Skin Cancer

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diagnosing and treating skin cancers with radiation

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Skin Cancer

  1. 1. Skin Cancer <ul><li>Understanding the disease </li></ul><ul><li>Treatment options </li></ul><ul><li>Results </li></ul>
  2. 2. Standard photograph for grading severe solar damage on the shoulders. Standard photographs for grading freckling of the back: (B) mild (C) moderate (D) extensive People with a lot of sun damage are more prone to skin cancers Journal of Clinical Oncology , Vol 24, No 22 (August 1), 2006: pp. 3590-3596
  3. 3. Basal Cell Carcinoma Basal cell carcinoma (BCC): About 80% of all skin cancers are BCC, a cancer that develops in the basal cells - skin cells located in the lowest layer of the epidermis. BCC can take several forms. It can appear as a shiny translucent or pearly nodule, a sore that continuously heals and then re-opens, a pink slightly elevated growth, reddish irritated patches of skin, or a waxy scar. Most BCCs appear on skin with a history of exposure to the sun, such as the face, ears, scalp, and upper trunk. These tumors tend to grow slowly and can take years to reach ½ inch in size. While these tumors very rarely metastasize
  4. 4. Typical basal cell on the nose
  5. 5. Typical basal cell below lower lip
  6. 6. Typical basal cell on the ear
  7. 7. Ulcer type of basal cell superficial type of basal cell
  8. 8. Classic presentation of basal cell
  9. 9. Classic superficial basal cell
  10. 10. Squamous Cell Carcinoma Squamous cell carcinoma (SCC): About 16% of diagnosed skin cancers are SCC. This cancer begins in the squamous cells, which are found in the upper layer of the epidermis. SCC tends to develop in fair-skinned middle-aged and elderly people who have had long-term sun exposure. It most often appears as a crusted or scaly area of skin with a red inflamed base that resembles a growing tumor, non-healing ulcer, or crusted-over patch of skin. While most commonly found on sun-exposed areas of the body, it can develop anywhere, including the inside of the mouth and the genitalia. SCC requires early treatment to prevent metastasis (spreading).
  11. 11. Typical squamous cell cancer on the ear
  12. 12. Typical squamous cell cancer on the face and scalp
  13. 13. Squamous Cancer of the Lower Lip
  14. 14. Typical squamous cell cancer on the hand
  15. 15. More advanced squamous cell cancer on the finger
  16. 16. Typical squamous cell cancer on the leg
  17. 17. Typical appearance of a well differentiated squamous cancer on the shin called keratoacanthoma
  18. 18. Malignant Melanoma Melanoma: Accounting for about 4% of all diagnosed skin cancers, melanoma begins in the melanocytes, cells within the epidermis that give skin its color. With early detection and proper treatment, the cure rate for melanoma is about 95%. Once its spreads, the prognosis is poor. Melanoma most often develops in a pre-existing mole or looks like a new mole, which is why it is important for people to know what their moles look like and be able to detect changes to existing moles and spot new moles.
  19. 19. Distribution of superficial spreading melanoma of the skin in men and women.
  20. 20. Superficial spreading melanomas in all stages of development. The small early lesions have irregular borders, irregular pigmentation, and small white areas indicating regression. The largest tumors show an accentuation of all of these features. 
  21. 21. Superficial Spreading Melanoma
  22. 22. Nodular Melanoma
  23. 23. Lentigo Maligna Melanoma
  24. 24. Variety of Melanoma Skin Lesions
  25. 25. Twenty images of skin lesions. Images 1-6, 7-13, and 14-20 show atypical, benign, and malignant lesions, respectively.
  26. 31. Literature Review (untreated basal cell) Technique Number of Cases Local Control surgical excision 2,606 90% radiation therapy 4,695 91% curettage and electr. 3,573 92% cryotherapy 269 93% Mohs' microsurgery 7,670 99%
  27. 32. Literature Review (recurrent basal cell) Technique Number of Cases Local Control surgical excision 522 83% radiation therapy 234 87% curettage and electr. 115 60% Mohs' microsurgery 3,009 94%
  28. 33. Control Rate with Radiation, 3 Large Series Control Rates with Radiation Basal Cell 98% 95% 96% Squamous Cell 92% 87% 88% Type Untreated Relapsed Basal Cell 95% 82% Squamous Cell 87% 65%
  29. 34. Control by Tumor Size Skin Damage with Radiation Size Control Rate < 2 cm 99% 2 - 5 cm 92% > 5 cm 60% Size Skin Damage < 1cm 0.9% 1 - 5 cm 6.5%
  30. 35. Radiation for Skin Cancer Electron beam for large areas. Daily (Mon-Fri) for 3 – 6 weeks
  31. 36. With electron beam then skin will get moderately sun-burned by the last day, but usually heals up in 2 to 3 weeks
  32. 38. Radiation for Skin Cancer HDR skin applicators – three times a week for 6 treatments over a two week period
  33. 39. Results with HDR for skin
  34. 40. Results with HDR for skin
  35. 41. Results with HDR Skin applicator for small basal cell cancers on the face
  36. 42. Small squamous cancer of the chin, appearance 3.5 weeks after radiation (HDR)
  37. 43. Results with Radiation
  38. 44. Results with HDR for skin on shin
  39. 45. Results with HDR for skin on shin
  40. 46. Radiation can be used for large areas of small recurrent basal cell cancers Area treated with electrons Appearance of skin two weeks after completion
  41. 47. Even large or neglected skin cancers usually heal well with radiation
  42. 48. Appearance at 2 months
  43. 49. Appearance at 3 months
  44. 50. Radiation for areas difficult to operate, squamous cancer of the finger before and 19 days after electron beam
  45. 51. Squamous Cancer of the Ear Helix The radiation healed the cancer and prevented further destruction of the ear
  46. 52. Side Effects of Skin Radiation The treated skin will get red, itchy and sunburned. There are a number of good creams than can be used including Aloe, Aquaphor, Sween, Biafine. The skin reaction may show up in a delayed manner (worse at 1-2 weeks) and may develop slight, superficial ulceration or crusting, but heals quickly (1-2 weeks) except the shin which heals more slowly
  47. 53. Side Effects of Skin Radiation most people get mild sun burn effect , but some get blistering or crusting (scab formation) but they heal quickly Prior to radiation 1 week after radiation
  48. 54. Side Effects of Skin Radiation Prior to radiation last day of radiation
  49. 55. Typical delayed reaction where the lesion forms a scab at 1 – 2 weeks after completion, the scab usually falls off in another week or two
  50. 56. Radiation side effects may show up in delayed manner after HDR Basal cell Last day Three weeks later Three months later
  51. 58. Delayed Skin Reaction with HDR
  52. 59. Skin reaction is often delayed with HDR and can take several weeks to return completely back to normal
  53. 61. Typical Time pattern for skin healing with HDR
  54. 63. Lesions on shin may heal more slowly
  55. 64. Typical delayed reaction with superficial ulceration but quick healing, the small ‘hole’ at the biopsy site may take 2-3 months to disappear
  56. 65. Skin healing over the shin in an elderly woman
  57. 66. Skin cancers on the shin in an elderly patient may take several months to heal
  58. 67. Radiation prescription for # Diagnosis: # Number of Treatments: #
  59. 68. Radiation prescription for # Diagnosis: # Number of Treatments: #

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