Skin Cancer

skin cancer only occurs in the

epidermis

skin stores

water, fat, vitamin d

what does skin protec† against

light, injury, infection

does skin regulate body temperature

yes

squamous cells contin

keratinocytes and langerhans cells

order of epidermis layers

squamous, basal, melanocyte, merkel

basal cell job

acts as a stem cell, new cells push old to the top

merkel cells are connected to

nerve endings

dermis contains

nerves, blood vessels, sweat, collagen

hypodermis relation to skin

not a part of

hypodermis contains collagen and fat cells to

connect skin to muscles and bones

hypodermis conserves body heat and acts as a

shock absorber

most common cancer of all malignancies

skin

epidemiology affected by

location, skin type, gender

etiology cia u

chronic irriation, immunosuppression, age, uvb light exposure

non melanoma skin cancer etiology

arsenic, radiation

melanoma etiology

moles, family history

uva penetrates (linked with melanoma)

deepest into the skin, not natural

uvb causes most (along with aging and immune system damage)

sunburns and skin cancers

uv c is

entirely absorbed by ozone

beside LENS, where is skin cancer most common

HN and extremity

what is the only type of diagnosis needed for skin cancer

histologic

excisional biopsy

diagnostic and therapeutic, for small

incisional biopsy

diagnostic only, for large

most common skin cancer

basal cell

basal cell spread and growth

slow growing, rarely met, invades surrounding

main cause basal cell

uv exposure

most common type of basal cell

nodular ulcerative type

nodular ulcerative type lesions are

smooth translucent or pink with central depression

morphea sclerosing bcc

flat, fibrotic, white yellow, firm with enlargment

bcc often confused with malignant melanoma

pigmented

does bcc or scc grow faster

scc

2nd most common skin cancer

scc

scc typically shows

irregular exophytic lesions with a warty keratotic scale

signs of scc

clustered, ulcerated, bleed with minor trauma

conical mounds of keratin formed in SCC are

cutaneous horns

major cause scc

uv exposure

other factors scc

chronic irritation, burns, occupation

immunosuppression affecting SCC

drug induced, leukemia/lymphoma, HIV

condition increasing risk of melanoma

xeroderma pigmentosum

risk of nodal involvement if well differentiated

1%

risk of nodal involvement if associated with burn/trauma

10-30%

bowen’s disease

scc in situ

bowens disease presentation

superficial, velvety, red-brown nodules

treatment modality should give greatest likelihood of cure with

acceptable cosmesis

surgery is common for lesions smaller than

3cm

advantage of surgery

short treatment time, pathologic assessment

curettage with electrodesicction

scraping technique, leave scar, no margin assess

moh’s surgery

IMRT of surgery

wide excision

removal of tumor with healthy surrounding skin

wide excision, if a large volume may require a

skin graft

RT preferred if

multiple lesions and lymph node mets

chemotherapy

cream applied to skin daily

photodynamic therapy

topical medication exposed to special light emitting device

cryotherapy uses

liquid nitrogen

laser therapy

narrow beam of high intensity light applied to outer layer of the skin

what can be used to control rt depth

superficial/orthovoltage, electrons

what protects critical structures such as the eye

lead/cerrobend cutouts

larger lesions rt require a

higher dose

dose to lesion is varied based on

location

small lesions (<2cm) dose

4500-5000 cGy

dose per fraction rt

300

2-3cm lesions rt dose

5000-6000

large (8-12cm) infiltrating lesions dose

6500-7500

70% of melanomas occur from a

change in a preexisting nevi

15% of melanomas have

lymph node spread at diagnosis

melanoma response to rt

radioresistant

superficial spreading melanoma

most common, trunk and extremities, may be unrelated to sun

2nd most common melanoma type

nodular, most aggressive

lentigo maligna melanoma

best prognosis, older adults excessive sun exposure

acral lentiginous melanoma (palms, soles, under nails)

most common form in dark skinned population

most powerful predictor of survival melanoma

number of positive nodes

worse anatomic site melanoma

trunk

first choice melanoma treatment

surgery with sentinel lymph node biopsy and wide local excision

20% of lymph node involvement in melanoma if

greater than 2mm thick

positive lymph nodes scan

MRI brain, PET

immunotherapy for melanoma metastatic disease

interferon, ipilimumab, HD IL-2

RT for melanoma treatment for (radioresistant)

lentigo maligna melanoma on the face