Skin Cancers

Risk factors for melanoma and non-melanoma

  • Melanoma
    • Adults, freckles, fair skin (never/minimal tanning–always getting burned), blondes, red heads, blue, green or gray eyes, being white, higher socioeconomic status
    • Intense sun exposure, history of sunburns, > 4 painful sunburns before 15, tanning
    • Genetic risk factors are strongly linked
      • Ex.  Familial atypical mole syndrome, hereditary dysplastic nevus syndrome
  • Melanoma
    • Curable if localized (early detection is key)
      • Melanoma is often serious & fatal (especially if its metastasized)
    • Surgery is necessary:
      • < 1mm in thickness requires a 1 cm margin
      • 2 mm in thickness requires a 2 cm margin
    • Adjuvant treatment:  chemo isn’t recommended but interferon-alfamay improve the survival of high risk patients (SE:  flu-like symptoms, neuro symptoms), vaccines
    • If the cancer is metastatic, treatment options include clinical trial (preferred), aldesleukin (IL-2), chemo
      • Aldesleukin (IL-2) can cure 2-5% of patients but it’s hard to tolerate (SE: n/v, cytokine-induced capillary leak syndrome)
      • Dacarbazine is the only approved chemo for melanoma
      • Temozolamide has great CNS penetration & efficacy similar to DTIC
      • Ipilimumab (still in clinical trials) is the first drug to ever show overall survival improvement in advanced melanoma
    • Prevention/screening: monthly self-exams of skin, avoid direction sun exposure between 10-4, wear hats to shade the face/ears/neck, avoid tanning beds, cover exposed skin with SPF >15 sunscreen
      • SPF 15 blocks 93% of UVB rays
      • Apply 15-30 min prior to sun exposure
      • Reapply ever 2 hours or after swimming
      • UVA = aging
      • UVB = burning
  • Basal cell skin cancer (non-melanoma)
    • Most common non-melanoma skin cancer  (75% of all skin cancer);rarely metastatic
    • Risk factors:  sun exposure, fair complexion, exposure to arsenic, psoriasis, radiation, etc.
    • Prevention/screening are key & similar to melanoma
    • Warning signs of basal cell carcinoma:  open sore, reddish patch, shiny bump, pink growth, scar-like area credability
    • Treatment (goal is to cure tumor):
      • Surgery (Moh’s surgery)
        • The majority of patients will be cured by removing the lesion (1/3 of patients with basal cell will develop another basal cell within 5 years)
          • Requires lots of follow-up
        • Cryotherapy has been used for small tumors that can’t tolerate surgery
      • Radiation
      • Chemo isn’t used but topical 5-FU or imiquimod may be used
  • Squamous cell skin cancer:  may metastasize occurred

Melanoma is the most serious type of skin cancer & it’s incidence & mortality are increasing each year
Skin melanocytes transform into malignant cells
Early detection = ABCDE

  • A:  asymmetric
  • B:  irregular borders
  • C:  color of lesion (not uniform)
  • D:  diameter (> 6 mm–size of a pencil eraser)
  • E:  evolving

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