Managing Skin Cancer (eBook)

Preface 5
Acknowledgements 6
Contents 7
Contributors 9
Chapter 1 12
Diagnosis of Skin Cancer 12
1.1 Clinical Evaluation and Risk Assessment 12
1.1.1 Actinic Keratosis and Squamous Cell Carcinoma 14
1.1.2 Basal Cell Carcinoma 16
1.1.3 Melanocytic Nevi 18
1.1.4 Malignant Melanoma 20
1.2 Noninvasive Imaging Techniques 21
1.2.1 Dermoscopy 21
1.2.2 Ultrasound 22
1.2.3 Optical Coherence Tomography 22
1.2.4 Refl ectance Confocal Microscopy 23
1.2.4.1 RCM Imaging of Actinic Keratosis (AK) and Squamous Cell Carcinoma (SCC) 24
1.2.4.2 Imaging of Basal Cell Carcinoma (BCC) 24
1.2.4.3 Melanocytic Nevi and Melanoma 24
1.3 Biopsy 25
1.3.1 Punch Biopsy 25
1.3.2 Shave Biopsy 25
1.3.3 Excisional Biopsy 25
1.3.4 Incisional Biopsy 25
References 25
Chapter 2 27
Histopathology of Skin Cancer 27
2.1 Basal Cell Carcinoma 27
2.2 Squamous Cell Carcinoma In Situ 30
2.2.1 Actinic Keratosis 30
2.2.1.1 Histology Appearance 31
Reference 32
2.2.2 Bowen’s Disease 33
2.2.2.1 Erythroplasia of Queyrat 33
2.2.2.2 Bowenoid Papulosis 33
2.3 Invasive Squamous Cell Carcinoma 34
2.3.1 Acantholytic Squamous Cell Carcinoma 35
2.3.2 Spindle Cell Squamous Cell Carcinoma 35
2.3.3 Verrucous Squamous Cell Carcinoma 35
2.3.4 Adenosquamous Carcinoma 36
2.3.5 Keratoacanthoma (KA), Variants of SCC 36
2.5 Merkel cell carcinoma 40
References 40
2.6 Kaposi’s Sarcoma 41
2.7 Dermatofi brosarcoma Protuberans 42
2.8 Atypical Fibroxanthoma 43
2.9 Malignant Fibrous Histiocytoma 44
References 44
Chapter 3 46
Basal Cell Carcinoma 46
3.1 Introduction/Epidemiology 46
3.2 Pathogenesis 47
3.3 Clinical/Histological Variants 48
3.4 Diagnosis/Work Up/Risk Factor Assessment 49
3.5 Treatment 49
3.5.1 Methods of Treatment 50
3.5.1.1 Destructive 50
Curettage and Electrodesiccation (CE) 50
Cryosurgery 50
Radiation Therapy (RT) 51
Photodynamic Therapy (PDT) 51
Laser Therapy 52
3.5.1.2 Surgical 52
Excision with Postoperative Margin Assessment (POMA) 52
Mohs Micrographic Surgery (MMS) 52
3.5.1.3 Pharmacological Treatments 53
Interferon (IFN) 53
Topical Chemotherapy 53
Retinoids 53
Immune Response Modifi er 53
Systemic Chemotherapy 54
Follow-Up 54
References 54
Chapter 4 59
Squamous Cell Carcinoma In Situ 59
4.1 Actinic Keratoses 59
4.1.1 Epidemiology and Ethiopathogenesis 59
4.1.2 Clinic 60
4.1.3 Histopathology 61
4.1.4 Treatment 61
4.1.4.1 Surgical Excision, Curettage 62
4.1.4.2 Cryotherapy 62
4.1.4.3 Chemical Peeling 62
4.1.4.4 Laser 62
4.1.4.5 Radiation 62
4.1.4.6 Photodynamic Therapy 62
4.1.4.7 Imiquimod 63
4.1.4.8 Topical 5-Fluorouracil 63
4.1.4.9 Retinoids 63
4.1.4.10 Diclofenac in Hyaluronic Acid Gel 63
4.1.5 Prevention 64
4.2 Bowen’s Disease 64
4.2.1 Epidemiology and Etiopathogenesis 64
4.2.2 Clinic and Diagnosis 64
4.2.3 Treatment 65
4.2.3.1 Excision 65
4.2.3.2 Curettage and Electrodissecation 65
4.2.3.3 Photodynamic Therapy 65
4.2.3.4 Cryotherapy 65
4.2.3.5 5-Fluorouracil 65
4.2.3.6 Imiquimod 65
References 65
Chapter 5 68
Invasive Squamous Cell Carcinoma of the Skin 68
5.1 Epidemiology and Etiopathogenesis 68
5.1.1 Epidemiology 68
5.1.2 Etiology 69
5.1.3 Pathogenesis 70
5.2 Clinical Presentation and Morphologic Variants of SCC 71
5.2.1 Typical Cutaneous SCC Including the Keratoacanthoma Subtype 71
5.2.2 Secondary SCC 72
5.2.3 Anogenital SCC 72
5.2.4 Verrucous Carcinoma 72
5.3 Diagnosis 73
5.3.1 History and Physical Examination 73
5.3.2 Tissue Biopsy 74
5.3.3 Differential Diagnosis 74
5.4 Management 74
5.4.1 Primary Disease Prevention 74
5.4.2 Identifi cation of “High Risk” Tumors and Further Disease Stratification 76
5.4.3 Treatment Techniques without Margin Control 77
5.4.4 Treatment Techniques with Margin Control 79
5.4.5 Therapy of Metastatic Cutaneous SCC 80
5.4.6 Therapeutic Alternatives for Distinct SCC Subtypes 81
5.4.7 Prognostic Indicators 82
5.4.8 Recommendation for Patient Follow-Up 82
References 83
Chapter 6 86
Cutaneous Malignant Melanoma 86
6.1 Epidemiology of Melanoma of the Skin 86
6.1.1 Introduction: Descriptive Epidemiology 86
6.1.1.1 Time Trends 87
6.1.2 Geographical Differences 87
6.1.2.1 Melanoma in Caucasians 87
6.1.2.2 Migrant studies 88
6.1.2.3 Melanoma in NonCaucasians 89
6.2 Risk Factors 90
6.2.1 Established Risk Factors 90
6.2.2 Genetics 90
6.2.3 Nonestablished Risk Factors 90
6.3 Types of Melanoma 91
6.4 Clinical Diagnosis 93
6.4.1 Key Steps to Diagnosis of Melanoma 93
6.5 Staging 98
6.6 Prognosis 98
6.7 Management of Melanoma 100
6.7.1 Surgical Excision of Primary Melanoma 100
6.7.2 Surgery Beyond the Primary Lesion 100
6.7.2.1 Elective Lymph Node Dissection 100
6.7.2.2 Sentinel Lymph Node Biopsy 101
6.7.2.3 Therapeutic Isolated Limb Perfusion 102
6.7.3 Systemic Adjuvant Therapies 102
6.7.3.1 Chemotherapy, Nonspecific Immune Stimulants, and Vaccines 102
6.7.3.2 Interferon 102
Results of Different Treatment Regimens with IFN in Adjuvant Setting 103
Biomarkers as Predictors of Response to IFN Therapy 104
6.7.3.3 Emerging Therapies in the Adjuvant Setting 104
6.8 Metastatic Melanoma 104
6.8.1 Brain Metastases 105
6.8.2 Surgery 106
6.8.3 Radiation Therapy 106
6.8.4 Immunotherapy 106
6.8.5 Single-Agent Chemotherapy 107
6.8.6 Combination Chemotherapy 108
6.8.7 Hormonal Therapy 108
6.8.8 Biochemotherapy 108
6.8.9 Experimental Immunotherapy Approaches 109
6.8.10 Targeted Therapies 109
6.9 Follow-Up of Patients 110
References 110
Further Reading 116
Chapter 7 118
Merkel Cell Carcinoma 118
7.1 Pathogenesis and Risk Factors 118
7.2 Clinical Features and Diagnosis 119
7.3 Pathology 120
7.4 Staging 120
7.5 Prognostic Factors 120
7.6 Treatment of MCC 120
7.6.1 Primary MCC (Stage I) 120
7.6.1.1 Excision 120
7.6.1.2 Sentinel Lymph Node Biopsy (SLNB) 121
7.6.1.3 Radiation Therapy 121
7.6.1.4 Chemotherapy 121
7.6.2 Treatment of Metastatic Disease 122
7.6.2.1 Stage II: Lymph Node Metastasis 122
7.6.2.2 Stage II: Local Recurrence 122
7.6.2.3 Stage II: Distant Metastasis 122
7.7 Occult MCC 122
References 122
Chapter 8 124
Cutaneous Lymphomas 124
8.1 Epidemiology and Etiopathogenesis 124
8.1.1 Epidemiology, Cutaneous T-Cell Lymphomas 124
8.1.2 Etiopathogenesis, Cutaneous T-Cell Lymphomas 125
8.1.3 Epidemiology, CutaneousB-Cell Lymphomas 125
8.1.4 Etiopathogenesis, Cutaneous B-Cell Lymphomas 125
8.2 Clinical and Histologic Presentation of Cutaneous Lymphoma 126
8.2.1 Cutaneous T-Cell Lymphomas 126
8.2.1.1 Mycosis Fungoides 126
8.2.1.2 Sézary Syndrome 127
8.2.1.3 Primary Cutaneous Anaplastic Large Cell Lymphoma 127
8.2.1.4 Lymphomatoid Papulosis 127
8.2.1.5 Adult T-Cell Leukemia/Lymphoma 128
8.2.1.6 Extranodal NK/T-Cell Lymphoma, Nasal Type 128
8.2.1.7 Subcutaneous Panniculitis-Like T-Cell Lymphoma 128
8.2.1.8 Primary Cutaneous Peripheral T-Cell Lymphoma, Unspecified 128
8.2.2 Primary Cutaneous B-Cell Lymphomas 129
8.2.2.1 Primary Cutaneous Follicle Center Lymphoma 129
8.2.2.2 Primary Cutaneous Marginal Zone B-cell Lymphoma 129
8.2.2.3 Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type 129
Primary Cutaneous Diffuse Large B-Cell Lymphoma, Other 129
8.3 Diagnosis 130
8.3.1 History, Physical Examination, and Skin Biopsy 130
8.3.2 Systemic Evaluation 130
8.3.3 Staging 130
8.4 Management and Prognosis 131
8.4.1 Cutaneous T-Cell Lymphomas 131
8.4.1.1 Mycosis Fungoides 131
8.4.1.2 Sézary Syndrome 132
8.4.1.3 Primary Cutaneous Anaplastic Large Cell Lymphoma 132
8.4.1.4 Lymphomatoid Papulosis 132
8.4.1.5 Adult T-Cell Leukemia/Lymphoma 132
8.4.1.6 Extranodal NK/T-Cell Lymphoma, Nasal Type 133
8.4.1.7 Subcutaneous Panniculitic-Like T-Cell Lymphoma 133
8.4.1.8 Primary Cutaneous Peripheral T-Cell Lymphoma, Unspecified 133
8.4.2 Primary Cutaneous B-Cell Lymphomas 133
8.4.2.1 Primary Cutaneous Follicle Center Lymphoma 133
8.4.2.2 Primary Cutaneous Marginal Zone B-cell Lymphoma 133
8.4.2.3 Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type 133
8.4.2.4 Primary Cutaneous Diffuse Large B-Cell Lymphoma, Other 133
References 134
Chapter 9 138
Kaposi Sarcoma 138
9.1 Introduction 138
9.2 Epidemiology 139
9.2.1 Classic KS (sporadic type) 139
9.2.2 AIDS-Associated KS (epidemic Type) 139
9.2.3 Iatrogenic KS 139
9.2.4 African KS (endemic type) 139
9.3 Pathogenesis 140
9.4 Clinical Features 140
9.5 Diagnosis 141
9.5.1 Histopathology 141
9.5.2 Differential Diagnoses 141
9.6 Therapy 142
References 142
Chapter 10 144
Other Skin Cancers 144
10.1 Fibrohistiocytic Skin Tumors 145
10.2 Dermatofibrosarcoma Protuberans 145
10.3 Atypical Fibroxanthoma 148
10.4 Malignant Fibrous Histiocytoma 149
10.5 Extramammary Paget’s Disease 151
References 153
Chapter 11 155
Skin Cancer Under Special Circumstances 155
11.1 Immunosuppression 156
11.1.1 Introduction 156
11.1.2 Squamous cell carcinoma 156
11.1.3 Basal Cell Carcinoma (BCC) 159
11.1.4 Merkel Cell Carcinoma (MCC) 159
11.1.5 Malignant Melanoma 160
11.1.5.1 De Novo Malignant Melanoma in Otx 160
11.1.5.2 History of Melanoma Prior to Transplantation 160
11.1.5.3 Transmission of Melanoma from the Donor Organ 160
11.1.6 Kaposi’s Sarcoma 161
11.1.7 Sunscreens 161
References 162
11.2 HIV 163
11.2.1 Skin Cancer Under Special Circumstances 163
11.2.2 Kaposi’s Sarcoma 164
11.2.3 Lymphoma 166
11.2.3.1 CD30+ Large Cell Lymphoma 167
11.2.3.2 Cutaneous T-Cell Lymphoma (CTCL) 167
11.2.4 Human Papilloma Virus (HPV)-Related Tumours 167
11.2.5 Nonmelanoma Skin Cancer (NMSC) 168
11.2.5.1 Basal and Squamous Cell Carcinoma 168
11.2.5.2 Squamous Cell Carcinoma 168
11.2.5.3 Merkel Cell Carcinoma 168
11.2.6 Melanoma 169
References 169
11.3 Genital Skin Cancers 171
11.3.1 Human Papilloma Virus (HPV)-Related Tumours 171
11.3.1.1 Anal Cancer 172
11.3.1.2 Penile Cancer 173
11.3.1.3 Vulvar Cancer 174
11.3.2 Squamous Cell Carcinoma and Lichen Sclerosis 174
11.3.3 Melanoma 175
11.3.4 Basal Cell Carcinoma 175
11.3.5 Paget’s Disease 175
11.3.6 Kaposi’s Sarcoma 176
11.3.7 Angiomyxoma, Angiomyofibroblastoma 176
11.3.8 Differential Diagnosis 176
11.3.8.1 Hidradenitis Suppurativa 176
11.3.8.2 Hypertrophic Herpes Simplex 176
11.3.8.3 Syringoma 177
11.3.8.4 Angiokeratoma 177
11.3.8.5 Hemangioma 177
11.3.8.6 Angiofibroma 177
References 177
11.4 Skin Cancers in Children 179
11.4.1 Introduction 179
11.4.2 Melanoma 180
11.4.2.1 Definition/Epidemiology/Pathogenesis 180
11.4.2.2 Clinical Features 180
11.4.2.3 Diagnosis 181
11.4.2.4 Treatment 181
11.4.3 Spitz Tumor/Reed Nevus 181
11.4.3.1 Definition/Epidemiology/Pathogenesis 181
11.4.3.2 Clinical Features 182
11.4.3.3 Diagnosis 182
11.4.3.4 Treatment 182
11.4.4 Rhabdomyosarcoma 183
11.4.4.1 Definition/Epidemiology/Pathogenesis 183
11.4.4.2 Clinical Features 183
11.4.4.3 Diagnosis 183
11.4.4.4 Treatment 183
11.4.5 Dermatofibrosarcoma Protuberans: DFSP 183
11.4.5.1 Definition/Epidemiology/Pathogenesis 183
11.4.5.2 Clinical Features 183
11.4.5.3 Diagnosis 184
11.4.5.4 Treatment 184
References 184
11.5 Nail Apparatus Cancer 186
11.5.1 Acrokeratosis Paraneoplastica 186
11.5.1.1 A Cutaneous Marker of Malignancy 186
First stage 186
Second stage 186
Third stage 187
References 187
11.5.2 Epidermoid Carcinoma 187
11.5.2.1 Bowen’s Disease: Squamous Cell Carcinoma 187
Classical Clinical Patterns 187
New Described Clinical Patterns 188
Differential Diagnosis 188
Etiology 189
11.5.2.2 Verrucous Carcinoma 189
11.5.2.3 Keratoacanthoma 189
Classical Treatment 189
Recent Alternatives 189
References 190
11.5.3 Basal Cell Carcinoma 191
References 192
11.5.4 Metastatic Tumors 192
References 193
11.5.5 Nail Apparatus Melanoma 193
11.5.5.1 Differential Diagnosis 195
11.5.5.2 Immunohistochemistry 196
11.5.5.3 Management of NAM 197
References 197
11.6 Ethnic Skin1 198
11.6.1 Role of Ultraviolet Light 199
11.6.2 Squamous Cell Carcinoma 200
11.6.3 Basal Cell Carcinoma 202
11.6.4 Melanoma 204
11.6.5 Dermatofibrosarcoma Protuberans 210
11.6.6 Kaposi Sarcoma 210
11.6.7 Cutaneous T-Cell Lymphoma 211
11.6.8 Other Tumors 211
11.6.9 Conclusion 211
11.6.10 Pearls 211
References 212
Chapter 12 217
Skin Cancer Prevention 217
12.1 Introduction 218
12.2 Sun Exposure 218
12.3 Skin Cancer Primary Prevention: Behaviors, Strategies 218
12.3.1 Primary Prevention Behaviors: Type, Evaluation 218
12.3.2 Primary Prevention Targets: Location, Age, Period, Environment 219
12.3.3 Sun Protection 220
12.3.3.1 Sun Protection Clothes 220
12.3.3.2 Sunscreens 220
12.3.4 The Role of Tanning Beds 221
12.4 Secondary Prevention: Who, Where, and How? 223
12.5 Population at High-Risk 224
12.5.1 Melanoma 224
12.5.2 Nonmelanoma Skin Cancer 225
12.5.3 Screening 225
12.6 Conclusion 225
References 226
Index 231