• Too much exposure to sunlight
• Tanning booths
• Fair skin, freckles
• History of sunburns, previous skin lesions
• Smoking
• Family History
• Immunisuppressive conditions (HIV, meds)
• Caucasion race
• Age

• A premalignant lesion is an abnormality in a tissue area which is just a step away from cancer
• Not all premalignant lesions change to cancer, but most have greater potential for doing so than normal tissue

• Think = precancerous
• Watchful waiting with appropiate treatment
• Example: Solar Keratoses

• Rough, scaly spots on sun-damaged skin
• Also known as actinic keratoses
• Appear as multiple flat or thickened, scaly or warty, skin colored or reddened lesions
• Abnormal skin lesions due to exposure to ultrviolet radiation
• Considered precancerous, but can develop into squamous cell carcinoma

• Removal of defective skin cells
• Cryotherapy
• Curettage & Cautery
• Excision
• 5-Fluorouracil cream

• Protect skin from ultraviolet radiation
• Regular skin examinations
• Stop smoking

• Common, potentially pre-cancerous disease of the mouth
• White spots on the mucous membrances of the tongue and inside of the buccal mucosa

• Occur in response to irritation:

1. Dentures
2. Tobacco
3. Alcohol Use

• Can represent early invasive squamous cell carcinoma

• Diagnosis: Brush Biopsy
• Treatment:

1. ? Beta-Carotene
2. Remove irritative cause
3. Good oral hygiene
4. If cancerous,

• Remove lesions
• Cryotherapy
• Laser Treatment

• Used to describe cancerous lesions
• Tending to become progressively worse
• Implies ability to invade, spread, and actively destroy normal tissue

• Think = Cancer
• No waiting, only aggressive treatment
• Example: Melanoma

Skin cancer begins in cells in the upper layer of your skin

3 different types of skin cancer

• Basal Cell Carcinoma
• Squamous Cell Carcinoma
• Melanoma

• Punch
• Shave
• Excisional
• Incisional

• Quick, convenient and usually only produce a small wound
• Allow pathologist to get a full thickness view of the skin

• Used if skin lesion is suspected to affect top layers of the skin (epidermis & dermis)
• Very superficial slice of skin
• Example: Solar Keratoses

• Only a portion of the suspicious tissue is cut into and removed for examination
• This procedure is considered when a lesion is large
• Example: punch & shave bx

• The entire area of suspect skin is cut out
• Normally done with a scalpel
• Full thickness of skin is removed for further examination

• Basal cell carcinoma is the most common type of skin cancer in fair-skinned people
• Usual locations: face, ears, scalp, neck, or upper body

This type of cancer can appear as:

• A red patch
• A pink, red or white bump that is shiny or pearly
• A crusty, open sore that will not heal
• A scar-like area
• Some with teleangiectatic vessels visible

• BCC may have slightly raised edges with a crusty, indented center
• BCC grows very slowly and usually does not spread to other parts of the body

• Simple surgical excision with clear margins
• Electrodesiccation and curettage (cut and burn)
• Cryotherapy
• Laser treatment
• Mohs Surgery (microscopically controlled excision)

• Second most common type of skin cancer in fair-skinned people
• It is twice as common in men as in women
• This cancer develops in the outer layer of the skin (epithelium)

• It may appear as a bump or scaly red patch on the face, neck, arms, scalp, ear, lips, or mouth
• Lip lesions common in smokers
• SCC is slow-growing but can spread to other parts of the body

• Squamous Cell Carcinoma can start out within solar keratoses
• Often crusty and may bleed easily
• Some SCCs appear as sores that fail to heal

• Simple surgical excision with clear margins
• Electrodesiccation and curettage (cut and burn)
• Cryotherapy
• Laser treatment
• Mohs Surgery (microscopically controlled excision)

• Least common type of skin cancer, but is the most serious
• Leading cause of all skin cancer related deaths

• Melanoma can quickly spread to other parts of the body
• Moles that develop into melanoma have certain unusual features
• Use "ABCDE" for early identification

• Asymmetry: Melanomas are generally asymmetric
• Borders: Melanomas have uneven borders (edges) that are ragged, notched, or blurred
• Color: Melanomas have uneven coloring
• Diameter: Melanomas are usually more than the size of a pencil eraser
• Evolution: Melanomas usually change in size, shape or color over a short period of time

• Refer to dermatologist for skin examination and possible biopsy of lesion
• Excisional biopsy is preferred method when melanoma is suspected (Do not use punch or shave bx)
• If melanoma has spread to the nearby lymph nodes, the affected lymph nodes may also be removed surgically
• Later stage Melanomas may also require radiation and chemotherapy

• Melanoma that has spread to distant sites in the body or to other organs cannot be cured
• Treatment is pallative

• "Atypical nevus"
• "Dysplastic nevus"
• "Atypical mole"

Clinical terms only while awaiting bx results

• Malignant tumor of the connective tissue
• Often associated with AIDS
• Bluisn-red or purple lesions on the skin
• May first appear on the feet, ankles, thighs, arms, hands, mouth or face
• May also affect internal organs and lymph nodes

• Lesions are flat, usually painless and do not blanche
• Biopsy for diagnosis

Management includes:

1. Antiviral therapy for the patient's stage of HIV infection
2. Preventive measures against opportunistic infections and prompt treatment of any infections that occur