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Skin Cancers (Basal Cell (Treatment (Mohs micrographic surgery, Excision,…
Skin Cancers
Basal Cell
Most common malignancy in US (~2 million annually)
Appearance
Pearly purple
Telangiectasias
Bleeds easily
Risk factors
Light skin
UV exposure
Radiation
Prior skin cancer
Syndromes
Gorlin
Xeroderma Pigmentosum
Treatment
Mohs micrographic surgery
Excision
Curettage and electrodessication
Topical chemo
Vismodegib
Squamous Cell
In-situ and invasive forms
Description
Painful
Erythematous keratotic plaques/nodules
+/- ulceration
Head/neck/arms/hands of men
Chronic ulcers
HPV link
Risk factors
Fair skin
Radiation
UV exposure
Genetics
Arsenic exposure
(farmers) - check soles
HPV infection
Immunosuppression/transplant pts
(30-100x)
Metasteses
SCC higher risk of mets and death than BCC
Bigger, deeper tumors
Location above neck
Immunosuppression
Treatment
See BCC
- same treatments, lower cure rates.
Melanoma
6th most common cancer -
incidence rising faster than any other cancer
ABCDEs
A
symmetry
B
order irregularity
C
olor variation
D
iameter (>pencil eraser)
E
volution
Types
Lentigo maligna melanoma
(ear)
Melanoma in situ
Nodular melanoma
Superficial spreading melanoma
Amelanotic melanoma
looks like BCC
Acral melanoma
Poor prognostic factors
Breslow depth:
deeper = BAD
Mitotic index: mitoses = bad
Ulceration: ulcerated = bad
Lymphatic invasion = bad
Regression = bad
Lack of inflammatory response = bad
Age > 60 = bad
Head/trunk = bad
Treatment: Mets
Block multiple pathways b/c rapid mutation/resistance w/ single therapy
MEK inhibitors
BRAF inhibitors
Immunotherapy
Interferon
Kaposi's Sarcoma
Risk Factors
HHV8
AIDS-defining illness
Transplant pts
(400-500x risk)
Description
Flat violaceous patches (at first)
Raised and nodular (later)
Mucosal lesions common
Treatment
Cryosurgery
Topical chemo
Excision
Intralesional chemo