Skin Cancer 2010

SKIN CANCER

WISNUBROTO, dr, SpB(K)OnkSurgical Oncology Consultant

Introduction

900,000 – 1,200,000 new cases per year in US

Non Melanoma skin cancer : High curability Rare metastasis Rare caused of death

Malignant Melanoma : More caused metastasis More caused of death

SKIN CANCER

Skin cancer

Non Melanoma

Malignant Melanoma

Non Melanoma

SQUAMUS CELL CARSINOMABASAL CELL CARSINOMA

INTRA EPITHELIAL Ca (BOWEN’S DISS)KERATOACANTHOMA

MARKEL CELL CaMYCOSIS FUNGOIDESKAPOSI’S SARKOMA

CUTANEUS METASTASIS

NON MELANOMA SKIN CANCER

ETIOLOGI

SUN DAMAGEGENETIC

CHEMICAL EXPOSUREIMMUNOSUPPRESSION

CHRONIC IRRITAION / INFLAMMATION

SUN DAMAGE Chronic exposure UV light ( 290-320

nm) < ozone Caused DNA damages in epidermis. Changed immune response in tumor. Cumulative exposure in advancing age

RISK FACTORS OF SKIN CANCER

GENETICMany syndrome caused skin cancer : Xeroderma pigmentosum defect DNA repair Basal cell nevus syndrome BCC Albinism melanin exposure UV Epidermodysplasia verruciformis SCC

PRE CANCER xeroderma pigmentosum, keratosis senilis, compound nevus, multiple dysplatic nevi

CHEMICAL Arsenicum SCC Coal Tar Scrotal skin cancer Smoker SCC lips and oral cavity

IMMUNOSUPPRESSION Patient with immunosuppressive drug post

organ transplantation AIDS Papiloma virus and Oncovirus

CHRONIC IRRITAION Burn Marjolin Ulcer SCC Chronic ulcer : fistula chronic osteomyelitis Syphilis Lupus Granulomas

CAUCASOID RAS

SQUAMOUS CELL CARCINOMA

Synonym : Epidermoid Carcinoma Plano cellular carcinoma

Squamous cell carcinoma is skin cancer arise from keratocid cell dermis.

DIAGNOSIS

High incidence in 50 – 70 year old Dark skin in tropic area Male > Female Normal skin or precancerous lesion

White skin : Ultraviolet exposure Chemical carcinogen: Coal tar, arsenic,

hydrocarbon polycyclic. Other skin : predisposition

Trauma Chronic ulcer Scar

Predilection : sun expose skin, mucous membrane

Locations : White skin :

Face Upper extrimity

Other skin : Lower extrimity. Lower lips dorsum manus.

Tumor : Skin lesion especially skin with

sun exposure or trauma plaque, nodus, papel, solid

tumor or ulcer, fast growing/ progressive: exophytic, endophytic, infiltrative.

de novo or arise from pre cancerous lesion.

Regional node : Lymphadenopathy regionalsingle or multiple, mobile or fixed.

Metastasis : Lung,Liver

Radiology: Chest X-Ray, Bone X-Ray in part of lesion, CT-Scan, MRI

Patologi:a) biopsy: < 2cm excisional biopsy

> 2 cm incisional biopsyb) specimen examination : in primary tumor:

Tumor size Histolopathological fiture, Differential cell grade, Depth infiltration of the tumor, Radicality of excision.

THERAPY

Stage I / II or III (T4 N0 M0) : Wide excision with 1 cm free margin Reconstruction ( if needed).

Stage III (any T N1 M0) : Wide excision and Lymph node dissection.

Stage IV : Palliative therapy.

BASALIOMA

Synonym : Basal cell carcinoma, Ulcus rodent

Basalioma is skin cancer arise from basal cell of the skin.

DIAGNOSIS

> 40 year old Male > Female Predisposition factors:

White skin (type I & II) and albinism with cumulative sun rays exposure

X ray exposure to face acne therapy Basal nevus syndrome (autosomal dominant) Chronic arsenic intoxication Chronic LE Chronic ulcer and fistula.

Lesión : soliter, múltiple (uncommon) Common Location on the face.

Danger area is : lateral or medial Canthus and naso labial fold

chic, nose, neck, Uncommon site : arm, hand, leg, foot

and scalp.

Skin Lesion : Type : papule, nodule, translucent like a

pearl, ulcer (rodent ulcer). Color : pink or red, telangiectasi. Pigmented type: brown, dark blue or black. Uncommon regional metastasis or distant

metastasis

CLINICAL VARIANS

1. Nodule ulcerative2. Pigmented3. Morphea like or fibrosing4. Superficial 5. Fibro epithelial6. Nevoid cell basal carcinoma

syndrome (Gorlin Galzt syndrome)7. Linier and generalized follicular

basal cell nevi

THERAPY

Wide Excision with 0,5 – 1 cm safety margin

Radiation therapy : No radical Non operable Recurrent

MALIGNANT MELANOMA

Arise from melanocyte cell of the skin 1-3 % all malignancy 25 – 40 % grow from nevus pigmentosus

( junctional nevus ), “ Hutchinson’s melanotic freckle “, giant pigmented nevus, “ blue nevus “

Incidence , 35 – 55 year old Male = female Very malignant Rapid metastasis via hematogenic or

lymphogenic

Diagnosis

Anamnesis : Nevus growing fast Itching and ulcer

Tumor : Dark color Plaque or ulcer

Asimetry Border ( undifine) Color (many color) Diameter : more than 6 mm Evolution

Biopsy : < 2 cm excisional biopsy > 2 cm incisional biopsy, with deeper

than base of tumor

Clark classification

Clark I : melanoma cell on basal membrane of epidermis (insitu)

Clark II : melanoma cell invade to papillary

dermis Clark III : melanoma cell invade to

border betwin papilaris and retikularis dermis.

Clark IV : melanoma cell invade to retikularis dermis

Clark V : melanoma cell invade to subcutan

Breslow Classification Breslow I : tumor < 0,76 mm in

deep Breslow II : tumor 0,76 mm – 1,5

mm in deep Breslow III : tumor > 1,5 mm in

deep

Malignant Melanoma types :1. Lentigo malignant melanoma

(LMM)2. Superficial spreading melanoma

(SSM)3. Nodular Malignant Melanoma

(NMM)4. Acral Lentigenous Melanoma (ALM)

THERAPY

Wide excision Wide excision + Lymph node

dissection Head and neck : neck lymph node

dissection Upper extrimity : axillary lymph node

dissection Lower extrimity : inguinal lymph node

dissection

Other type skin cancer

Adeno carcinoma of the skin : Arise from adnexa of the skin

Merkel Cancer Arise from neuroendocrine cell of the skin

Dermato fibro sarcoma pro tuberans Pre cancer lesion :

Actinic Keratosis Kerato Acantoma Bowen’s Disease Erythroplasia of Queyrat Xeroderma Pigmentosum

Thank you