Clinical Cases in Skin Cancer Surgery and Treatment


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Bibliographic Information

These include squamous cell carcinomas, basal cell carcinomas and Merkel cell carcinomas. We also care for patients who are at higher risk of developing melanoma due to their family history, genetic mutations or having many abnormal moles. Our team includes dermatologists, medical and surgical oncologists, radiation oncologists and dermatopathologists, all of whom specialize in the diagnosis and treatment of skin cancer.

This designation recognizes centers that provide full-spectrum, cutting-edge cancer care. Treatment options include surgery, chemotherapy, radiation therapy, biological therapy and immunotherapy. Our various specialists meet for a weekly "tumor board" to evaluate complex cases and make treatment recommendations. We perform skin exams using dermatoscopes, handheld instruments that allow us to distinguish cancerous lesions from noncancerous lesions with greater accuracy.

We may also use digital dermoscopic photography — photographs taken with the dermatoscope — to closely track suspicious lesions over time. UCSF has been on the forefront of recent breakthroughs in the treatment of melanoma and nonmelanoma skin cancers. As a patient, you may be offered the option of participating in clinical trials. Phone: Fax: Email: melanoma ucsf. Need a doctor? Call us at UCSF or browse our directory. Experts here are pioneers in translating transformative research into improved cancer treatments.

Vital signs: Melanoma incidence and mortality trends and projections—United States, — Prevalence and costs of skin cancer treatment in the US, — and — Am J Prev Med.


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Burden of Skin Disease. Incidence estimate of nonmelanoma skin cancer keratinocyte carcinomas in the US population. JAMA Dermatol. Published online April 30, 5 Muzic, JG et al. Excision of such a recurrence would be the treatment of choice, and consideration should be given to Mohs micrographic surgery. Because of long-term damage to the skin, radiation therapy usually is not given to persons under the age of forty and is uncommonly given to patients under fifty.

Surgery, including Mohs micrographic surgery, is usually performed in the younger patient. One week after the treatment brisk erythema will develop in the irradiated area. If the original lesion is ulcerated, there will be a period of exudation after which a large and unsightly crust will form. This process takes about six weeks to resolve.

The development of secondary infection, of course, would require the appropriate treatment, although such infection does not normally occur.

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The patient is usually seen 6 to 8 weeks after radiation treatment or curettage and electro-fulguration. Patients are then advised to see their physician at six-month intervals for the first year and yearly thereafter, for examination of the treatment site and other sun-exposed skin. Many patients will develop a second basal cell carcinoma. Many patients who continue to develop new lesions require follow-up examinations quarterly.

The minimum intervals suggested for follow-up examination of the treatment site and regional lymph nodes is one year. Each patient should have their sun-exposed skin examined at each visit. Even after five years, they should be inspected, at least annually, for new actinic keratosis or skin cancers. Criteria: Poorly differentiated or infiltrating on histology or rapidly growing lesion by history. More frequent follow-up for immuno-suppressed individuals is required. Examination of the treatment site and the regional lymph nodes every two to three months for the first year, decreasing in stages to annually after 5 years.

Each patient should have their sun-exposed skin examined at each follow-up visit and even after five years, examined at least yearly for new actinic keratosis or skin cancers. The following suggestions are intended to assist the practitioner in providing the best possible management for his or her patient with skin cancer.

We are concerned about the number of patients who, after surgery with a curative intent, are referred with incompletely excised skin cancers; these patients present a difficult problem and often require radiation therapy that might have been avoided by alternative initial management. We prefer that patients with difficult tumours be jointly assessed so that the best possible treatment is advised.

This management clinic is available for the assessment of any patient with a skin cancer. In addition to providing treatment services when appropriate, we would be pleased to see any patient for a consultation only. Please designate your preference in the referral letter that should accompany the patient to the Agency. All Rights Reserved. David Huntsman named Aubrey J. Tingle Prize recipient Moving on up — new exercise resources for cancer patients Dr.

Chapters Back to top 1. Staging 3. Gallagher et al a,b The most important environmental risk factor for all 3 types of skin cancer is solar ultraviolet radiation UVR. Effective sun protection encompasses behavior change and includes all the options outlined. Management Policies 1. Basal Cell Carcinoma 2. Squamous Cell Carcinoma 3. Keratoacanthomas 4. Merkel Cell Tumour 5. Kaposi's Sarcoma Classical 6. Other Skin Cancers 7.

Large Lesions by Virtue of Area or Degree of Infiltration minimum 5 mm margin Patients with these lesions are often best referred for specialist opinion or to the Skin Management Clinic.

Recurrent Basal Cell Carcinomas If the cancer is recurrent, consider changing therapeutic modality to treat the recurrence e. Incompletely Excised Basal Cell Carcinomas While histologically incompletely excised basal cell carcinomas are sometimes observed, those with a morpheic, spindling pattern should always be treated to histologic cure. Morpheic Basal Cell Carcinoma Synonym: Sclerosing, Spindling, Infiltrating Morpheic basal cell carcinomas require excision with wider margins up to a centimeter.

Topical 5-fluorouracil Therapy Topical 5-fluorouracil therapy, while appropriate for actinic keratosis, is not appropriate therapy for basal cell carcinomas because of a very low cure rate, and the possibility of subclinical spread. Invasive Squamous Cell Carcinoma Squamous cell carcinoma can be either a slowly evolving lesion arising from a long standing actinic keratosis or a rapidly growing lesion with a high metastatic potential.

Squamous cell carcinomas of the skin may metastasize to regional lymph nodes. Squamous cell carcinoma of the lip is discussed under the Head and Neck section. Keratoacanthomas A true keratoacanthoma is considered to be a benign self-limited tumour. However, there may be difficulty separating keratoacanthoma from squamous cell carcinoma, clinically and histologically.

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Dermatology

It is suggested that, in general, this lesion is best treated as if it were a low risk invasive squamous cell carcinoma, that is, by complete excision or by radiation therapy. Staging Liver function tests and a CT scan of the regional nodes should be obtained. Treatment Primary tumour. Either a biopsy followed by radiation therapy with a wide margin 3 cm.

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The choice will depend on the potential morbidity and cosmetic result of either treatment. Regional lymph nodes. Prophylactic or, in the case of those with established metastases, therapeutic irradiation of the regional nodes is recommended. This is considered preferable to surgical node dissection.

Systemic therapy. Adjuvant chemotherapy is not recommended. There may be a role for palliative chemotherapy for systemic metastases. Kaposi's Sarcoma Classical Patients with localized disease are treated effectively with wide field irradiation.

Other Skin Cancers A variety of other skin tumours occur and the physicians at the Skin Management Clinic are always willing to see or discuss patients and make recommendations on management or undertake special therapy. Fluorouracil is not a suitable therapy for invasive skin cancers.

It is typically achieved using liquid nitrogen. It is primarily used for treatment of a single, or a small number of, precancerous skin growths, such as actinic keratosis. It is most efficiently delivered using a specially designed apparatus, called Cry-AC, instead of cotton tip applicators.

Melanoma and Skin Cancer Program | UCSF Medical Center

Cryotherapy is not usually effective enough against invasive skin cancers, which require surgery. Should liquid nitrogen therapy for invasive skin malignancy be necessary, it can be arranged by referral to the Skin Management Clinic. Surgery is indicated for the removal of many cutaneous malignancies. If the surgical excision of any skin malignancy is expected to produce a significant cosmetic deformity especially of the face , or if the patient is medically unfit for surgery, radiation therapy is usually considered to be the treatment of choice.

Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment
Clinical Cases in Skin Cancer Surgery and Treatment Clinical Cases in Skin Cancer Surgery and Treatment

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