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4The Royal MarsdenBasal cell carcinoma– Most common cutaneous malignancy– Incidence increasing– Risk factors:– Age– Male– Chronic sun exposure– Immunosuppression– Previous radiotherapy– Rare – Gorlins syndrome, xeroderma pigmentosa

5The Royal MarsdenClinical features– Four main subtypes– Nodular or ulcerative 45-60%– Diffuse (infiltrating and morphoeic) 4-17%– Superficial (multifocal) 15-35%– Pigmented 1-7%

7The Royal MarsdenSeborrhoeic Keratoses– Benign– 30s onwards– Inherited– Trunk, face– Eruptive (Leser Trelat)

8The Royal MarsdenSquamous cell carcinoma– 20% cutaneous tumours – head and neck– Incidence rising– Risk factors– Age– Male– Chronic sun exposure– Previous radiotherapy– HPV (16 and 18)– Chronic ulcers – Marjolins– Immunosuppression/ HIV– Rare – Xeroderma pigmentosa

9The Royal MarsdenImmunosuppression – Transplant patientsRatio SCC: BCC reversedMore aggressive tumoursOften painfulOften look quite banal

10The Royal MarsdenPrecursor lesionsActinic keratoses– 25% remit spontaneously, 2% go on to NMSCSCC in situ– BowensArsenical keratosesChronic radiation keratoses

11The Royal MarsdenClinical features– Indurated plaques– Tumid lesions– Verrucous– Ulcerated– Hyperkeratotic/warty/cutaneous horns

12The Royal MarsdenDifferential diagnosis– Keratoacanthomas– BCC– Actinic Keratoses– Viral wart– Seborrhoeic Keratoses

13The Royal MarsdenMalignant melanomaWorldwide number of cases is increasing faster thanany other cancer

14The Royal MarsdenMalignant melanoma– 2000 deaths per year in the UK– 10,000 cases per year– Commonest cancer in 15 to 34 year olds– Increasing faster than any other cancer

15The Royal MarsdenAetiology - Sun exposure– Sun exposure in childhood is a major risk factor– Recent study has shown that sun burn later on in life alsoincreases risk– Intermittent exposure + blistering sun burn– Sunbeds

16The Royal MarsdenClinical historyRecent history of change– New naevus– Longstanding naevus

17The Royal MarsdenDiagnosis - Glasgow seven point checklistMajor featuresMinor features– change in size– irregular shape– irregular colour– largest diameter 7mm ormore– inflammation– oozing– change in sensation

18The Royal MarsdenABCDEABCDEAsymmetryBorder irregularityColour variationDiameter over 6 mmEvolving (enlarging, changing)

19The Royal MarsdenExamination– Skin type– Freckling, red hair– Evidence of sun damage– Lots of naevi– The ‘ugly duckling’ sign

20The Royal MarsdenAetiology - host factors– Atypical Naevi– >5mm diameter– irregular– variegate pigmentation– Atypical naevus syndrome

21The Royal MarsdenMelanoma clinical typesSuperficial spreading90%Lentigo maligna3%Nodular melanoma5%Acral lentiginous2%

22The Royal MarsdenDermoscopy– To identify a melanocytic lesion

23The Royal MarsdenExamination - dermoscopy– Dermoscopy refers to the examination of the skin using skinsurface microscopy, and is also called ‘dermatoscopy’,‘epiluminoscopy’ and ‘epiluminescent microscopy’.– Dermoscopy is mainly used to evaluate pigmented skinlesions.– In experienced hands it can make it easier to diagnosemelanoma

24The Royal MarsdenExamination - dermoscopy

25The Royal MarsdenDermoscopy – 3 point checklist– 1. Asymmetry– 2. Atypical network – irregular holes and thick lines– 3. Blue white structures– Two out of three = positive = excise

26The Royal MarsdenExamination - Dermoscopy– Often more helpful to reassure you it’s benign– Some studies shown better than naked eye examination – notconsistent– Reduces excision of benign lesions– If clinically suspicious and ‘normal’ examination consider maybe a melanoma excise anyway.

27The Royal MarsdenWhen to consider the diagnosis of melanomaHistory of change– One of the three Major criteria of the Glasgow 7 point checklist– High risk factors – AMS, FHx– Examination – ‘ugly duckling’, dermoscopic changes– Can’t exclude a melanoma

28The Royal MarsdenThank you!