Malignant Skin Lesions

A

General

• 1.

  Most common skin malignancy

• 2.

  Originates from epidermis: basal epithelial cells and hair follicles

• 3.

  Clinical presentation

  • a.

    Waxy or cream-colored

  • b.

    Classically described with pearly, rolled borders

  • c.

    Central ulceration common; slow, indolent growth

  • d.

    70% occur on face

  • e.

    Local destruction; rarely metastatic disease

• 4.

  Types

  • a.

    Nodular—classic type

  • b.

    Superficial—slow growing, scaly, pink plaque

  • c.

    Sclerosing/morpheaform—rarest form (5%–10%), resembles scar, most aggressive

• 5.

  Risk factors

  • a.

    Ultraviolet light, radiation therapy (XRT), immunosuppression, arsenic

  • b.

    Genetic predisposition: basal-nevus syndrome (PTCH-1), xeroderma pigmentosa (XP), other rare conditions

B

Diagnosis

• 1.

  Punch biopsy

• 2.

  Excisional biopsy for smaller lesions

C

Treatment

• 1.

  Surgical excision with 3–5-mm margins ideal

• 2.

  Electrodissection and curettage/photodynamic therapy (PDT)/laser ablation for smaller lesions/premalignant lesions

• 3.

  Mohs micrographic surgery

  • a.

    For cosmetically sensitive areas, high-risk or recurrent lesions

  • b.

    Serial excision of tumor with immediate evaluation of frozen sections until normal tissue margins obtained

• 4.

  Radiation therapy

• 5.

  Topical treatment with 5-fluorouracil (5FU)/imiquimod cream for multiple lesions, low-risk superficial lesions

• 6.

  Systemic treatment for rare metastasis or locally advanced disease not amenable to surgery or radiation: Smoothened (SMO) inhibitors

A

General

• 1.

  Second-most common skin malignancy

• 2.

  Squamous cell carcinoma greater than 2 cm or if poorly differentiated has an increased likelihood of metastasis compared with basal cell carcinoma of similar size

• 3.

  Associated with ultraviolet exposure, chronic scars, and irradiated skin, immunosuppression, genetic disorders (e.g., XP)

• 4.

  Precursor is actinic keratosis majority of time

• 5.

  Clinical presentation

  • a.

    Arises in sun-exposed areas (i.e., face, extremities)

  • b.

    Erythematous, scaly plaque, ulcerated mass or nodule

• 6.

  Bowen disease

  • a.

    Squamous cell carcinoma in situ

  • b.

    Five percent develop into invasive squamous cell carcinoma

• 7.

  Marjolin ulcer—squamous cell carcinoma arising in old burn scar

• 8.

  Erythroplasia of Queyrat—in situ squamous cell carcinoma of penis

B