common mmalignant skin tumours, m elanoma, biopsy m ethods, surgical

Common MMalignant Skin

Tumours, M elanoma, Biopsy M ethods, Surgical Therapy

Claire Temple MD MSc FRCSC

Associate Professor, UW O

Division of Plastic Surgery

Hand and Upper Limb Centre

Skin Examination

Physical Examination

Overall skin type Lesion description

Fitzpatrick classification

I W hite II W hite III W hite IV Pale brown V Brown VI Dark brown/black

Always burns, never tans Always burns, little tan Slight burn, slow tan Slight burn, fast tan Rarely burns, dark tan Never burns, dark tan

Lesion description

Size in mm - two dimensions Color Surface characteristics –

scale(excess keratin) crust(dried serum) excoriated/erosion/ulcer

Lesion description

NOUN Macule/patch flat lesion<>1cmPapule/plaque raised lesion <>1cmNodule/tumour deep dermal lump <>1cmVesicle/bulla elevated fluid filled lesion<>1cm

If pigmented lesion, also describe:

A asymmetry B borders C color D diameter E elevation

Biopsy Techniques

Biopsy Techniques

Incisional Shave Punch

Incisional

ellipse

Excisional

Punch biopsy

Punch biopsy

Punch biopsy

Punch Biopsy

Incisional biopsy

Excisional Biopsy

Basal Cell Carcinoma

Etiology - MM ultifactorial

UVR (Sun, tanning beds) Ionizing radiation

Age >40 Fitzpatrick I, II phenotype Immunosuppression Old, unstable scars Genetic conditions Insecticides, hydrocarbons, arsenic

Basal Cell Carcinoma

Malignant tumour arising from basal cell layer of epidermis 90% of all skin cancers

40% of North Americans will develop a BCC 85% facial, 30% nose

Basal Cell Carcinoma

Nodular Form Telangiectatic papule

translucent

pearly rolled

border

Slow growing Rarely metastasizes

Variants

Nodular - 60%

Superficial

Pigmented Morpheaform or sclerosing

Nodular BCC

Rodent Ulcer

Sclerosing BCC

Somme Exammples to Practice

Pigmented Basal Cell Carcinoma

Superficial Basal Cell Carcinoma

Treatment

Prevention

Electrodessication/Curettage Surgical Excision with 4 mm margins

Mohs

Respect Basal Cell Carcinoma

Squamous Cell Carcinoma

Squamous Cell Cancer

Actinic Keratoses

SCC

Malignant lesion arising in epidermis Age >40 15% lifetime risk in Caucasians Risk of metastases 0.5-6% Thickened, ulcerated, erythematous lesion Examine nodal basins

SCC

Main treatment is surgical

6mm or wider margin

Radiation

May recur along nerves

May metastasize