Skin Cancer

Skin CancerSkin Cancer

Prof. Dr. Mohamed NasrProf. Dr. Mohamed Nasr

Largest organ of the body (15% of body weight)Largest organ of the body (15% of body weight)Two main layersTwo main layers– epidermisepidermis

stratified squamous epitheliumstratified squamous epitheliumcontains 5 layerscontains 5 layers

– dermisdermisconnective tissue layerconnective tissue layer

Rests on subcutaneous layer or hypodermisRests on subcutaneous layer or hypodermisNormal thickness of 1-2 mm, up to 6 mmNormal thickness of 1-2 mm, up to 6 mm– thicker skin (palms & soles) has stratum lucidum, no hair thicker skin (palms & soles) has stratum lucidum, no hair

follicles or sebaceous glandsfollicles or sebaceous glands

Types of CancerTypes of Cancer

Melanoma-forms in melanocytes (skin Melanoma-forms in melanocytes (skin cells that make pigment). cells that make pigment). Basal Cell Carcinoma-forms in basal cells Basal Cell Carcinoma-forms in basal cells (small, round cells in the base of the outer (small, round cells in the base of the outer layer of skin).layer of skin).Squamous cell carcinoma-forms in Squamous cell carcinoma-forms in squamous cells (cells that form the surface squamous cells (cells that form the surface of the skin).of the skin).

Neuroendocrine carcinoma-forms in Neuroendocrine carcinoma-forms in neuroendocrine cells (cells that release neuroendocrine cells (cells that release hormones in response to signals from the hormones in response to signals from the nervous system).nervous system).Melanoma is the most serious type of Melanoma is the most serious type of cancer of the skin.cancer of the skin.Basal and Squamous cell cancer are the Basal and Squamous cell cancer are the two most common types of skin cancer.two most common types of skin cancer.

Basal cell carcinomaBasal cell carcinoma

Affects fair skinned adults(>40y) who have Affects fair skinned adults(>40y) who have had a lot of sun exposure or repeated had a lot of sun exposure or repeated episodes of sunburn(male>female)episodes of sunburn(male>female) No Metastasis but BCCs can cause No Metastasis but BCCs can cause destructive changes in surrounding tissuesdestructive changes in surrounding tissuesLocally malignantLocally malignant

Basal cell carcinoma-types:Basal cell carcinoma-types:

Nodular BCC-most common typeNodular BCC-most common typeSuperficial BCC-commonSuperficial BCC-commonUlcerative (rodent ulcer)Ulcerative (rodent ulcer)Pigmented BCC- can resemble melanomaPigmented BCC- can resemble melanomaTurban BCCTurban BCCBasisquamous BCC-mixed BCC/SCCBasisquamous BCC-mixed BCC/SCC

Nodular BBCNodular BBC

Superfacial spreading BBCSuperfacial spreading BBC

Nodular basal cell carcinomaNodular basal cell carcinoma

Pigmanted BCCPigmanted BCC

Turban tumor (Cylinderinoma)Turban tumor (Cylinderinoma)

KeratoacanthomaKeratoacanthoma

Why BCCs need treatmentWhy BCCs need treatment

BCC- treatment:BCC- treatment:

Excision with 5mm safety margin. Excision with 5mm safety margin. Mohs micrographic excisionMohs micrographic excisionImiquimod 5% cream-highly effective for Imiquimod 5% cream-highly effective for superficial BCCssuperficial BCCsCryotherapyCryotherapyRadiotherapyRadiotherapy

Actinic keratosisActinic keratosisRough ,scaly spots on sun-damaged skinRough ,scaly spots on sun-damaged skinRepresent abnormal skin development Represent abnormal skin development due to exposure to UV radiationdue to exposure to UV radiationShould be considered potentially Should be considered potentially precancerous(>10 AKs = 10-15% risk precancerous(>10 AKs = 10-15% risk SCC)SCC)Common on exposed sites eg backs of Common on exposed sites eg backs of hands,face,scalp and ears of bald menhands,face,scalp and ears of bald men

Actinic keratosisActinic keratosis

Bowen’s diseaseBowen’s disease

Bowen’s disease is intraepidermal Bowen’s disease is intraepidermal squamous cell carcinomasquamous cell carcinomaIt is effectively carcinoma-in situIt is effectively carcinoma-in situIt may progress into squamous cell It may progress into squamous cell carcinoma (approximately 5%)carcinoma (approximately 5%)Because of this, it is very important to treat Because of this, it is very important to treat it effectivelyit effectively


Presents as a pink or red ,irregular scaly Presents as a pink or red ,irregular scaly patchpatchUsually develops in a sun –exposed area Usually develops in a sun –exposed area of skinof skinCommon sites include hands and face in Common sites include hands and face in both sexes, scalp in men, lower legs in both sexes, scalp in men, lower legs in womenwomenDiagnosis should be confirmed by biopsyDiagnosis should be confirmed by biopsy


Xeroderma pigmentosaXeroderma pigmentosa

Squamous cell carcinomaSquamous cell carcinoma

SCC is a common type of skin cancerSCC is a common type of skin cancerIt develops in the epidermis from It develops in the epidermis from squamous cells which produce keratinsquamous cells which produce keratinUsual presentation is a slowly –growing Usual presentation is a slowly –growing Can present as a non-healing sore or ulcer Can present as a non-healing sore or ulcer “punched out” in appearance“punched out” in appearanceSometimes growth is rapid over a matter Sometimes growth is rapid over a matter of weeksof weeks

Squamous cell carcinomaSquamous cell carcinoma

Squamous cell carcinoma-causes:Squamous cell carcinoma-causes:

UV radiation-damages DNA in skinUV radiation-damages DNA in skinSCC may develop in an actinic keratosis or patch of SCC may develop in an actinic keratosis or patch of Bowen’s diseaseBowen’s diseaseGenetic predisposition to develop SCCsGenetic predisposition to develop SCCsSmoking-especially SCC lipSmoking-especially SCC lipThermal burnsThermal burnsChronic leg ulcersChronic leg ulcersImmunosuppression-Azathioprine/Ciclosporin.Immunosuppression-Azathioprine/Ciclosporin.

Organ transplantation patients highly susceptibleOrgan transplantation patients highly susceptiblePre-existing skin conditions eg lichen sclerosus and Pre-existing skin conditions eg lichen sclerosus and lichen planus can predispose to development of genital lichen planus can predispose to development of genital and oral SCCsand oral SCCs

Marjolin ulcerMarjolin ulcer

Squamous cell carcinoma-Squamous cell carcinoma-treatmenttreatment

Excision with 2cm safety margin +_ block Excision with 2cm safety margin +_ block dissectiondissection

Radiotherapy may be neededRadiotherapy may be needed

Malignant melanomaMalignant melanoma

Melanocytes are found in the basal layers Melanocytes are found in the basal layers of the epitheliumof the epitheliumNon-cancerous growth of melanocytes Non-cancerous growth of melanocytes results in moles or frecklesresults in moles or frecklesCancerous growth of melanocytes results Cancerous growth of melanocytes results in malignant melanomain malignant melanoma

Malignant melanoma-risk factors:Malignant melanoma-risk factors:

Sun exposure, particularly during Sun exposure, particularly during childhoodchildhoodFair skin which burns easilyFair skin which burns easilyBlistering sunburn, especially when youngBlistering sunburn, especially when youngPrevious melanomaPrevious melanomaFamily history of melanomaFamily history of melanomaPrevious non-melanoma skin cancerPrevious non-melanoma skin cancerLarge numbers of moles/ dysplastic molesLarge numbers of moles/ dysplastic moles

Common sites for melanoma:Common sites for melanoma:

In men commonest site is the backIn men commonest site is the backIn women commonest site is the legIn women commonest site is the legCan occur on mucous membranes, eg lips Can occur on mucous membranes, eg lips or genitalsor genitalsCan occur under the nailCan occur under the nailCan occur in eye or mouthCan occur in eye or mouth

BEWARE AMELANOTIC MELANOMABEWARE AMELANOTIC MELANOMA

The ABCDE of melanomaThe ABCDE of melanoma

A AsymmetryA AsymmetryB Border irregularityB Border irregularityC Colour variationC Colour variationD Diameter over 6mmD Diameter over 6mmE Evolving (enlarging or changing)E Evolving (enlarging or changing)


When benign melanoma turn malignant, there are:Rapid growth (in size, thickness). Melanotic nodules around (satellite nodules).Induration. Metastasis in lymph nodes.Development of tingling, itching, ulceration and bleeding

FrecklesFreckles

Lentigo MalignaLentigo Maligna

Lentigo maligna melanomaLentigo maligna melanoma

Growth of melanomasGrowth of melanomas

Horizontal growth within Horizontal growth within epidermis=melanoma in situepidermis=melanoma in situVertical growth through basement Vertical growth through basement membrane into dermis=invasive membrane into dermis=invasive melanomamelanomaOnce melanoma penetrates dermis,it Once melanoma penetrates dermis,it spreads via lymphatic and blood streamspreads via lymphatic and blood stream

= metastatic melanoma= metastatic melanoma


Histological classification:Histological classification: Breslow thickness:Breslow thickness:

This is the thickness of the melanoma in mmThis is the thickness of the melanoma in mm

Clark’s level:Clark’s level:This describes which layer of skin has been This describes which layer of skin has been breachedbreachedClark’s level 1-epidermis-melanoma in situClark’s level 1-epidermis-melanoma in situClark’s level 2-dermal invasionClark’s level 2-dermal invasionClark’s level 5- invasion of subcutaneous fatClark’s level 5- invasion of subcutaneous fat

Treatment of melanomaTreatment of melanomaSurgical excision with safety marginSurgical excision with safety marginThicker melanomas> wider excision +/- Thicker melanomas> wider excision +/- sentinel node biopsysentinel node biopsyRegional chemotherapyRegional chemotherapy

Prognosis of melanomaPrognosis of melanoma

Breslow thickness< 1mm, almost 100% Breslow thickness< 1mm, almost 100% 5 year survival5 year survivalBreslow thickness > 4mm, only 50%Breslow thickness > 4mm, only 50%

5 year survival5 year survival

Remember, melanoma is a major cause of Remember, melanoma is a major cause of death from malignancy in young peopledeath from malignancy in young people

Superficial spreading melanomaSuperficial spreading melanoma

Nodular Nodular Malignant melanomaMalignant melanoma

Lentigo Maligna melanomaLentigo Maligna melanoma

Acral melanomaAcral melanoma

Acral melanomaAcral melanoma

Advanced melanomaAdvanced melanoma

Cutaneous lymphomaCutaneous lymphoma

Metastatic nodules (pancreatic)Metastatic nodules (pancreatic)

Kaposi tumorKaposi tumor

AngiosarcomaAngiosarcoma

Merkel cell tumorMerkel cell tumor

Health & Medicine

Skin Cancer