ON14 Skin Cancer

Skin cancer is the most ❌ cancer in New Zealand. New skin cancers total about 82,000 per year, compared
to a total of 16,000 for all other types of cancer. Our skin cancer rates are the ❌ in the world.

Risk factors for skin cancer:
• ❌ skin color, hair color, eye color, freckles
• Genetics
• Certain types of ❌
• Long-term ❌ exposure
• History of childhood ❌

Skin Cancer Basics = an abnormal change in the skin resulting from uncontrolled cellular growth.
• Pre-Cancerous skin cancer » ❌
• There are three main types of skin cancer:
» ❌ Cell Carcinoma (BCC)
» ❌ Cell Carcinoma (SCC)
» ❌

Causes of Skin Cancer?
• ❌ (UV) radiation is the main cause. NZ UV radiation is 40% ❌ during summer compared to northern
hemisphere. The ❌ ozone levels here – the ozone layer absorbs a good deal of UVB ultraviolet light from the Sun.
• Artificially-produced UV radiation
• Chemicals (rare)

Actinic (solar) Keratosis:
•A ❌-cancerous condition of thick, scaly ❌ of sun-damaged skin.
• Benign but can progress to invasive malignant disease if left ❌
• Cryosurgery or topical treatment (more soon)

Basal Cell Carcinoma (BCC):
- Basal Cells form the ❌ layer (basal layer) of the epidermis, and function as the precursors of all the skin cells above them.
- BBC is the ❌ dangerous of the skin cancers, grows ❌, and rarely ❌ beyond original location.
• Easily ❌ and treated
• Seldom life-threatening
- Appearance:
• Open ❌, reddish patches, ❌ bump, pink growth, ❌ like area, lump that bleeds and crusts

Squamous Cell Carcinoma (SCC)
- Squamous Cells arethe most ❌ cells in the skin, located primarily in the ❌
- About SCC: Can spread to other areas (metastasize) and cause death, but this is ❌. Most cases are not dangerous if detected and treated early. Considered “more aggressive” than basal cell carcinoma, although they are both highly ❌. ❌% of skin cancers are SCC.
- Appearance:
• ❌-like growth,
• ❌ red patch(es),
• open sore(s) that persist
• Often appear as ❌ growths with a central
depression

BCC and SCC can usually be removed by:
• ❌ excision
• ❌ tumor (cryosurgery)
• Topical treatments (❌)
• Radiation is used in ❌ cases

Topical Tx:
1. Fluorouracil 5% cream (20g subsidised tube.) MoA: incorporates into ❌ inhibiting ❌ replication. Application likely to cause ❌, etc, which repairs afterwards.
2. Imiquimod cream 5% (sold as 12 satchets). MoA: Immune response modification, ❌. Can cause ❌ and painful erosions on mucus ❌.

Melanoma (MM): A skin cancer that arises in a ❌ producing cell.
- 80-96% is caused by ❌ exposure
- One of the most common types of cancer for ❌ year olds
- ❌ form of skin cancer
– Can be found ❌ on the body
– Melanoma was the ❌ most common cancer that people died from in New Zealand

(Appearance) Melanoma can:
• appear as a ❌ spot
• be an existing spot, freckle or mole that ❌ colour, size or shape
• sometimes be ❌ or bleed
• look different to other spots
• appear ❌ on the body (even on parts that aren’t usually exposed to the sun, such as the soles of your feet or under your toenails)
• be ❌ ('sticky out') and look ❌ in appearance
• appear quickly

Detection:
• ❌-examination
• Apps
• Mole ❌
• Healthcare visits
• ❌ detection is KEY

ABCDEs of Melanoma Screening:
- ❌ (bad)
- ❌ (round = healthy)
- ❌ (uniform colour = healthy)
- ❌ (>❌ = bad)
- ❌ (raised/flat combined = bad)

Prognostic features - melanoma: based on "Breslow" depth.
1. Good prognosis – Breslow ❌.
2. Intermediate prognosis – Breslow ❌. (10 year survival rate 100% - ❌%.)
3. Bad prognosis – Breslow ❌. (10 year survival rate ❌%.)

Sentinel lymph node biopsy for MM: Recommended for MM with Breslow ❌mm.
– Lymphadenectomy for ❌ nodes
• Powerful ❌ feature for disseminated disease... (bad sign...)
• It does not affect ❌ of patients

Treatment of Melanoma:
- Surgical excision (Mohs*)
• In situ = ❌ margin
• Invasive= ❌ cm depending on ❌ depth

- Immunotherapy
e.g. ❌ (Pembrolizumab)

- Radiotherapy
Can specifically ❌ areas

Mohs surgery (a certain method invented by a mr mohs) yields higher ❌ rates than standard excision, and smaller wounds - therefore better ❌ results. Widely accepted as treatment of first choice for ❌ melanoma and ❌ basal cell carcinoma and squamous cell carcinoma.

Prevention
• Avoid Artificial Sun
– ❌/sun lamps

- Limit Sun Exposure:
• Avoid ❌ sun
• Apply ❌ often (at least ❌ SPF)
• Use UVA/UVB blocking ❌