SKIN CANCER

Basal Cell Carsinoma

• Skin cancer is the most commonly diagnosed cancer
• Skin cancer are either non-melanoma 0r melanoma
• A persistent skin lesion that does heal is highly
suspicious for malignancy and should be examined
by a health care provider
• Early detection and treatment can often lead to a
highly favourable prognosis
• The visibility of the skin lesions increases the
likehood early detection and diagnosis
 Types of Skin Cancers

Non Melanoma ( > 90% )

Basal Cell Carcinoma ( BCC ) = 70%
Squamous Cell Carcinoma ( SCC ) = 20%
Sebaceous Carcinoma sangat jarang = 0,2
4,6%, Carcinoma Apocrine, Carcinoma Eccrine
<<<

- Melanoma ( 3 % )
 Basal Cell Carsinoma (BCC)
• BCC is the most common type of skin cancer
• It generally appears on sun-exposed areas of
the body and is more prevalent in regions
where the population is subjected to intense
and extensive exposure to the sun.
• The incidence is proportional to the age of the
patient and the total amount of sun exposure,
and it is inversely proportional to the amount
of melanin in the skin
 Basal Cell Carcinoma
Basal cell carcinoma (BCC) is a locally
destructive epithelial tumor (epidermal basal
cell) that grows slowly and rarely metastasizes.
 Basal Cell Carcinoma
Risk factors include :
*Chronic UV exposure
*Fair skin
*Increasing age
*Male sex
*Immunosuppression
*Chronic arsenic ingestion
*Genetic predisposition.
*BCCs develop frequently in some genetic diseases, such as
albinism, xeroderma pigmentosum, nevoid basal cell carcinoma
syndrome, Muir-Torre syndrome, Bazex syndrome, and
epidermodysplasia verruciformis. They can also develop on
scars and rarely on nevus sebaceous
BCC most frequently arises on sun-
exposed areas of the head and neck but
can occur anywhere on the body.

Characteristic features that may vary

among different clinical subtypes
include translucency, ulceration,
telangiectasias, and rolled border.

* Clinical Presentation
The ABCDE’s of The Skin Self-Exam

BCC and SCC

*Flat, firm, pale areas or small raised, p
shiny, waxy areas that may bleed afte
*Rough, scaly lumps or a crusty surfac
*Flat reddish pathces that appear to gro

Melanoma
*A new spot on the skin
*A sore that does not heal
*A charge in sensation: itchiness, tende
*A bump or nodule that is scaly, oozes
 Basal Cell Carcinoma

*Nodular BCC-most common type

*Superficial BCC-common
*Ulcerative (rodent ulcer)
*Pigmented BCC – can resemble
melanoma
*Turban BCC
*Basisquamous BCC- mixed BCC/SCC
 Diagnosis

Differential diagnosis depends on the clinical

subtype.
* SCC, dermal nevus, appendage tumor,
dermatofibroma, scar, seborrheic keratosis,
melanoma, compound nevus, blue nevus,
Bowen’s disease, mammary or extramammary
Paget’s disease, single plaque of psoriasis or
eczema, morphea, trichoepithelioma, skin tag,
or fibroma.
Factors influencing prognosis of BCC

* Tumor size
* Tumor site
* Definition of clinical margins
* Histological subtype
* Histological features of aggression
* Failure of previous treatment
* Immunosuppression
* The aim of the treatment is to cure the tumor
with the best cosmetic result. Taking into
account clinical and histological tumor
characteristics, the patient’s overall health,
and the cosmetic outcome, the decision for the
appropriate treatment can be taken.
* Treatment options include surgical and
nonsurgical techniques.

*Treatment
* Surgical Techniques Standard excision with
tumor-adjusted margins and conventional
histology should be used as the method of
choice.
* Mohs micrographic surgery is recommended for
lesions localized near eyelids, lips, nose, and
ears, depending on the size and the
histological type. It should also be used in case
of recurrent tumors.

*Surgical Techniques
 * Nonsurgical Techniques
*Radiation therapy is indicated in case of inoperable
tumors or patient’s refusal of surgery, incomplete tumor
resection, and recurrence. The type of radiation is
chosen according to the affected area, the tumor size,
and the patient’s overall health
 Nonsurgical Techniques
* Cryotherapy can be used for small superficial tumors,
especially those localized on eyelids. It is also useful for
elderly patients that may not tolerate a more invasive
procedure.
* Photodynamic therapy can be used for primary superficial
BCCs.
* Topical treatment with imiquimod is another alternative for
superficial BCCs, especially in case of multiple tumors.
* 5-FU can also be tried in case of low-risk, superficial BCCs.
* Systemic treatment in the context of clinical trials or the use
of vismodegib could be considered in case of metastatic or
inoperable disease.
* TNM classifaction of non-melanoma based on AJCC (2018)
TNM of the Skin Cancer
 Skin Carcinoma of the Head and Neck
Rules for Classification
* The classification applies only to cutaneous carcinomas of the head and neck region excluding the
eyelid and excluding Merkel cell carcinoma and malignant melanoma. There should be histological
confirmation of the disease.

The following are the procedures for assessing T, N, and M categories:

* T categories Physical examination and imaging
* N categories Physical examination and imaging
* M categories Physical examination and imaging

Note (T)
* Deep invasion is defined as invasion beyond the subcutaneous fat or >6 mm (as measured from the
granular layer of adjacent normal epidermis to the base of the tumour), perineural invasion for T3
classification is defined as clinical or radiographic involvement of named nerves without foramen or
skull base invasion or transgression.M categories Physical examination and imaging

Note (N)
* The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying
muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extranodal
extension.
Skin Carcinoma of the Head and Neck
 Carsinoma of Skin of The
Rules of Classification
Eyelid
*There should be histological confirmation of the disease and
division of cases by histological type – for example, basal
cell, squamous cell, sebaceous carcinoma.

The following are procedures for assessing T, N, and M

categories:
*T categories Physical examination
*N categories Physical examination
*M categories Physical examination and imaging

Regional Lymph Nodes

The regional lymph nodes are the preauricular, submandibular,
and cervical lymph nodes.
 Carcinoma of Skin (excluding eyelid, head and neck, perianal,
vulva, and penis)

Rules for Classification*

The classification applies only to carcinomas, excluding Merkel cell carcinoma.
There should be histological confirmation of the disease and division of cases by
histological type.

The following are the procedures for assessing T, N, and M categories:

* T categories Physical examination
* N categories Physical examination and imaging
* M categories Physical examination and imaging

Note
* The AJCC only includes the classification for skin carcinoma of the head and neck.

Regional Lymph Nodes

* The regional lymph nodes are those appropriate to the site of the primary
tumour.
Note (T)
* Deep invasion is defined as invasion beyond the subcutaneous
fat or >6 mm (as measured from the granular layer of adjacent
normal epidermis to the base of the tumour); perineural
invasion for T3 classification is defined as clinical or
radiographic involvement of named nerves without foramen or
skull base invasion or transgression.

In the case of multiple simultaneous tumours, the tumour with

the highest T category is classified and the number of separate
tumours is indicated in parentheses, e.g., T2(5).

Note (N)
* Contralateral nodes in non melanoma non head and neck
cancer are distant metastases.
* Carcinoma of Skin (excluding eyelid, head and neck, perianal, vulva, and penis)
 *Malignant Melanoma of Skin
Rules for Classification
There should be histological confirmation of the disease.

The following are the procedures for assessing N and M categories:

* N categories Physical examination and imaging
* M categories Physical examination and imaging

Regional Lymph Nodes

The regional lymph nodes are those appropriate to the site of the primary tumour.

Note (N)
* Satellites are tumour nests or nodules (macro or microscopic) within 2 cm of the
primary
* tumour. In transit metastasis involves skin or subcutaneous tissue more than 2 cm
* from the primary tumour but not beyond the regional lymph nodes.
* Malignant Melanoma of Skin
* Malignant Melanoma of Skin