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Skin CancerSkin CancerDiagnosis and Diagnosis and ManagementManagement

Dr Rob Paver Dr Rob Paver Medical DirectorMedical DirectorSkin and Cancer Foundation WestmeadSkin and Cancer Foundation Westmead

Skin Cancer StatisticsSkin Cancer StatisticsSkin Cancer accounts for more than 80% of newly Skin Cancer accounts for more than 80% of newly diagnosed cancer in Australiadiagnosed cancer in Australia

2 out of 3 Australians will be diagnosed with skin 2 out of 3 Australians will be diagnosed with skin cancer in their lifetimecancer in their lifetime (DHA 2010)(DHA 2010)

GP’s in Australia have about 1 million patient GP’s in Australia have about 1 million patient consultations per year for skin cancer related consultations per year for skin cancer related concernsconcerns

Australia’s incidence of skin cancer is the highest in Australia’s incidence of skin cancer is the highest in the world and nearly 4 times the rate of Canada, USA the world and nearly 4 times the rate of Canada, USA and UK and UK

(Australian Institute of Health and Welfare Cancer in Australia (Australian Institute of Health and Welfare Cancer in Australia 2001)2001)

Non Melanoma Skin CancerNon Melanoma Skin CancerMore than 430,000 patients are treated each year More than 430,000 patients are treated each year for non melanoma skin cancer for non melanoma skin cancer 296000 BCC 138000 SCC296000 BCC 138000 SCC (2008) (2008)

More than 400 die of NMSC per year(2008)More than 400 die of NMSC per year(2008)

Skin cancer is our most expensive cancerSkin cancer is our most expensive cancer

NMSC cost the government $264,000,000 in 2001NMSC cost the government $264,000,000 in 2001

Melanoma cost $30,000,000 in 2001 (more now)Melanoma cost $30,000,000 in 2001 (more now) (Australian Institute of Health and Welfare Cancer in Australia (Australian Institute of Health and Welfare Cancer in Australia

2001)2001)

Non Melanoma Skin CancerNon Melanoma Skin Cancer

Actinic KeratosesActinic Keratoses

Basal Cell CarcinomaBasal Cell Carcinoma

Squamous Cell CarcinomaSquamous Cell Carcinoma

Benign Differential DiagnosesBenign Differential Diagnoses

Treatment OptionsTreatment Options

Actinic KeratosesActinic Keratoses

Macular – telangiectaticMacular – telangiectatic

Papular – keratoticPapular – keratotic

Hypertrophic – hyperkeratoticHypertrophic – hyperkeratotic

Cutaneous HornCutaneous Horn

Single, few or multipleSingle, few or multiple

Actinic KeratosesActinic KeratosesMultiple Macular Single Papular

HypertrophicCutaneous Horn

Actinic KeratosesActinic Keratoses

Keratotic Actinic Cheilitis

Diffuse Macular Diffuse Inflammatory

Differential diagnoses of Actinic Differential diagnoses of Actinic Keratoses – Seborrhoeic WartsKeratoses – Seborrhoeic Warts

Verrucal Standard

Superficial Skin Tags

Differential diagnoses of Actinic Differential diagnoses of Actinic Keratoses – Seborrhoeic WartsKeratoses – Seborrhoeic Warts

Verrucal Lichenoid

Macular Multiple

Differential diagnoses of Actinic Differential diagnoses of Actinic KeratosesKeratoses

Bowens Disease Superficial BCC’s

Actinic Porokeratoses Lupus Erythematosus

Differential diagnoses of Actinic Differential diagnoses of Actinic KeratosesKeratoses

Stucco Keratoses

Seborrhoeic Dermatitis

Treatment Options for Actinic Treatment Options for Actinic KeratosesKeratoses

CryotherapyCryotherapy

SolarazeSolaraze

EfudixEfudix

AldaraAldara

PDTPDT

Chemical PeelChemical Peel

Laser resurfacingLaser resurfacing

Curettage and cauteryCurettage and cautery

ExcisionExcision

CryotherapyCryotherapy

Solaraze (3%Diclofenac gel)Solaraze (3%Diclofenac gel)

Apply bd for 2 to 3 months Apply bd for 2 to 3 months

Cease for a week if too inflamedCease for a week if too inflamed

Adverse effects Adverse effects - local irritation- local irritation

- like NSAID: bleeding etc- like NSAID: bleeding etc

Efficacy - less effective than Efudix but Efficacy - less effective than Efudix but may have less noticeable inflammationmay have less noticeable inflammation

Efudix bd for 3 weeksEfudix bd for 3 weeks

Aldara for Solar KeratosesAldara for Solar KeratosesDose: 3x per week for up to 16 weeks with Dose: 3x per week for up to 16 weeks with 1 week holidays from Rx for severe 1 week holidays from Rx for severe inflammationinflammation

Always titrate the duration of treatment Always titrate the duration of treatment against the severity of responseagainst the severity of response

Adverse effects: local inflammation, Adverse effects: local inflammation, hypopigmentation, headache and flu like hypopigmentation, headache and flu like illnessillness

Efficacy: longer lasting response than Efficacy: longer lasting response than efudix/solaraze, but higher cost and efudix/solaraze, but higher cost and variable responsevariable response

AldaraAldara

PDTPDT

Good field treatmentGood field treatment

PainfulPainful

More expensiveMore expensive

Need special Need special equipmentequipment

Resurfacing / Chemical PeelResurfacing / Chemical Peel

Basal Cell CarcinomaBasal Cell Carcinoma

Superficial MultifocalSuperficial MultifocalNodularNodularNoduloulcerativeNoduloulcerativeMicronodularMicronodularPigmentedPigmentedMorphoeicMorphoeicInfiltrativeInfiltrativeRecurrentRecurrent

Superficial - Basal Cell CarcinomaSuperficial - Basal Cell Carcinoma

Nodular – Basal Cell CarcinomaNodular – Basal Cell Carcinoma

Ulcerative - Basal Cell CarcinomaUlcerative - Basal Cell Carcinoma

Pigmented and Micronodular BCCPigmented and Micronodular BCC

Morphoeic - Basal Cell CarcinomaMorphoeic - Basal Cell Carcinoma

Infiltrating - Basal Cell CarcinomaInfiltrating - Basal Cell Carcinoma

Recurrent - Basal Cell CarcinomaRecurrent - Basal Cell Carcinoma

Recurrent - Basal Cell CarcinomaRecurrent - Basal Cell Carcinoma

Differential Diagnoses of BCCDifferential Diagnoses of BCC

Dermal NevusBowens

Granuloma Annulare Syringomas

Differential Diagnoses of BCCDifferential Diagnoses of BCC

Nevus Sebaceous

Dermatofibroma

Amyloidosis Sebaceous Hyperplasia

Dermatofibroma

Differential Diagnoses of BCCDifferential Diagnoses of BCC

Achrocordon SCC

Minimally Pigmented NevusAmelanotic Melanoma

BCC Treatment OptionsBCC Treatment Options

CryotherapyCryotherapy

Curettage and CauteryCurettage and Cautery

AldaraAldara

PDTPDT

ExcisionExcision

Radiation TherapyRadiation Therapy

Mohs SurgeryMohs Surgery

CryotherapyCryotherapy

Curettage and CauteryCurettage and Cautery

Aldara (Imiquimod)Aldara (Imiquimod)

Primary Superficial BCCsPrimary Superficial BCCs

5x per week for 6 weeks5x per week for 6 weeks

Treatment Holidays if too inflammatoryTreatment Holidays if too inflammatory

80% cure rate80% cure rate

Aldara – Before, During, AfterAldara – Before, During, After

This is presentation is continued in the next This is presentation is continued in the next file…file…