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  1. 1. Skin Cancer Diagnosis and ManagementDr Rob PaverMedical DirectorSkin and Cancer Foundation Westmead
  2. 2. Skin Cancer StatisticsSkin Cancer accounts for more than 80% of newlydiagnosed cancer in Australia2 out of 3 Australians will be diagnosed with skincancer in their lifetime (DHA 2010)GP’s in Australia have about 1 million patientconsultations per year for skin cancer relatedconcernsAustralia’s incidence of skin cancer is the highest inthe world and nearly 4 times the rate of Canada, USAand UK (Australian Institute of Health and Welfare Cancer in Australia 2001)
  3. 3. Non Melanoma Skin CancerMore than 430,000 patients are treated each yearfor non melanoma skin cancer296000 BCC 138000 SCC (2008)More than 400 die of NMSC per year(2008)Skin cancer is our most expensive cancerNMSC cost the government $264,000,000 in 2001Melanoma cost $30,000,000 in 2001 (more now) (Australian Institute of Health and Welfare Cancer in Australia2001)
  4. 4. Non Melanoma Skin CancerActinic KeratosesBasal Cell CarcinomaSquamous Cell CarcinomaBenign Differential DiagnosesTreatment Options
  5. 5. Actinic KeratosesMacular – telangiectaticPapular – keratoticHypertrophic – hyperkeratoticCutaneous HornSingle, few or multiple
  6. 6. Actinic KeratosesMultiple Macular Single Papular Cutaneous Horn Hypertrophic
  7. 7. Actinic Keratoses Keratotic Actinic CheilitisDiffuse Macular Diffuse Inflammatory
  8. 8. Differential diagnoses of ActinicKeratoses – Seborrhoeic Warts Verrucal Standard Superficial Skin Tags
  9. 9. Differential diagnoses of ActinicKeratoses – Seborrhoeic Warts Verrucal Lichenoid Macular Multiple
  10. 10. Differential diagnoses of Actinic KeratosesBowens Disease Superficial BCC’sActinic Porokeratoses Lupus Erythematosus
  11. 11. Differential diagnoses of Actinic Keratoses Stucco Keratoses Seborrhoeic Dermatitis
  12. 12. Treatment Options for Actinic KeratosesCryotherapySolarazeEfudixAldaraPDTChemical PeelLaser resurfacingCurettage and cauteryExcision
  13. 13. Cryotherapy
  14. 14. Solaraze (3%Diclofenac gel)Apply bd for 2 to 3 monthsCease for a week if too inflamedAdverse effects - local irritation - like NSAID: bleeding etcEfficacy - less effective than Efudix butmay have less noticeable inflammation
  15. 15. Efudix bd for 3 weeks
  16. 16. Aldara for Solar KeratosesDose: 3x per week for up to 16 weeks with1 week holidays from Rx for severeinflammationAlways titrate the duration of treatmentagainst the severity of responseAdverse effects: local inflammation,hypopigmentation, headache and flu likeillnessEfficacy: longer lasting response thanefudix/solaraze, but higher cost andvariable response
  17. 17. Aldara
  18. 18. PDTGood field treatmentPainfulMore expensiveNeed specialequipment
  19. 19. Resurfacing / Chemical Peel
  20. 20. Basal Cell CarcinomaSuperficial MultifocalNodularNoduloulcerativeMicronodularPigmentedMorphoeicInfiltrativeRecurrent
  21. 21. Superficial - Basal Cell Carcinoma
  22. 22. Nodular – Basal Cell Carcinoma
  23. 23. Ulcerative - Basal Cell Carcinoma
  24. 24. Pigmented and Micronodular BCC
  25. 25. Morphoeic - Basal Cell Carcinoma
  26. 26. Infiltrating - Basal Cell Carcinoma
  27. 27. Recurrent - Basal Cell Carcinoma
  28. 28. Recurrent - Basal Cell Carcinoma
  29. 29. Differential Diagnoses of BCC Dermal Nevus Bowens Granuloma Annulare Syringomas
  30. 30. Differential Diagnoses of BCC Nevus Sebaceous Dermatofibroma Dermatofibroma Amyloidosis Sebaceous Hyperplasia
  31. 31. Differential Diagnoses of BCC Achrocordon SCC Amelanotic MelanomaMinimally Pigmented Nevus
  32. 32. BCC Treatment OptionsCryotherapyCurettage and CauteryAldaraPDTExcisionRadiation TherapyMohs Surgery
  33. 33. Cryotherapy
  34. 34. Curettage and Cautery
  35. 35. Aldara (Imiquimod)Primary Superficial BCCs5x per week for 6 weeksTreatment Holidays if too inflammatory80% cure rate
  36. 36. Aldara – Before, During, After
  37. 37. This is presentation is continued in the next file…