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Skin CancerSkin CancerDiagnosis and Diagnosis and ManagementManagement
Dr Rob Paver Dr Rob Paver Medical DirectorMedical DirectorSkin and Cancer Foundation WestmeadSkin and Cancer Foundation Westmead
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Skin Cancer StatisticsSkin Cancer StatisticsSkin Cancer accounts for more than 80% of newly Skin Cancer accounts for more than 80% of newly diagnosed cancer in Australiadiagnosed cancer in Australia
2 out of 3 Australians will be diagnosed with skin 2 out of 3 Australians will be diagnosed with skin cancer in their lifetimecancer in their lifetime (DHA 2010)(DHA 2010)
GP’s in Australia have about 1 million patient GP’s in Australia have about 1 million patient consultations per year for skin cancer related consultations per year for skin cancer related concernsconcerns
Australia’s incidence of skin cancer is the highest in Australia’s incidence of skin cancer is the highest in the world and nearly 4 times the rate of Canada, USA the world and nearly 4 times the rate of Canada, USA and UK and UK
(Australian Institute of Health and Welfare Cancer in Australia (Australian Institute of Health and Welfare Cancer in Australia 2001)2001)
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Non Melanoma Skin CancerNon Melanoma Skin CancerMore than 430,000 patients are treated each year More than 430,000 patients are treated each year for non melanoma skin cancer for non melanoma skin cancer 296000 BCC 138000 SCC296000 BCC 138000 SCC (2008) (2008)
More than 400 die of NMSC per year(2008)More than 400 die of NMSC per year(2008)
Skin cancer is our most expensive cancerSkin cancer is our most expensive cancer
NMSC cost the government $264,000,000 in 2001NMSC cost the government $264,000,000 in 2001
Melanoma cost $30,000,000 in 2001 (more now)Melanoma cost $30,000,000 in 2001 (more now) (Australian Institute of Health and Welfare Cancer in Australia (Australian Institute of Health and Welfare Cancer in Australia
2001)2001)
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Non Melanoma Skin CancerNon Melanoma Skin Cancer
Actinic KeratosesActinic Keratoses
Basal Cell CarcinomaBasal Cell Carcinoma
Squamous Cell CarcinomaSquamous Cell Carcinoma
Benign Differential DiagnosesBenign Differential Diagnoses
Treatment OptionsTreatment Options
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Actinic KeratosesActinic Keratoses
Macular – telangiectaticMacular – telangiectatic
Papular – keratoticPapular – keratotic
Hypertrophic – hyperkeratoticHypertrophic – hyperkeratotic
Cutaneous HornCutaneous Horn
Single, few or multipleSingle, few or multiple
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Actinic KeratosesActinic KeratosesMultiple Macular Single Papular
HypertrophicCutaneous Horn
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Actinic KeratosesActinic Keratoses
Keratotic Actinic Cheilitis
Diffuse Macular Diffuse Inflammatory
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Differential diagnoses of Actinic Differential diagnoses of Actinic Keratoses – Seborrhoeic WartsKeratoses – Seborrhoeic Warts
Verrucal Standard
Superficial Skin Tags
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Differential diagnoses of Actinic Differential diagnoses of Actinic Keratoses – Seborrhoeic WartsKeratoses – Seborrhoeic Warts
Verrucal Lichenoid
Macular Multiple
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Differential diagnoses of Actinic Differential diagnoses of Actinic KeratosesKeratoses
Bowens Disease Superficial BCC’s
Actinic Porokeratoses Lupus Erythematosus
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Differential diagnoses of Actinic Differential diagnoses of Actinic KeratosesKeratoses
Stucco Keratoses
Seborrhoeic Dermatitis
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Treatment Options for Actinic Treatment Options for Actinic KeratosesKeratoses
CryotherapyCryotherapy
SolarazeSolaraze
EfudixEfudix
AldaraAldara
PDTPDT
Chemical PeelChemical Peel
Laser resurfacingLaser resurfacing
Curettage and cauteryCurettage and cautery
ExcisionExcision
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CryotherapyCryotherapy
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Solaraze (3%Diclofenac gel)Solaraze (3%Diclofenac gel)
Apply bd for 2 to 3 months Apply bd for 2 to 3 months
Cease for a week if too inflamedCease for a week if too inflamed
Adverse effects Adverse effects - local irritation- local irritation
- like NSAID: bleeding etc- like NSAID: bleeding etc
Efficacy - less effective than Efudix but Efficacy - less effective than Efudix but may have less noticeable inflammationmay have less noticeable inflammation
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Efudix bd for 3 weeksEfudix bd for 3 weeks
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Aldara for Solar KeratosesAldara for Solar KeratosesDose: 3x per week for up to 16 weeks with Dose: 3x per week for up to 16 weeks with 1 week holidays from Rx for severe 1 week holidays from Rx for severe inflammationinflammation
Always titrate the duration of treatment Always titrate the duration of treatment against the severity of responseagainst the severity of response
Adverse effects: local inflammation, Adverse effects: local inflammation, hypopigmentation, headache and flu like hypopigmentation, headache and flu like illnessillness
Efficacy: longer lasting response than Efficacy: longer lasting response than efudix/solaraze, but higher cost and efudix/solaraze, but higher cost and variable responsevariable response
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AldaraAldara
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PDTPDT
Good field treatmentGood field treatment
PainfulPainful
More expensiveMore expensive
Need special Need special equipmentequipment
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Resurfacing / Chemical PeelResurfacing / Chemical Peel
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Basal Cell CarcinomaBasal Cell Carcinoma
Superficial MultifocalSuperficial MultifocalNodularNodularNoduloulcerativeNoduloulcerativeMicronodularMicronodularPigmentedPigmentedMorphoeicMorphoeicInfiltrativeInfiltrativeRecurrentRecurrent
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Superficial - Basal Cell CarcinomaSuperficial - Basal Cell Carcinoma
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Nodular – Basal Cell CarcinomaNodular – Basal Cell Carcinoma
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Ulcerative - Basal Cell CarcinomaUlcerative - Basal Cell Carcinoma
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Pigmented and Micronodular BCCPigmented and Micronodular BCC
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Morphoeic - Basal Cell CarcinomaMorphoeic - Basal Cell Carcinoma
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Infiltrating - Basal Cell CarcinomaInfiltrating - Basal Cell Carcinoma
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Recurrent - Basal Cell CarcinomaRecurrent - Basal Cell Carcinoma
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Recurrent - Basal Cell CarcinomaRecurrent - Basal Cell Carcinoma
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Differential Diagnoses of BCCDifferential Diagnoses of BCC
Dermal NevusBowens
Granuloma Annulare Syringomas
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Differential Diagnoses of BCCDifferential Diagnoses of BCC
Nevus Sebaceous
Dermatofibroma
Amyloidosis Sebaceous Hyperplasia
Dermatofibroma
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Differential Diagnoses of BCCDifferential Diagnoses of BCC
Achrocordon SCC
Minimally Pigmented NevusAmelanotic Melanoma
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BCC Treatment OptionsBCC Treatment Options
CryotherapyCryotherapy
Curettage and CauteryCurettage and Cautery
AldaraAldara
PDTPDT
ExcisionExcision
Radiation TherapyRadiation Therapy
Mohs SurgeryMohs Surgery
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CryotherapyCryotherapy
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Curettage and CauteryCurettage and Cautery
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Aldara (Imiquimod)Aldara (Imiquimod)
Primary Superficial BCCsPrimary Superficial BCCs
5x per week for 6 weeks5x per week for 6 weeks
Treatment Holidays if too inflammatoryTreatment Holidays if too inflammatory
80% cure rate80% cure rate
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Aldara – Before, During, AfterAldara – Before, During, After
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This is presentation is continued in the next This is presentation is continued in the next file…file…