 95%
1 to 4mm reducing with increased depth
>4mm 50%
Organ involvement <10% 5 yr survival

32. Melanoma follow up
Examine surgical site
Examine lymph nodes
Full skin exam for other melanomas
3 months, 3 months, 6 months, 6 months
then every year

33. Miscellaneous Skin Tumours
Pyogenic granuloma
Kaposi’s Sarcoma

34. Miscellaneous Tumours
Paget’s Disease
Extramammary
Pagets disease

35. Miscellaneous Tumours
Merkel Cell Tumour
Dermatofibrosarcoma
protruberans (DFSP)

36. Miscellaneous Tumours
Metastatic Tumour
Cutaneous lymphoma