![Page 1: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/1.jpg)
Skin Cancer Overview ; The Challenge of Skin Cancer Overview ; The Challenge of Diagnosing Older PatientsDiagnosing Older Patients
Wendy E. Roberts MD
![Page 2: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/2.jpg)
Is this not a challenge?Is this not a challenge?
![Page 3: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/3.jpg)
Skin cancer overviewchallenges
• Skin barrier• Xerosis• Immunosuppression• Purpura• Photodamage
• All may obscure the diagnosis
![Page 4: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/4.jpg)
Skin cancer in the Older patient• NMSCs are the most common malignancies in the Caucasian population,
more than one third of all adult cancers in the US
• 900,000 to 1,200,000 new cases per year,3 up to 18- to 20-fold more than malignant melanoma.4
• The incidence of NMSC has been steadily increasing worldwide at a rate of 3% to 8% per year since 1964,5 with greater increases nearer the equator.6 In Australia,
• The incidences of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) rose by 133% and 35%, respectively, between 1985 and 2002.7
• Immunosuppressed transplant patients have an even higher incidence of NMSC (eg, after kidney transplantation, 1-year incidence of SCC is 7%, increasing to 70% after 20 years8). Transplant patients have a 10-fold increased risk of BCC and a 40- to 150-fold increased risk of developing SCC
![Page 5: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/5.jpg)
Actinic keratosis No way to identify the transformers (SCC )
Field Cancerization- multiple AK’s within a body area
Usually on a sun exposed site
Transplant and Immunosuppressed may
Have more aggressive disease.
![Page 6: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/6.jpg)
6
• 20% of actinic keratoses will convert to SCC within a 1-year time course
• SCCs resulting from actinic keratoses rarely metastasize, with an actual risk of between 2% and 6%. However, lesions located on the lips, ears, anogenital region are at increased risk of metastasis. There are no unique morphologic characteristics indicative of lesions that are most likely to convert.
• The lifetime chance of conversion of persistent lesions is believed to increase over time, related to reductions in the immune responsiveness associated with chronologic aging.
• Although continued overexposure to UV radiation increases the risk of photocarcinogenesis, treatment with cytotoxic or immunosuppressive agents can accelerate the conversion of AKs to SCCs
6
![Page 7: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/7.jpg)
Bowen’s disease
• 3% Become invasive and 1/3 metastasize
• may be misdiagnosed as eczema or LSC which causes treatment delayys
• Lesions on lower legs which are poorly vasculalrized and heal slowly
• Malignant transformation in the immunosuppressed renal failure and transplant patients
![Page 8: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/8.jpg)
Squamous Cell carcinoma
• Lesions which present in ulcers or non healing wounds lead to diagnosis delay and often on poorly vascularized area with thin dermis such as the tibia
• Lesions hidden on the scalp or on the helix which carry higher rates of metastases
![Page 9: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/9.jpg)
The Challenge
• Obstacles to receive a FBSE• Access• Transportation• Mobility• Unwillingness to get undressed
![Page 10: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/10.jpg)
109
![Page 11: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/11.jpg)
1111
![Page 12: Skin Cancer Overview ; The Challenge of Diagnosing Older Patients Wendy E. Roberts MD](https://reader035.vdocument.in/reader035/viewer/2022062517/56649f165503460f94c2cbf3/html5/thumbnails/12.jpg)
1212