4part2

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4part2

  1. 1. Skin Cancer Diagnosis and Management Continued
  2. 2. Photodynamic Therapy (PDT)For superficial BCCsCream on for 3 hoursIlluminate 7 to 9minutesRepeat after 1 to 3weeks80% cure rate
  3. 3. PDT
  4. 4. Excisional Surgery
  5. 5. Mohs Surgery
  6. 6. Mohs Surgery
  7. 7. Squamous Cell CarcinomaIn Situ SCC (Bowens)Hyperkeratotic SCCKeratoacanthomaUlcerative SCCNodular (tumorous) SCCRecurrent SCC
  8. 8. Squamous Cell CarcinomaMetastatic 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. 9. Metastatic Cutaneous SCC80%of metastases go to loco regional nodesTreatment protocols debated5yr survival 73% Sx and Xray vs 54%Sxalone (Veness et al Laryngoscope 2005)
  10. 10. Squamous Cell CarcinomaBowens (In Situ SCC) Well Differentiated Keratotic SCC Ulcerated SCC Ulcerated SCC
  11. 11. Squamous Cell CarcinomaUlcerated SCC Tumorous SCCTumorous SCC Tumorous SCC
  12. 12. Keratoacanthoma
  13. 13. Treatment OptionsEfudix/Aldara (In Situ SCC)Intralesional MTX, Bleo (KA)ExcisionRadiation Therapy
  14. 14. Pigmented Lesions and MelanomaBenign NaeviLesions 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. 15. Benign NaeviJunctional and Compound naevi Dermal Naevus Halo Naevus Blue Naevus
  16. 16. Potential for Melanoma Dysplastic Naevi HMFCongenital Naevus
  17. 17. Congenital Naevi Melanoma RiskRisk for giant (>20cm) naevi is 5% – 7%by age 60Small (< 1.5cm) minimal riskIntermediate (1.5cm to 20cm) (debated)when it does it is usually after puberty
  18. 18. MelanomaIncidence 10684 new cases (2005)Deaths 1272 (2005) (Australian Government DHA 2010)
  19. 19. Melanoma Clinical VariantsIn situSuperficial spreadingNodularLentigo maligna melanomaAmelanoticAcral lentiginousSubungal
  20. 20. MelanomaIn situ melanoma Superficial Spreading Lentigo maligna melanoma Nodular
  21. 21. MelanomaAcral lentiginous melanoma Amelanotic HMF Subungal Melanoma Amelanotic SSM
  22. 22. Differential DiagnosisDysplastic naevus Ulcerated sccSeborrhoeic Lentigo malignakerartosisDermatofibromaThrombosedhaemangiomaPigmented bccSuperficial bcc
  23. 23. Melanoma DDDysplastic Naevi In situ melanoma
  24. 24. Melanoma DDSuperficial BCC Amelanotic Melanoma
  25. 25. Melanoma DDSeborrhoeic Keratoses
  26. 26. Melanoma DDDermatofibroma Seborrhoeic keratosis
  27. 27. Melanoma DDApocrine hydrocystoma Blue naevus
  28. 28. Melanoma DDPigmented BCC Pigmented solar keratosis
  29. 29. Melanoma DDSole of the foot eccrine spiradenoma Ulcerated NMSC
  30. 30. Melanoma TreatmentIn situ at least 5mm margin<1mm at least 1 cm margin>1mm 2cm margin plus sentinal lymphnode biopsy option
  31. 31. Melanoma PrognosisIn situ 98 – 100%< 1mm 95%1 to 4mm reducing with increased depth>4mm 50%Organ involvement <10% 5 yr survival
  32. 32. Melanoma follow upExamine surgical siteExamine lymph nodesFull skin exam for other melanomas3 months, 3 months, 6 months, 6 months then every year
  33. 33. Miscellaneous Skin TumoursPyogenic granulomaKaposi’s Sarcoma
  34. 34. Miscellaneous TumoursPaget’s DiseaseExtramammaryPagets disease
  35. 35. Miscellaneous TumoursMerkel Cell TumourDermatofibrosarcomaprotruberans (DFSP)
  36. 36. Miscellaneous TumoursMetastatic TumourCutaneous lymphoma

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