Prevention of skin cancer

1. Histology of Skin

1.1. 5 Layers

1.1.1. Cool Lucy Got Skin Bacteria

1.1.1.1. Stratum basolum

1.1.1.2. Stratum spinosum

1.1.1.3. statum granulosum

1.1.1.4. Stratum lucidum

1.1.1.5. Stratum corneum

2. Types of skin tumors

2.1. Neuro endocrine carcinoma

2.2. Melanoma

2.2.1. Third most common diagnosed cancer

2.2.2. Cause: Sever intermittent bout of sun exposure

2.2.3. Site: Exposed and non exposed

2.2.4. Second most common cancer to affect young women

2.2.5. High metastatic potential - local, lymph nodes, lung, liver and brain

2.2.6. 30% arise in a pre-existing mole

2.2.6.1. Features to look out for are asymmetry of the mole, irregular shape and irregular colour

2.2.7. Most commonly arise in normal skin in renal transplant patients

2.2.8. Types

2.2.8.1. Superficial spreading

2.2.8.2. Nodular

2.2.8.3. Acral

2.2.8.4. lentiginous-8%

2.2.8.5. Lentigo maligna-

2.2.8.6. Others

2.2.9. Risk factors

2.2.9.1. Moles

2.2.9.2. pale skin

2.2.9.3. family Hx

2.2.9.4. immune suppression

2.2.9.5. too much Uv

2.2.9.6. Age

2.2.10. Clinical manefistation

2.2.10.1. ABCD

2.2.10.1.1. Asymmetry

2.2.10.1.2. Border

2.2.10.1.3. Color

2.2.10.1.4. Diameter

2.2.10.2. dark brown or black patch with irregular borders

2.2.10.2.1. characterized by the uncontrolled growth of pigment-producing tanning cells

2.2.11. Therapy

2.2.11.1. Excision +/- LND

2.2.11.2. Sentinel lymphoscintigraphy

2.2.11.3. No effective adjuvant therapy

2.2.11.3.1. Interferon alpha-2b

2.2.11.3.2. radiology

2.2.11.3.3. Chemotherapy

2.3. Squamous cell carcinoma

2.3.1. 2nd most common in Caucasian

2.3.2. due to Chronic sun exposure

2.3.3. Risk factors

2.3.3.1. Pale skin

2.3.4. Common on sun exposed areas

2.3.5. metastatic to lymph nodes then liver then lungs

2.3.6. Erythematous (Red) to skin colored

2.3.7. Hyperkeratotic

2.3.8. scaly papule/plaque +/- overlying crust or eschar, underlying induration, and ulceration.

2.3.9. Differentiation

2.3.9.1. Poor

2.3.9.2. moderat

2.3.9.3. well

2.3.10. High risk for metastasis if

2.3.10.1. in the lower lip 16%

2.3.10.2. Osteomyelitic ulcer (31%), an area of prior radiation (20%), or burn scar (18%)

2.3.10.3. “Modified” skin, e.g., the glans penis (alraa9), the vulva, or the oral mucosa

2.3.10.4. Host is immunocompramised

2.3.10.5. Diameter more than 2 Cm

2.4. Basal cell carcinoma

2.4.1. Most common skin cancer diagnosed

2.4.2. Major cause: Sun exposure

2.4.3. Common sites

2.4.3.1. Face

2.4.3.2. Trunk

2.4.4. Not metastasic (Invaeds localy)

2.4.4.1. But rarely metastasic

2.4.5. can be pearly papule or scaling macule/plaque

2.4.5.1. macule

2.4.6. From basal layer of epidermis (5th layer)

2.4.6.1. Stratum Basalis

2.4.7. most common

2.4.7.1. After age 40

2.4.7.1.1. BUT, increasingly seen in young people

2.4.8. cure rate is 95% if treated early

2.4.9. Types

2.4.9.1. Nodulo-ulcerative or nodular

2.4.9.1.1. Translucent, waxy papule/plaque with “rolled-edge” border +/- central ulceration

2.4.9.1.2. telangiectasia (Spider vessels)

2.4.9.2. superficial multifocal

2.4.9.2.1. Ill-defined, erythematous, scaling papule/plaque with minimal underlying induration

2.4.9.3. Morpheaform or sclerosing

2.4.9.3.1. Ill-defined, depressed, firm skin-colored to yellowish papule/plaque with rare ulceration

2.4.9.4. pigmented

2.4.9.4.1. Similar to nodular basal cell carcinoma but has pigment

2.4.9.4.2. is diagnosed melanoma sometimes

2.4.9.5. Fibroepithelioma

2.4.9.5.1. Pedunculated, skin-colored to erythematous papules 1o on the trunk

2.4.10. Histological subtypes

2.4.10.1. `Solid

2.4.10.2. cysting

2.4.10.3. adenoid

2.4.10.4. keratotic (Basosquamous)

2.4.11. Treatment

2.4.11.1. Shave ED & C

2.4.11.2. Excision

2.4.11.3. Mohs micrographic surgery

3. Checking for anything new

3.1. New mole

3.2. New Color

3.2.1. Red or darker color flaky patch

3.3. New flesh-colored firm bump

3.4. Change in size,shape color, or feel of a mole

3.5. sore that doesn't heal

4. Effects of the Sun

4.1. Acute (protective)

4.1.1. tanning

4.1.2. epidermal thickening

4.1.3. sun burn

4.2. Chronic

4.2.1. photocarcinogenesis

4.2.2. photoaging

4.3. Ozone depletion

4.3.1. location

4.3.2. time of day

4.3.3. UV index

4.3.4. Harmful effect of UV beam

5. Changes to watch for

5.1. Size

5.1.1. sudden or continuous growth bigger than a pencil eraser

5.2. Shape

5.2.1. not symmetrical

5.3. Color

5.3.1. dark center

5.3.2. pearly

5.3.3. translucent

5.3.4. tan

5.3.5. brown

5.3.6. black

5.3.7. pink

5.3.8. multicolored

5.4. Elevation

5.5. Surface Characteristics

5.5.1. Bleeding

5.5.2. itching

5.5.3. oozing

5.5.4. hurting

5.5.5. crusting

5.5.6. scabbing

5.6. Surrounding skin

5.6.1. redness

5.6.2. swelling

5.6.3. spots or colors

5.7. Consistency

5.7.1. Softness

5.7.2. hardness

5.7.3. crumbling of skin

5.8. Sensation

5.8.1. Open sore for 4 weeks, heals, and opens again

5.8.2. itching, tenderness, pain

5.8.3. scaly or crusty: dry and rough with prickling or tenderness

6. Prevention

6.1. Sun block

6.1.1. Sun screen

6.1.1.1. Reflectant

6.1.1.1.1. Reflect UVB

6.1.1.2. Absorbent

6.1.1.2.1. Absorb UVB into chemicals and re-emit as small quantities of heat

6.2. reduce exposure

6.3. protective clothing

6.4. self exam

6.5. dermatology visits

6.6. education

6.6.1. cotton cricket hat is kwyysa

6.6.2. Nylon stockings have sun protection F of about 2

6.6.3. panama hats give poor protection

6.6.4. silk is best

6.6.5. finer the weave, greater the protection

6.7. Importance of self-exams

6.7.1. Most skin cancers can be cured if found and treated early

6.7.2. Less chance of metastasis

6.7.3. Examine yourself regularly

6.7.4. the best way is after a bath or by standing in front of a full length mirror

6.7.5. use a handheld mirror to help view difficult areas

6.7.6. if you notice odd markings, call a doctor