04 Malignant Skin Lesions

When metastasis or recurrence develops it is

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Unformatted text preview: common sites of metastasis are regional lymph nodes, the lungs, and the liver. When metastasis or recurrence develops, it is typically within 3 years after treatment of the index lesion. Treatment For primary SCC, as for BCC, surgical excision remains the mainstay of treatment; however, the recommended margin of excision for SCCs is generally larger than that for BCCs, ranging from 0.5 to 2 cm. Smaller lesions can often be closed primarily; larger lesions may require rotation flaps or skin grafting. © 2006 WebMD, Inc. All rights reserved. ACS Surgery: Principles and Practice 3 BREAST, SKIN, AND SOFT TISSUE Nonexcisional therapeutic options for SCC are similar to those for BCC. Surgical choices include cryosurgery, curettage and cauterization, and Mohs’ micrographic surgery. Nonsurgical choices include radiotherapy, photodynamic therapy, and topical therapy with agents such as 5-FU, imiquimod, and intralesional IFN-α. Posttreatment recommendations for SCC patients are essentially the same as for BCC patients [see Basal Cell Carcinoma,Treatment, above]: frequent self-examination to look for suspicious lesions, counseling to reduce sun exposure, and the offer of oral retinoid therapy for high-risk patients.17 4 Malignant Skin Lesions — 4 Table 1—ABCD Guidelines for Pigmented Lesions Characteristic Comments Asymmetry Most early lesions grow at uneven rate, resulting in an asymmetrical appearance Border irregularity Uneven growth rate also results in irregular border Color variegation Irregular growth also causes new shades of black and of light and dark brown Diameter Lesions with ABC features and diameter > 6 mm should be considered suspicious for melanoma MELANOMA Incidence and Epidemiology Although melanoma is less common than BCC or SCC, it is clearly more deadly than either. It is currently the sixth leading cause of cancer-related death in the United States, and its incidence is increasing faster than the incidence of any other malignancy. Melanoma is slightly more common in men than in women, and the median age at diagnosis is 57 years.6 An average of 18.8 life-years are lost for each melanoma death,24 and it is estimated that one United States citizen dies of melanoma every hour.25 Melanoma results from the malignant transformation of melanocytes, which are responsible for pigment production.The genetic factors implicated in this transformation have not been well characterized. As noted [see Assessment of Potentially Malignant Skin Lesions, Clinical Evaluation, History, above], patients with a family history of melanoma are at substantially higher risk for the development of melanoma.6 Somatic mutations in the p16 tumor suppressor gene have been identified in both familial and sporadic cases of melanoma.26 Environmental factors—specifically, exposure to ultraviolet radiation—are also implicated in the maligant transformation of melanocytes. Increased risk of melanoma is associated with intermittent intense sun exposure rather than with the cumulative effect of...
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