1. Skin Cancer
Diagnosis and
Management
Dr Rob Paver
Medical Director
Skin and Cancer Foundation Westmead

2. Skin Cancer Statistics
Skin Cancer accounts for more than 80% of newly
diagnosed cancer in Australia
2 out of 3 Australians will be diagnosed with skin
cancer in their lifetime (DHA 2010)
GP’s in Australia have about 1 million patient
consultations per year for skin cancer related
concerns
Australia’s incidence of skin cancer is the highest in
the world and nearly 4 times the rate of Canada, USA
and UK
(Australian Institute of Health and Welfare Cancer in Australia 2001)

3. Non Melanoma Skin Cancer
More than 430,000 patients are treated each year
for non melanoma skin cancer
296000 BCC 138000 SCC (2008)
More than 400 die of NMSC per year(2008)
Skin cancer is our most expensive cancer
NMSC cost the government $264,000,000 in 2001
Melanoma cost $30,000,000 in 2001 (more now)
(Australian Institute of Health and Welfare Cancer in Australia
2001)

4. Non Melanoma Skin Cancer
Actinic Keratoses
Basal Cell Carcinoma
Squamous Cell Carcinoma
Benign Differential Diagnoses
Treatment Options

5. Actinic Keratoses
Macular – telangiectatic
Papular – keratotic
Hypertrophic – hyperkeratotic
Cutaneous Horn
Single, few or multiple

6. Actinic Keratoses
Multiple Macular Single Papular
Cutaneous Horn
Hypertrophic

7. Actinic Keratoses
Keratotic Actinic Cheilitis
Diffuse Macular Diffuse Inflammatory

8. Differential diagnoses of Actinic
Keratoses – Seborrhoeic Warts
Verrucal Standard
Superficial Skin Tags

9. Differential diagnoses of Actinic
Keratoses – Seborrhoeic Warts
Verrucal Lichenoid
Macular Multiple

10. Differential diagnoses of Actinic
Keratoses
Bowens Disease Superficial BCC’s
Actinic Porokeratoses Lupus Erythematosus

11. Differential diagnoses of Actinic
Keratoses
Stucco Keratoses
Seborrhoeic Dermatitis

12. Treatment Options for Actinic
Keratoses
Cryotherapy
Solaraze
Efudix
Aldara
PDT
Chemical Peel
Laser resurfacing
Curettage and cautery
Excision

13. Cryotherapy

14. Solaraze (3%Diclofenac gel)
Apply bd for 2 to 3 months
Cease for a week if too inflamed
Adverse effects - local irritation
- like NSAID: bleeding etc
Efficacy - less effective than Efudix but
may have less noticeable inflammation

15. Efudix bd for 3 weeks

16. Aldara for Solar Keratoses
Dose: 3x per week for up to 16 weeks with
1 week holidays from Rx for severe
inflammation
Always titrate the duration of treatment
against the severity of response
Adverse effects: local inflammation,
hypopigmentation, headache and flu like
illness
Efficacy: longer lasting response than
efudix/solaraze, but higher cost and
variable response

17. Aldara

18. PDT
Good field treatment
Painful
More expensive
Need special
equipment

19. Resurfacing / Chemical Peel

20. Basal Cell Carcinoma
Superficial Multifocal
Nodular
Noduloulcerative
Micronodular
Pigmented
Morphoeic
Infiltrative
Recurrent

21. Superficial - Basal Cell Carcinoma

22. Nodular – Basal Cell Carcinoma

23. Ulcerative - Basal Cell Carcinoma

24. Pigmented and Micronodular BCC

25. Morphoeic - Basal Cell Carcinoma

26. Infiltrating - Basal Cell Carcinoma

27. Recurrent - Basal Cell Carcinoma

28. Recurrent - Basal Cell Carcinoma

29. Differential Diagnoses of BCC
Dermal Nevus
Bowens
Granuloma Annulare Syringomas

30. Differential Diagnoses of BCC
Nevus Sebaceous Dermatofibroma
Dermatofibroma
Amyloidosis Sebaceous Hyperplasia

31. Differential Diagnoses of BCC
Achrocordon SCC
Amelanotic Melanoma
Minimally Pigmented Nevus

32. BCC Treatment Options
Cryotherapy
Curettage and Cautery
Aldara
PDT
Excision
Radiation Therapy
Mohs Surgery

33. Cryotherapy

34. Curettage and Cautery

35. Aldara (Imiquimod)
Primary Superficial BCCs
5x per week for 6 weeks
Treatment Holidays if too inflammatory
80% cure rate

36. Aldara – Before, During, After

37. This is presentation is continued in the next
file…