1. Early Diagnosis of Skin Tumors Daniel B. Allen, MD Associate Professor of Surgery UCSF East Bay Grand Rounds – August 4, 2011

2. ABC’s OF MELANOMA Asymmetry Border Irregularity Color Variegation Diameter often > 6mm

3. CHARACTERISTICS OF PIGMENTED LESIONS BenignMalignant Size Smaller Larger Color Uniform Variegated Border Regular Irregular Surface Regular Irregular

7. Nodular Basal Cell Carcinoma

8. Morpheaform Basal Cell Carcinoma

10. Pigmented Basal Cell Carcinoma

11. 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

12. PRS, Oct. 2010pp. 1222-1231 MarginRecurrenceClear Margins 5 mm 0.39% 85% 4 mm 1.62% 85% 3 mm 2.56% 85% 2 mm 3.96% 82%

13. 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.

14. All reported cases of positive margins treated by observation since 1965Recurrence rate 27%

15. Management of the Positive MarginNonmelanoma 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

16. Dermatofibroma Benign Most common on lower extremities Rarely > 2cm

18. Bowen’s Disease

24. Keratoacanthoma

25. Keratoacanthoma of the hand. Note resemblance to a SCC

29. Marjolin’s Ulcer

31. Lentigo Maligna Melanoma - melanoma in situ TX: Surgical Excision with 5mm margins

35. Lentigo Maligna Melanoma

36. Acral Lentiginous

37. Subungual Melanoma

38. Invasive Melanoma

39. Melanoma

40. Melanoma

41. Superficial Spreading Melanoma

42. Nodular Melanoma

46. Arises from the dermis

47. Trunk or thighs most common

73. 8/19/2009

74. 8/19/2009

89. 5/21/2009

90. 5/21/2009

91. 5/27/2009

92. 5/27/2009

93. 5/27/2009

94. 5/27/2009

95. 7/1/2009

96. 7/1/2009

97. 7/1/2009

98. 10/7/2009

99. 10/7/2009

100. 10/7/2009

101. 10/7/2009

102. 3/3/2010

103. 4/30/2010

104. 4/30/2010