Grand rounds 8 4-2011

Early Diagnosis of Skin Tumors

Daniel B. Allen, MDAssociate Professor of Surgery

UCSF East BayGrand Rounds – August 4, 2011

ABC’s OF MELANOMA

AsymmetryBorder IrregularityColor VariegationDiameter often > 6mm

CHARACTERISTICS OF PIGMENTED LESIONS

BenignMalignant

Size Smaller LargerColor Uniform

VariegatedBorder Regular IrregularSurface Regular Irregular

Nodular Basal Cell Carcinoma

Morpheaform Basal Cell Carcinoma

Pigmented Basal Cell Carcinoma

BASAL CELL CARCINOMA

Incidence in United States 146/100,000

Incidence in Australia 788/100,000

85% of basal cell carcinomas occur in the head and neck region

PRS, Oct. 2010pp. 1222-1231

Margin Recurrence Clear Margins

5 mm 0.39% 85%

4 mm 1.62% 85%

3 mm 2.56% 85%

2 mm 3.96% 82%

Approach to the patient with skin

lesions

I don’t know what it is.

Would you like this to be removed?

Your lesion may not be completely excised; in that event additional treatment could be needed.

All reported cases of positive margins treated

by observation since 1965

Recurrence rate 27%

Management of the Positive Margin

Nonmelanoma Skin Lesion The best prediction of recurrence: location histology

Most patients will not recur, but observation is not right for everyone

Talk to the patient and document the plan

Dermatofibroma Benign Most common on lower extremities Rarely > 2cm

Bowen’s Disease

Keratoacanthoma

Keratoacanthoma of the hand. Note resemblance to

a SCC

Marjolin’s Ulcer

Lentigo Maligna Melanoma- melanoma in situTX: Surgical Excision with 5mm margins

Lentigo Maligna Melanoma

Acral Lentiginous

Subungual Melanoma

Invasive Melanoma

Melanoma

Superficial Spreading Melanoma

Nodular Melanoma

Dermatofibrosarcoma protuberans- Hard, protuberant mass- Arises from the dermis- Trunk or thighs most common- Extremely locally aggressive

5/21/2009

5/27/2009

7/1/2009

10/7/2009

3/3/2010

4/30/2010

Grand rounds 8 4-2011

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