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LIVE BLOG: Skin Cancer Update with Johnnie Woodson, MD

In this live blog, Dr. Johnnie Woodson presents on Skin Cancer through an “image quiz” providing the answers with pertinent information including treatment plans, clinical presentation, and epidimiology.  Enjoy this highlighted summary of Dr. Woodson’s lecture at the SDPA Fall Conference.
Basal Cell Carcinoma
+ Mainly seen in male patients older than 40 years of age 
+ UVR mostly UVB spectrum (290-320) induces mutations in suppressor genes
+ Seen mainly with skin phototypes I-II, prolonged UV exposure, heavy UV exposure during youth, x-ray for facial acne, arsenic ingestion
Clinical Presentation
+ Erosian or bleeding with minimal trauma
+ Danger sites: medial and lateral canthi, nasolabial fold, post aricular
+ Papule or nodule, translucent or pearly in color, surface telangiectasis, ulcer with rolled borders (rodent ulcer)
MOHs Surgery
Vismodegib (new treatment, this is something to look into)
Basal Cell Nevus Syndrome (BCNS)
+ Found often through gene mutations: chromosome 9q
+ Physical signs include skeletal malformations
+ Can be diagnosed in childhood or early adolescence, and extend throughout life
+ Found in both sun exposed areas and covered areas
+ Physical signs of frontal bossing, odontogenic keratocyst, short forth metacarpals
scoliosis and kyphosis, ovarian fibromas, teratomas, cystadenomas, palmar pitting
Squamous Cell Carcinoma
+ Found in patients mainly older than 55 years of age, but also found in 20’s and 30’s in Southern California, New Zealand, Florida, Australia
+ 12 per 100,000 caucasians males in the US, 7 per 100,000 caucasians females; 62 per 100,0000 caucasians in Hawaii
+ Males affected more than females
+ Caused from sunlight exposure, phototherapy, PUVA, excessive photo chemotherapy
+ Found with caucasian skin and poor tanning capacity (skin I-II type)
More likely to be found in:
Solid organ transplant recipients, with HIV disease increase incidents of UVR and HPV-induced SCC
Exposure to pitch tar, paraffin oil
Merkel Cell Carcinoma 
+ Cutaneous neuroendocrine tumor, specialized epithelial cell, non-keraticing, clear cell in basal cell layer
+ Associated to polyoma virus
+ Recurrence rate high
+ Cutaneous to subcutaneous papule, nodule of tumor, pink, reddish brown
+ Grows rapidly in persons greater than 50 years old
+ Treatment with excision, MOHs surgery
Malignant Melanoma 
+ 5% of all cancers in males, 6% in females
+ New melanoma deaths in the US in 2008: 8,400
+ Found mainly on Caucasian male’s backs and upper extremities, female lower extremities
+ Black and Asian patients: soles, palms, nail beds
+ Superficial spreading melanomas 70%
+ Nodular melanoma 15%
+ Lentigo meligna melanoma 5%
+ Acral melanoma 10%
Treat with total excisional biopsies with narrow margin if possible
Incisional or punch biopsy acceptable when total excisional biopsy cannot be performed
melanoma in-situ
Metastatic Melanoma 
+ Found in 15-26% of Stage II types
+ Spread of disease: primary melanoma to regional metastasis
+ First spreads to distant lymph nodes, skin and subcutaneous tissue
Remember A B C D E of Spotting Melanoma 
Border irregular
Color not uniformed
Diameter changed in size
Enlarging or Elevation
[Image by Daniel Blume]

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