General Skin Care
Limit bath time Avoid strong soaps Shave carefully Pat dry Moisturize dry skin Eat a healthy diet
Hydrating the Skin
Emollient immediately after bathing or showering
Best Emollients
Eucerin Vanicream Cetaphil Nutraderm Aquaphor Vaseline
Smoking & the Skin
Thickened “leathery” skin
Prominent wrinkles
Damages collagen & elastin
Smoking narrows tiny blood vessels
Prevention of Skin Cancer
Sunscreen > SPF 30
Wear protective clothing
Schedule activities before 10 AM or after 4 PM
Avoid all tanning activity
Extra caution near water, snow, & sand
Educate on Sunscreen Use
Reapply every 2 hours
Reapply after swimming or sweating
Apply 15-20 minutes before sun exposure
Screening & Early Detection of Skin Cancer
Inspect moles for changes
Remove suspicious moles
Remove AK & other precancerous lesions
When should someone perform monthly self-exams for screening for sun cancer?
Personal history of skin cancer
1st degree family history of skin cancer
Precursor lesions
Sun damaged skin
Types of Skin Cancers
Melanoma
BCC
SCC
Kaposi’s Sarcoma
Epidemiology of Melanoma
Great majority of skin cancer deaths
Men = Women
Major Risk Factors of Melanoma
Fair skin
Episodic intense sun exposure (severe blistering sunburn history)
1st degree family history
Precursor lesions
ABCs of Melanoma
A: asymmetric B: border irregularity C: color D: diameter E: enlargement or evolutions
7 Point Checklist
Major: change in size, color, shape
Minor: inflammation, bleeding or crusting, sensory change, lesion diameter >6 mm
Define Nevus
Congenital discoloration of a circumscribed area of the skin due to pigmentation
Define Dysplastic Nevus
Nevus which has some malignant characteristics
Define Breslow Thickness
Refers to tumor thickness
Define Clark Level
Refers to anatomical descriptor of depth of the malignant cells
Subtypes of Melanoma
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Superficial Spreading Melanoma
Great prognosis
Men: torso
Women: legs
30-50 years old
Nodular Melanoma
Invasive from onset
Poor prognosis
Any site
Diagnosed in 6th decade of life
Lentigo Maligna Melanoma
Tendency for H&N
More common >60 years old
Least aggressive of melanomas
Acral Lentiginous Melanoma
Occurs on palms, soles, sublingual areas, & mucous membranes
More common in darker skin types
Diagnosed at advanced stage
Poor prognosis
Clinical Presentation of Acral Lentiginous Melanoma
Longitudinal pigmented streak
Appearance: irregular in shape, develops quickly, widen & darker
Pigmented globules
Refer for biopsy
Benign Longitudinal Melanonychia
Pigmented bands Trauma Medications Infections Other issues
Medications That can Cause Benign Longitudinal Melanonychia
Minocycline
Chemo
Anti-malarials
Infections that can Cause Benign Longitudinal Melanonychia
Fungal
Other Issues that can Cause Benign Longitudinal Melanonychia
Addison’s
B12 deficiency
Hemochromatosis
Malignant Longitudinal Melanonychia
Solitary
Most frequent: thumb/great toe
Define Halo Nevus
Pigmented nevus surrounded by de-pigmented zone
What is the concerning for the presence of melanoma?
Sudden onset of multiple halo nevi
Non-cutaneous Melanoma
Ocular melanoma
Mucosal melanoma
Most Common Location of Ocular Melanoma
Choroid
Ciliary body
Most Common Location of Mucosal Melanoma
H&N Vulva & vagina Anal Urethra Esophagus
Epidemiology of BCC
One of most common malignancies
Incidence increases with age & rising
Common in caucasians
Uncommon in dark-skinned populations
Where does BCC arise from?
Basal layer of epidermis
DNA damage of keratinocytes
Appearance of BCC
Translucent/pearly white papule
Telangiectasias
Development of central ulceration
Presentation of BCC
70% on the face
Majority “nodular”
Also “superficial” & “morpheaform”
Treatment of BCC
Surgical excision Radiation therapy Electrodessication & curettage Cryotherapy (superficial BCC) Topical 5-FU (Efudex): superficial BCC Imiquimod (Aldara): superficial BCC
Prognosis of BCC
Most frequent skin cancer
Mets rare
Good prognosis
Where does SCC arise from?
Malignant proliferation of the keratinocytes of the epidermis
Define Bowen’s DIsease
SCC in situ
Level following AK
Presentation of Invasive SCC
Flesh-colored nodule that enlarges & often undergoes ulceration & crusting
Treatment of Actinic Keratoses
Liquid nitrogen cryotherapy Topical: 5-FU, imiquimod (Aldara), TCA Curettage for hypertrophic lesions Chemical peels Laser Photodynamic therapy
Treatment of Non-hypertrophic AK’s
Liquid nitrogen cryotherapy
Treatment of Hypertrophic AK’s
Surgical curettage
Treatment of Multiple AK’s
Topical 5-FU (Efudex)
Imiquimod (Aldara)
Treatment of Bowen’s Disease
Surgical excision of the lesion
Cryotherapy
5-FU (Efudex) for 6 weeks under occlusion
Treatment of Advanced Squamous Cell Carcinoma
Surgical excision or radiation
Define Keratoacanthoma
Cutaneous tumor that presents as a dome-shaped nodule with a central keratin-filled crater
Kaposi’s Sarcoma (KS) Associated with What Infections
Herpesvirus 8 (HHV-8) KS-associated herpesvirus (KSHV)
4 Forms of Kaposi’s Sarcoma
Classic
Endemic or African
Organ-transplant associated
AIDS related
Who is most susceptible for classic Kaposi’s sarcoma?
Older men of Mediterranean & Jewish origin
Who is most susceptible for endemic or African Kaposi’s sarcoma?
People of equatorial Africa, particularly sub-Saharan Africa
Characteristic Skin Findings of Kaposi’s Sarcoma
Papular
Elliptical along skin tension lines
Multiple colors
Surrounded by yellow halo
What does Kaposi’s sarcoma affect?
Oral cavity
GI tract
Respiratory tract
Local Treatment of Kaposi’s Sarcoma
Surgery Radiation therapy Cryotherapy & laser therapy Intralesional therapy Topical therapy: imiquimod
Systemic Treatment of Kaposi’s Sarcoma
Chemotherapy
Immunomodulators