Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

1064 Nonmelanoma Skin Cancers: SCC

differential diagnosis

■Basal cell carcinoma

■War ts

■Chronic ulcer

■Discoid lupus erythematosus

■Psoriasis or nummular eczema

■Seborrheic keratosis

■Other non-melanoma skin cancers

■Hypertrophic actinic keratosis

management

■Examination to determine invasion or metastasis

specific therapy

■Based on location, etiology, size, histologic type and immune status

■Smaller lesions: excisional biopsy with 2-mm margin with an ellipse

or tangential (saucer) excision

■Large flat lesion: incisional or punch biopsy

■Large bulky lesion: incisional biopsy

■Biopsy technique: injection of local anesthetic around and not into

the lesion

treatment

■CURETTAGE & ELECTRODESICCATION (C&D)

➣Best for superficial or small, nodular non-recurrent lesions

➣May lead to hypertrophic or hypopigmented scars and notching

of eyelids or lips

➣Residual tumor may be buried under scar, making detection of

recurrence difficult.

■MOHS MICROGRAPHIC SURGERY

➣Best for large, invasive, recurrent or in dangerous areas such as

the “H” area of the face (nose, nasolabial folds, periorbital or

periauricular area). Excellent histologic control of margins.

➣Immunosuppressed patients

➣Aggressive histologic pattern with poor differentiation, perineu-

ral or lymphatic invasion

■CRYOSURGERY

➣Smaller (<2 cm), well differentiated, superficially invasive, and

not in areas with high risk of recurrence

➣Disadvantages includes prolonged healing and hypopigmented

scars.