Grand rounds 8 4-2011

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Grand rounds 8 4-2011

  1. 1. Early Diagnosis of Skin Tumors<br />Daniel B. Allen, MD<br />Associate Professor of Surgery<br />UCSF East Bay<br />Grand Rounds – August 4, 2011<br />
  2. 2. ABC’s OF MELANOMA<br />Asymmetry<br />Border Irregularity<br />Color Variegation<br />Diameter often > 6mm<br />
  3. 3. CHARACTERISTICS OF PIGMENTED LESIONS<br />BenignMalignant<br />Size Smaller Larger<br />Color Uniform Variegated<br />Border Regular Irregular<br />Surface Regular Irregular<br />
  4. 4.
  5. 5.
  6. 6.
  7. 7. Nodular Basal Cell Carcinoma<br />
  8. 8. Morpheaform Basal Cell Carcinoma<br />
  9. 9.
  10. 10. Pigmented Basal Cell Carcinoma<br />
  11. 11. BASAL CELL CARCINOMA<br />Incidence in United States 146/100,000<br />Incidence in Australia 788/100,000<br />85% of basal cell carcinomas occur in the head and neck region<br />
  12. 12. PRS, Oct. 2010pp. 1222-1231<br />MarginRecurrenceClear Margins <br /> 5 mm 0.39% 85%<br /> 4 mm 1.62% 85%<br /> 3 mm 2.56% 85%<br /> 2 mm 3.96% 82%<br />
  13. 13. Approach to the patient with skin lesions<br /> I don’t know what it is.<br /> Would you like this to be removed?<br /> Your lesion may not be completely excised; in that event additional treatment could be needed.<br />
  14. 14. All reported cases of positive margins treated by observation since 1965Recurrence rate 27%<br />
  15. 15. Management of the Positive MarginNonmelanoma Skin Lesion<br />The best prediction of recurrence:<br /> location<br /> histology<br />Most patients will not recur, but observation is not right for everyone<br />Talk to the patient and document the plan<br />
  16. 16. Dermatofibroma<br />Benign<br />Most common on lower extremities<br />Rarely > 2cm<br />
  17. 17.
  18. 18. Bowen’s Disease<br />
  19. 19.
  20. 20.
  21. 21.
  22. 22.
  23. 23.
  24. 24. Keratoacanthoma<br />
  25. 25. Keratoacanthoma of the hand. Note resemblance to a SCC<br />
  26. 26.
  27. 27.
  28. 28.
  29. 29. Marjolin’s Ulcer<br />
  30. 30.
  31. 31. Lentigo Maligna Melanoma<br />- melanoma in situ<br />TX: Surgical Excision with 5mm margins<br />
  32. 32.
  33. 33.
  34. 34.
  35. 35. Lentigo Maligna Melanoma<br />
  36. 36. Acral Lentiginous<br />
  37. 37. Subungual Melanoma<br />
  38. 38. Invasive Melanoma<br />
  39. 39. Melanoma<br />
  40. 40. Melanoma<br />
  41. 41. Superficial Spreading Melanoma<br />
  42. 42. Nodular Melanoma<br />
  43. 43.
  44. 44.
  45. 45. Dermatofibrosarcoma protuberans<br /><ul><li>Hard, protuberant mass
  46. 46. Arises from the dermis
  47. 47. Trunk or thighs most common
  48. 48. Extremely locally aggressive</li></li></ul><li>
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  66. 66.
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  69. 69.
  70. 70.
  71. 71.
  72. 72.
  73. 73. 8/19/2009<br />
  74. 74. 8/19/2009<br />
  75. 75.
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  85. 85.
  86. 86.
  87. 87.
  88. 88.
  89. 89. 5/21/2009<br />
  90. 90. 5/21/2009<br />
  91. 91. 5/27/2009<br />
  92. 92. 5/27/2009<br />
  93. 93. 5/27/2009<br />
  94. 94. 5/27/2009<br />
  95. 95. 7/1/2009<br />
  96. 96. 7/1/2009<br />
  97. 97. 7/1/2009<br />
  98. 98. 10/7/2009<br />
  99. 99. 10/7/2009<br />
  100. 100. 10/7/2009<br />
  101. 101. 10/7/2009<br />
  102. 102. 3/3/2010<br />
  103. 103. 4/30/2010<br />
  104. 104. 4/30/2010<br />

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