Recognition & Treatment of Pre-Malignant & Malignant skin lesions Bruce Philp St. Andrews ...

214 Pages·2013·6.77 MB·English

by  Bruce Philp

Recognition & Treatment of Pre-Malignant &
Malignant skin lesions

Bruce Philp
St. Andrews Centre
Broomfield Hospital
Skin cancer
• 27 % primary care consultations related to
skin conditions
• 1.7% skin lesions
NICE Guidance on skin cancer
UK Incidence 2010
• Skin cancer most common form of cancer
• Incidence quadrupled in past 30 years
• Melanoma – 12,800/year
• NMSC – 99,549/year
• Majority BCC - 50-60,000 new
diagnosis/year in UK
Structured Approach to Diagnosis
• Is it Cancer?
• Risk Group ? – high or low
• What referral pathway ?
Is it Cancer?
• Melanoma
• SCC
• BCC
• Low grade lesion (pre-malignant)
• Rare tumours
Relative Risk
• High - MM } - 2 week rule
- SCC } - Urgent
- Others }

• Low - BCC } - Soon 4 – 6 wks
- AK /Bowens }

• Benign -Neavi etc } - Routine -13 wks
DIAGNOSIS ?
What do I do?
• If in doubt – cut it out

• …. or else get someone else to do it
• Dermoscopy allows more detailed
examination, reduce delay in diagnosis of
high risk lesions and reduce excision of
benign lesions
Skin cancer & Pre-malignant
lesions
• Pre-malignant lesions
- Solar/Actinic keratoses  SCC
- Bowens disease  SCC
- Sebaceous naevus -> BCC
- Lentigo maligna  MM
- Leucoplakia  SCC
• Very high risk
- Xeroderma Pigmentosum
- Immunosuppression (organ transplant)
Benign lesions
• Seborrhoeic keratoses
• Pigmented naevi
• Sebaceous hyperplasia
• Vascular lesions