SKIN CANCER


3 types of skin Ca

  1. Basal cell carcinoma (aka "epithelioma"): most common, least aggressive--nearly 100% survival rate if tx'd
  2. Squamous cell carcinoma: intermediate in incidence and aggression; often develops on old skin ulcerations; may be a sequela of Actinic Keratoses
  3. Malignant melanoma: least common, most aggressive; "Clark's" staging, I-V; mets to bone, lung, liver, brain. In men us. on back, in women on legs. Dark-skinned people rarely get melanoma, but when they do, it's on less pigmented areas like ventral hands/feet, and very aggressive. Staging system ("Breslow Classification") depends on depth of skin penetration by Ca. "Nonmalignant/Juvenile Melanoma"--in kids/teens, who almost never get malignant melanoma. Warning signs for jnal nevus transforming to melanoma: getting darker, larger, bleeding, itching

Etiology: sun exposure, arsenic (basal cell), therapeutic radiation, persistent fistulae, chronic ulcers, e.g. from venous stasis, chronic osteomyelitis

Treatment: 

Basal--surgery, radiation, imiquimod, topical NSAIDs, topical 5-fluorouracil; In a systematic review of 18 clinical trials on treatment of BCC, radiotherapy c/w surgery was ass'd with sig. higher recurrence rate and sig. greater long-term cosmetic defects over 4y (BMJ 329:705, 2004--JW)

Squamous--surgery

Melanoma--Local excision with/without LN resection