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Skin cancers (Basal cell carcinoma (BCC) (Diagnosis (History PC/HPC:…

- - - - Topical chemotherapy
        Indication: superficial or small nodular BCC (low-high risk)
        E.g. imiquimod
        MOA: absorbed into superficial skin layer,
        acts to suppress proliferation of cancer cells
      - Radiotherapy
        Indication: frail/elderly, palliative
        MOA: irradiation of cancerous cells and cancer cell death
        SEs: adverse cosmetic outcome, increased cancer risk in young people in later life
    - - Excision
        Indication: larger and/or high risk tumours
        MOA: deep surgical plane plus margin (4mm);
        may need larger margin for morphoeic tumours
      - Curettage and cautery
        Indication: small and superficial tumours (high/low risk), palliative
        MOA: cut out the nodule and cauterise base to kill remaining cells and stop blood flow to the nodule
      - Cryotherapy
        Indication: small and superficial tumours (low/high risk)
        MOA: freeze the nodule with liquid nitrogen, freeze-thaw cycles to kill the cancerous cells; may need multiple appointments
        NB. avoid in lower legs (poor healing)
      - Micrographic surgery
        Indication: high risk with likely extension e.g. morphoeic
        MOA: surgical margins examined during procedure to ensure tumour is clear, if not more sections can be taken
- - - - Micrographic surgery
        Indication: technically difficult sites/indistinct margins
        MOA: surgical margins examined during procedure to ensure tumour is clear, if not more sections can be taken
      - Excision
        Indication: 1L high or low risk SCC
        MOA: remove tumour plus 4mm margin (if <2cm) or 6mm margin for tumours >2cm
      - Curettage and cautery
        Indication: small (<1cm) low risk SCC;palliative high risk SCC
        MOA: removal of tumour bulk then cauterise base to kill blood supply and residual tumour cells
        SEs: recurrence
    - - Radiotherapy
        Indication: difficult areas (lips/eyes/nose/ear); surgery unsuitable
        MOA: fractionated RT, kills rapidly proliferating cells
        SEs: cartilage necrosis (use fractionated doses over few weeks)
      - Cryotherapy
        Indication: small (<1cm), superficial, low risk SCC
        MOA: freeze SCC with liquid nitrogen to kill cancer cells
- - - - Excision
        Indication: 1L for non-metastatic MM
        MOA: removal of MM plus wide margin, flap repair
- - - - Moisturisers
        Indication: early disease
      - Steroids
        Indication: early disease
        MOA: anti-inflammatory, reduce abherrant T-cell proliferation
      - Phototherapy
        Indication: early disease
        MOA: cancerous T-cells sensitive to light, light exposure causes apoptosis/necrosis of cancerous cells
      - Radiotherapy
        Indciation: extensive/advanced disease
        MOA: radiotherapy kills rapidly dividing cells
      - Chemotherapy
        Indication: extensive/advanced disease
        MOA: chemo targets and kills rapidly proliferating cells