Skin Ca

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  • Prominent nests/islands of basaloid cells attached to the undersurface of the epidermis and in the dermis. Basaloid cells uniform, frequent mitotic activity, abundant apoptosis. Characteristic retraction artifact.
  • 92% p53 mutation
  • Upper granular to bottom of tumor
  • Skin Ca

    1. 1. Basal Cell Ca, Squamous Cell Ca, and Melanoma Jeanette Prante, MS3
    2. 2. Normal Skin Histology
    3. 3. Basal Cell CA • Older individuals • Sun-exposed areas – Irregular exposure to sun • Small, well-circumscribed pearly tan-gray papule with telangiectasia – Enlarges – Ulcerates (rat tooth)
    4. 4. Nevoid BCC Syndrome/BC Nevus Syndrome/Gorlin Syndrome • AD (PTCH) • Multiple BCCs • <20 years • Other tumors – Ovarian fibromas – Medulloblastomas • Cleft lip/palate, rib/vertebral abnormalities • Pits soles, palms
    5. 5. Diagnosis BCC • Shave bx • Excisional bx – Small lesion – Multiple skin cancers
    6. 6. Melton J. Dec 1996. Loyola University Dermatology Education Website. <http://www.meddean.luc.edu/lumen/MedEd/medicine/dermatology/melton/content1.htm> Assessed Mar 2007.
    7. 7. Treatment BCC • Surgical – Primary excision – Moh’s surgery • Destructive – Electrodessication/curretage – Cryosurgery – Laser phototherapy • Medical – Radiotherapy
    8. 8. Metastasis • RARE! • When happens, lesion advanced
    9. 9. Squamous Cell Carcinoma • Malignancy of epidermal keratinocytes • Men>60 • Sun-exposed areas • Solitary, slowly enhancing indurated nodule – Central ulceration
    10. 10. Ray T. 2005 Sept. <http://tray.dermatology.uiowa.edu/Home.html> Assessed Mar 2007
    11. 11. SCC Risk Factors • Solar irradiation (UVA/B) – Number of lifetime burns • X-ray therapy • Carcinogens (tars, oils) • Hereditary diseases – Xeroderma pigmentosa – Albinism • Actinic keratoses, HPV, burn scars
    12. 12. Diagnosis SCC • Shave bx • Excisional bx – Small lesion – Multiple skin cancers
    13. 13. UCSF School of Medicine Dermatology Glossary. <http://missinglink.ucsf.edu/lm/DermatologyGlossary/squamous_cell_carcinoma.html> Assessed March 2007.
    14. 14. Treatment SCC • Surgical – Primary excision – Moh’s surgery • Destructive – Electrodessication/curretage – Cryosurgery – Laser phototherapy • Medical – Radiotherapy
    15. 15. Metastasis • More likely on ears, scalp, nostrils, extremities • Overall 1-2% • More likely with larger (2 cm), deeper lesions (4 mm)
    16. 16. Malignant Melanoma • Asymmetric, irregularly-pigmented lesions with ill-defined borders • >4 mm (>10mm) • M>F • Age>50
    17. 17. Ray T. 2005 Sept. <http://tray.dermatology.uiowa.edu/Home.html> Assessed Mar 2007
    18. 18. Risk Factors • UV light – Sun lamps before age 25 • Light-colored skin • Freckling • Moles – >50 – h/o dysplastic – Congenital • Family history
    19. 19. Growth Patterns • Superficial spreading- MC • Nodular- aggressive, vertical growth • Lentigo Maligna- slow growth, rarely metastasize • Acral Lentiginous- More common in non- Caucasians, soles/palms, subungal
    20. 20. Conti I. Sept 2001. Histology. <http://www.xiphophorus.org/pathology.htm> Assessed
    21. 21. Melanoma Staging/Dx • Tumor thickness (Breslow) • Ulceration • Number of metastatic LNs • DX with incisional/excisional bxs • Sentinal node bx
    22. 22. Treatment • Narrow excisional bx • Wide local excision • Excision deep fascia inc. risk of mets • Adjuvant- risk for distant mets – Immunotherapy – Chemotherapy
    23. 23. Recurrence/Mets • Most likely local recurrence • Late recurrence >10 yrs, 25% • Mets- MC skin, subcutaneous tissue, LNs • ? Primary
    24. 24. The BIG Picture • Those at risk for all 3 – UV radiation- prevention key • Basal Cell- Rarely metastasizes, nests of cells, MC skin cancer • Squamous Cell- Can metastasize, Keratin pearls • Melanoma- Late mets, “great mimicker”, no shave biopsy

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