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Skin Cancer

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Property of Prof. Dr. Mohamed Ali Nasr, Department of General Surgery, Faculty of Medicine, University of Zagazig, Egypt

Publicado en: Salud y medicina
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Skin Cancer

  1. 1. Skin CancerSkin Cancer Prof. Dr. Mohamed NasrProf. Dr. Mohamed Nasr
  2. 2. Largest organ of the body (15% of body weight)Largest organ of the body (15% of body weight) Two main layersTwo main layers – epidermisepidermis stratified squamous epitheliumstratified squamous epithelium contains 5 layerscontains 5 layers – dermisdermis connective tissue layerconnective tissue layer Rests on subcutaneous layer or hypodermisRests on subcutaneous layer or hypodermis Normal thickness of 1-2 mm, up to 6 mmNormal thickness of 1-2 mm, up to 6 mm – thicker skin (palms & soles) has stratum lucidum, no hairthicker skin (palms & soles) has stratum lucidum, no hair follicles or sebaceous glandsfollicles or sebaceous glands
  3. 3. Types of CancerTypes of Cancer Melanoma-forms in melanocytes (skinMelanoma-forms in melanocytes (skin cells that make pigment).cells that make pigment). Basal Cell Carcinoma-forms in basal cellsBasal Cell Carcinoma-forms in basal cells (small, round cells in the base of the outer(small, round cells in the base of the outer layer of skin).layer of skin). Squamous cell carcinoma-forms inSquamous cell carcinoma-forms in squamous cells (cells that form thesquamous cells (cells that form the surface of the skin).surface of the skin).
  4. 4. Neuroendocrine carcinoma-forms inNeuroendocrine carcinoma-forms in neuroendocrine cells (cells that releaseneuroendocrine cells (cells that release hormones in response to signals from thehormones in response to signals from the nervous system).nervous system). Melanoma is the most serious type ofMelanoma is the most serious type of cancer of the skin.cancer of the skin. Basal and Squamous cell cancer are theBasal and Squamous cell cancer are the two most common types of skin cancer.two most common types of skin cancer.
  5. 5. Basal cell carcinomaBasal cell carcinoma Affects fair skinned adults(>40y) who haveAffects fair skinned adults(>40y) who have had a lot of sun exposure or repeatedhad a lot of sun exposure or repeated episodes of sunburn(male>female)episodes of sunburn(male>female) No Metastasis but BCCs can causeNo Metastasis but BCCs can cause destructive changes in surroundingdestructive changes in surrounding tissuestissues Locally malignantLocally malignant
  6. 6. Basal cell carcinoma-types:Basal cell carcinoma-types: Nodular BCC-most common typeNodular BCC-most common type Superficial BCC-commonSuperficial BCC-common Ulcerative (rodent ulcer)Ulcerative (rodent ulcer) Pigmented BCC- can resemble melanomaPigmented BCC- can resemble melanoma Turban BCCTurban BCC Basisquamous BCC-mixed BCC/SCCBasisquamous BCC-mixed BCC/SCC
  7. 7. Nodular BBCNodular BBC
  8. 8. Superfacial spreading BBCSuperfacial spreading BBC
  9. 9. Nodular basal cell carcinomaNodular basal cell carcinoma
  10. 10. Pigmanted BCCPigmanted BCC
  11. 11. Turban tumor (Cylinderinoma)Turban tumor (Cylinderinoma)
  12. 12. KeratoacanthomaKeratoacanthoma
  13. 13. Why BCCs need treatmentWhy BCCs need treatment
  14. 14. BCC- treatment:BCC- treatment: Excision with 5mm safety margin.Excision with 5mm safety margin. Mohs micrographic excisionMohs micrographic excision Imiquimod 5% cream-highly effective forImiquimod 5% cream-highly effective for superficial BCCssuperficial BCCs CryotherapyCryotherapy RadiotherapyRadiotherapy
  15. 15. Actinic keratosisActinic keratosis Rough ,scaly spots on sun-damaged skinRough ,scaly spots on sun-damaged skin Represent abnormal skin developmentRepresent abnormal skin development due to exposure to UV radiationdue to exposure to UV radiation Should be considered potentiallyShould be considered potentially precancerous(>10 AKs = 10-15% riskprecancerous(>10 AKs = 10-15% risk SCC)SCC) Common on exposed sites eg backs ofCommon on exposed sites eg backs of hands,face,scalp and ears of bald menhands,face,scalp and ears of bald men
  16. 16. Actinic keratosisActinic keratosis
  17. 17. Bowen’s diseaseBowen’s disease Bowen’s disease is intraepidermalBowen’s disease is intraepidermal squamous cell carcinomasquamous cell carcinoma It is effectively carcinoma-in situIt is effectively carcinoma-in situ It may progress into squamous cellIt may progress into squamous cell carcinoma (approximately 5%)carcinoma (approximately 5%) Because of this, it is very important to treatBecause of this, it is very important to treat it effectivelyit effectively
  18. 18. Bowen’s diseaseBowen’s disease Presents as a pink or red ,irregular scalyPresents as a pink or red ,irregular scaly patchpatch Usually develops in a sun –exposed areaUsually develops in a sun –exposed area of skinof skin Common sites include hands and face inCommon sites include hands and face in both sexes, scalp in men, lower legs inboth sexes, scalp in men, lower legs in womenwomen Diagnosis should be confirmed by biopsyDiagnosis should be confirmed by biopsy
  19. 19. Bowen’s diseaseBowen’s disease
  20. 20. Xeroderma pigmentosaXeroderma pigmentosa
  21. 21. Squamous cell carcinomaSquamous cell carcinoma SCC is a common type of skin cancerSCC is a common type of skin cancer It develops in the epidermis fromIt develops in the epidermis from squamous cells which produce keratinsquamous cells which produce keratin Usual presentation is a slowly –growingUsual presentation is a slowly –growing Can present as a non-healing sore orCan present as a non-healing sore or ulcer “punched out” in appearanceulcer “punched out” in appearance Sometimes growth is rapid over a matterSometimes growth is rapid over a matter of weeksof weeks
  22. 22. Squamous cell carcinomaSquamous cell carcinoma
  23. 23. Squamous cell carcinoma-causes:Squamous cell carcinoma-causes: UV radiation-damages DNA in skinUV radiation-damages DNA in skin SCC may develop in an actinic keratosis or patch ofSCC may develop in an actinic keratosis or patch of Bowen’s diseaseBowen’s disease Genetic predisposition to develop SCCsGenetic predisposition to develop SCCs Smoking-especially SCC lipSmoking-especially SCC lip Thermal burnsThermal burns Chronic leg ulcersChronic leg ulcers Immunosuppression-Azathioprine/Ciclosporin.Immunosuppression-Azathioprine/Ciclosporin. Organ transplantation patients highly susceptibleOrgan transplantation patients highly susceptible Pre-existing skin conditions eg lichen sclerosus andPre-existing skin conditions eg lichen sclerosus and lichen planus can predispose to development of genitallichen planus can predispose to development of genital and oral SCCsand oral SCCs
  24. 24. Marjolin ulcerMarjolin ulcer
  25. 25. Squamous cell carcinoma-Squamous cell carcinoma- treatmenttreatment Excision with 2cm safety margin +_ blockExcision with 2cm safety margin +_ block dissectiondissection Radiotherapy may be neededRadiotherapy may be needed
  26. 26. Malignant melanomaMalignant melanoma Melanocytes are found in the basal layersMelanocytes are found in the basal layers of the epitheliumof the epithelium Non-cancerous growth of melanocytesNon-cancerous growth of melanocytes results in moles or frecklesresults in moles or freckles Cancerous growth of melanocytes resultsCancerous growth of melanocytes results in malignant melanomain malignant melanoma
  27. 27. Malignant melanoma-risk factors:Malignant melanoma-risk factors: Sun exposure, particularly duringSun exposure, particularly during childhoodchildhood Fair skin which burns easilyFair skin which burns easily Blistering sunburn, especially when youngBlistering sunburn, especially when young Previous melanomaPrevious melanoma Family history of melanomaFamily history of melanoma Previous non-melanoma skin cancerPrevious non-melanoma skin cancer Large numbers of moles/ dysplastic molesLarge numbers of moles/ dysplastic moles
  28. 28. Common sites for melanoma:Common sites for melanoma: In men commonest site is the backIn men commonest site is the back In women commonest site is the legIn women commonest site is the leg Can occur on mucous membranes, eg lipsCan occur on mucous membranes, eg lips or genitalsor genitals Can occur under the nailCan occur under the nail Can occur in eye or mouthCan occur in eye or mouth BEWARE AMELANOTIC MELANOMABEWARE AMELANOTIC MELANOMA
  29. 29. The ABCDE of melanomaThe ABCDE of melanoma A AsymmetryA Asymmetry B Border irregularityB Border irregularity C Colour variationC Colour variation D Diameter over 6mmD Diameter over 6mm E Evolving (enlarging or changing)E Evolving (enlarging or changing)
  30. 30. Malignant melanomaMalignant melanoma
  31. 31. When benign melanoma turn malignant, there are: •Rapid growth (in size, thickness). •Melanotic nodules around (satellite nodules). •Induration. •Metastasis in lymph nodes. Development of tingling, itching, ulceration and bleeding
  32. 32. FrecklesFreckles
  33. 33. Lentigo MalignaLentigo Maligna
  34. 34. Lentigo maligna melanomaLentigo maligna melanoma
  35. 35. Growth of melanomasGrowth of melanomas Horizontal growth withinHorizontal growth within epidermis=melanoma in situepidermis=melanoma in situ Vertical growth through basementVertical growth through basement membrane into dermis=invasivemembrane into dermis=invasive melanomamelanoma Once melanoma penetrates dermis,itOnce melanoma penetrates dermis,it spreads via lymphatic and blood streamspreads via lymphatic and blood stream = metastatic melanoma= metastatic melanoma
  36. 36. Malignant melanomaMalignant melanoma
  37. 37. Histological classification:Histological classification: Breslow thickness:Breslow thickness: This is the thickness of the melanoma in mmThis is the thickness of the melanoma in mm Clark’s level:Clark’s level: This describes which layer of skin has beenThis describes which layer of skin has been breachedbreached Clark’s level 1-epidermis-melanoma in situClark’s level 1-epidermis-melanoma in situ Clark’s level 2-dermal invasionClark’s level 2-dermal invasion Clark’s level 5- invasion of subcutaneous fatClark’s level 5- invasion of subcutaneous fat
  38. 38. Treatment of melanomaTreatment of melanoma Surgical excision with safety marginSurgical excision with safety margin Thicker melanomas> wider excision +/-Thicker melanomas> wider excision +/- sentinel node biopsysentinel node biopsy Regional chemotherapyRegional chemotherapy
  39. 39. Prognosis of melanomaPrognosis of melanoma Breslow thickness< 1mm, almost 100%Breslow thickness< 1mm, almost 100% 5 year survival5 year survival Breslow thickness > 4mm, only 50%Breslow thickness > 4mm, only 50% 5 year survival5 year survival Remember, melanoma is a major cause ofRemember, melanoma is a major cause of death from malignancy in young peopledeath from malignancy in young people
  40. 40. Superficial spreading melanomaSuperficial spreading melanoma
  41. 41. NodularNodular Malignant melanomaMalignant melanoma
  42. 42. Lentigo Maligna melanomaLentigo Maligna melanoma
  43. 43. Acral melanomaAcral melanoma
  44. 44. Acral melanomaAcral melanoma
  45. 45. Advanced melanomaAdvanced melanoma
  46. 46. Cutaneous lymphomaCutaneous lymphoma
  47. 47. Metastatic nodules (pancreatic)Metastatic nodules (pancreatic)
  48. 48. Kaposi tumorKaposi tumor
  49. 49. AngiosarcomaAngiosarcoma
  50. 50. Merkel cell tumorMerkel cell tumor

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