Dr. Sunil Chopra The London Dermatology Centre

Skin Cancer SCC and BCC

Dr. Sunil Chopra

The London Dermatology Centre

Topics Covered

!  Solar Keratoses (aka Actinic Keratoses)

!  Squamous Cell Carcinoma

!  Basal Cell Carcinoma

"  Rough scaly spots on sun-damaged skin

"  Syn: Actinic keratoses.

Solar Keratoses

!  Dysplasia of epidermal cells.

!  Precancerous.

!  Multiple flat or thickened, scaly or warty, skin

colored or reddened.

!  May develop into a cutaneous horn.

!  Exposure to sun

!  Dorsa of hands, face - nose, cheeks, upper lip,

temples and forehead.

!  Lips - actinic cheilitis.

What are Solar Keratoses?

"  Fair-skinned

"  Worked outdoors

"  Sun-damaged skin is also dry, discolored

and wrinkled.

Patient Characteristics

Actinic Keratoses

Actinic Keratoses

Actinic Keratoses

Actinic Keratoses

Actinic Chielitis

Actinic Keratoses

Bowen’s Disease

!  Uncomfortable and unsightly.

!  Squamous Cell Carcinoma.

!  More than ten solar keratoses - 10 to 15%.

Are Solar Keratoses Dangerous?

!  Blistering and shedding of the sun damaged

skin.

!  Face - peel off after about 10 days

!  Hands - 3 weeks

!  Legs - 12 weeks to heal.

Cryotherapy

!  Thicker keratoses

!  Pathological examination.

!  Heals over a few weeks, leaving a small

scar.

Curettage & Cautery

!  Multiple keratoses on the face.

!  Twice daily for two to four weeks.

!  Treated areas become red, raw and uncomfortable.

5 – Fluorouracil Cream

Efudix

!  Ensures lesion has been completely

removed, confirmed by pathological

examination.

!  Permanent scar.

Excision

!  Immune response modifier

!  Three times weekly for four to sixteen

weeks.

!  Inflammatory reaction - maximal at three

weeks.

Imiquimod

!  Photosensitizer (porphyrin)

!  Visible light.

Photodynamic Therapy

"  Well tolerated

"  2x Day 2/12

Diclofenac Gel

!  Extract of a common plant, petty spurge or

milk weed (Euphorbia peplus).

!  Specifically grown in Queensland

Ingenol Mebutate Gel (Picato)

!  Refrigerated.

!  Face and scalp- 0.015% OD 3/7

!  Trunk and extremities- 0.05% OD 2/7

Ingenol Mebutate Gel (Picato)

!  Dry for 15 minutes

!  Do not touch for 6 hours

!  Avoid excessive sweating

!  Treated areas become inflamed, often

crusted, and then heal over a few days.

!  Moisturise after skin peels off.

Ingenol Mebutate Gel (Picato)

Pre Treatment

Day Five

Day Thirteen

"  Solar keratoses may be prevented by

protecting skin from ultraviolet radiation.

"  Polypodium Leucotomos ?

Prevention of Keratoses

"  Prevention is better than cure!

"  Treat early with topical treatment

"  Refer those that need cryotherapy or any

further invasive Rx

"  Beware AKs on lips and ears

Conclusions

!  Ultraviolet radiation

!  Inherited predisposition to skin cancer.

!  Smoking – especially SCC of the lip.

!  Thermal burn scars.

!  Longstanding leg ulcers.

!  Immunosuppression

!  Infection with human papillomavirus (HPV)

SCC Causes

SCC Cheek

SCC Ear

SCC Lip

!  2 week rule

!  Excision

!  Radiotherapy

Treatment

!  Rodent ulcer and basalioma.

!  keratinocytic

!  Most common type of cancer in humans

!  Rarely a threat to life.

Basal Cell Carcinoma

!  Most common type on the face

!  Pearly

!  Telengiectasia

!  Rolled edges

Nodular BCC

BCC

!  Younger patients

!  Multiple

!  Upper trunk and shoulders

!  Pink or red scaly irregular plaques

!  Slowly grow

Superficial BCC

!  Sclerosing BCC

!  Mid-facial sites

!  Skin-coloured, waxy, scar-like

!  Prone to recur after treatment

!  May infiltrate cutaneous nerves (perineural

spread)

Morphoeic BCC

!  Brown, blue or greyish lesion

!  Nodular or superficial

!  May resemble melanoma

Pigmented BCC

!  Avoid sunburn in childhood

!  Sun protection lifelong

!  Nicotinamide (vitamin B3) 500 mg twice

daily

!  Polypodium Leucotomos ?

Prevention

!  Type

!  Size

!  Location

!  Number

!  Expertise of the doctor

Treatment of BCC

!  Confirm BCC

!  Subtype of BCC

Biopsy

!  Nodular

!  Infiltrative

!  Morphoeic BCCs.

Excision Biopsy

!  Shave

!  Curettage, & cautery

!  Small

!  Well-defined

!  Nodular

!  Superficial BCCs

!  No stitches.

Superficial Skin Surgery

!  High-risk areas

!  Poorly defined BCCs

!  Morphoeic BCCs

!  Recurrent BCCs

Mohs

!  70 to 80% of small superficial BCCs

!  Good cosmetic result

!  Avoid high risk sites

Photodynamic Therapy

!  Three to five times each week

!  Six to sixteen weeks

!  70 to 80% of small superficial BCCs

!  Long term follow up

Imiquimod Cream

!  Superficial small

!  12 weeks

!  Twice daily

!  Cure rates lower than with imiquimod cream.

Fluorouracil Cream

!  Small (<1cm)

!  Superficial BCCs

!  Scarring

!  Low risk sites

Cryotherapy

!  Face in the elderly

!  Multiple fractions

!  Once-weekly treatments for several

weeks.

Radiotherapy

!  Advanced or metastatic basal cell

carcinoma

!  $ 75, 000 ! (USA)

Vismodegib

!  NMSCs are uncommonly life threatening

!  Prevention is better than cure

!  Early diagnosis means less invasive

treatments

!  Don’t forget 2 week rule- if in doubt

REFER!

Conclusions