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Community Skin Cancer Awareness Promotion

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Community Skin Cancer Awareness Promotion The World Book of Family Medicine – Iberoamericana Edition 2016 Maria Cristina Jacomette Maldonado, MSc [email protected] 65 – Community Skin Cancer Awareness Promotion Maria Cristina Jacomette Ageing is a complex process that results from intrinsic factors, under genetic control, Maldonado, MSc and extrinsic, due to environmental factors that produces accumulation of molecular Specialist in Dermatology from damage over time. Physiological cell decline is inexorable, but prolonged exposure to the Brazilian Health System ultraviolet radiation and harmful lifestyle habits such as smoking and alcoholism Assistant Professor at Heliopolis Hospital, São Paulo, Brazil accelerate the process and cause significant damage, producing photo-ageing, solar melanosis, and pre-malignant lesions. It is important that the general practitioner (GP) pays attention to such conditions, since at this stage he could act in preventing the evolution of these lesions to skin cancer. Following we present some pre- malignant lesions that may evolve to or be confused with skin cancer. When a malignant condition is suspected, it is necessary to refer the patient to the specialist Lentigo senilis or solar melanosis is a benign pigmented spot that can be mistaken for a malignant lesion called lentigo maligna-melanoma. The diagnosis is clinical (by dermoscopy) and, if necessary, by histopathology. LentigoSenilis or Solar Melanosis (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=230) Lentigo Maligna-Melanoma (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=229) 1 The World Book of Family Medicine – Iberoamericana Edition 2016 Solar (or actinic) keratosis is a fairly common pre-malignant lesion that affects photo-exposed areas in middle-aged or elderly light-skinned adults. It presents clinically as yellowish or brownish maculopapular lesions with a rough surface. It presents a potential for malignancy. Solar (actinic) Keratosis (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=218) The cutaneous horn is a solar keratosis whose most superficial layer (horny layer) has grown excessively, acquiring the appearance of a little horn. The cutaneous horn may be a manifestation of other diseases such as squamous cell carcinoma (SCC). Thus, every cutaneous horn should be removed and sent for histopathological examination. Cutaneous horn (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=85) Actinic cheilitis is characterized in its acute phase by erythema, oedema, vesicles, crusting and peeling, and in its chronic phase by hypochromia and atrophy. It is located on the submucosa tissue of the lips, predominantly the lower one. It is most common in fair-skinned individuals exposed to the sun. There may be epithelial carcinogenic damage analogous to that of solar skin keratoses. So, it presents potential for transformation into SCC. 2 The World Book of Family Medicine – Iberoamericana Edition 2016 Actinic Cheilitis (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=16) Bowen's disease is an in situ intraepidermal SCC. Commonly presents as a solitary lesion, which can sometimes be multiple. It is characterized by a reddish area with a scaly or crusted surface, well delimited that can form plaques. It may occur in any area of the body, preferring the trunk. Despite being an in situ carcinoma, the potential transformation for invasive carcinoma is low. Still, the best therapeutic option is surgical removal with histopathological examination, which is necessary to confirm the diagnosis. Bowen’s disease (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=59) Paget's disease is most often localized in the nipples, areolas and adjacent skin. It clinically resembles an eczematous lesion with discharge, crusting and itching that progressively increases. It occurs in women and commonly is unilateral, which makes a differential diagnosis with contact eczema that is often bilateral. There are very few cases described in men. When skin lesions are accompanied by nipple retraction, the presence of underlying carcinoma (non-invasive intraductal or extensive with axillary metastasis) is probable. In this case and even in the presence of eczematous lesions resistant to conservative treatment, biopsy and breast cancer investigation are imperative. 3 The World Book of Family Medicine – Iberoamericana Edition 2016 Paget’s Disease (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=341 Erythroplakia is an in situ SCC situated in the oral mucosa, glans or foreskin and eventually in the female genital mucosa that may eventually become invasive. It presents as a bright red, velvety, finely grainy plaque with little or no infiltration that grows progressively. The highest incidence occurs in male over 50 years. It is necessary to make the differential diagnosis with psoriasis, chronic balanoposthitis, among others, by histopathological examination. Erythroplakia with clinically suspicion of malignant transformation (available at https://screening.iarc.fr/atlasoral_detail.php?flag=0&lang=1&Id=ZZ000004&cat=A3) Leukoplakia is characterized by slightly elevated grey-white plaques, not removable from friction, located on the lips, jugal mucosa, and gums. It mainly affects male smokers over 40 years old. The diagnosis is confirmed by histopathological examination and treatment is surgical, with the aim of avoiding the evolution to SCC. In addition, it is recommended to avoid risk factors such as smoking. 4 The World Book of Family Medicine – Iberoamericana Edition 2016 Leukoplakia (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=239) In the oral mucosa, mainly soft palate, ventral face of the tongue and floor of the mouth, erythroplakia may coexist with leukoplakia, constituting the erythroleukoplakia. This can indicate the presence of an early invasive squamous cell carcinoma. The highest frequency occurs in smoking men aged 65 to 74 years. The diagnosis is by histopathology and the treatment is surgical. In addition to the above-mentioned pre-malignant lesions, the GP should be concerned with malignant skin lesions such as basal cell carcinoma, SCC and melanoma, which should be referred to the specialist. Basal cell carcinoma originates in the basal layer of the epidermis and is the most common epithelial neoplasm, accounting for 65% of the total. It usually occurs in individuals older than 40 years and presents a slow evolution, rarely metastasizing. Predisposing factors are photo-exposure, fair skin, previous radiotherapy, exposure to arsenic compounds, scars (including burns) and even tattoos. It is preferably located on the face and less commonly on the trunk and extremities. It does not occur on the palms, soles and mucous membranes. Although there are several clinical forms, the GP should consider the diagnosis before lesions with the following characteristics: pinkish, pearly (shiny) papule that grows and evolves into a nodular form that can become ulcerated. The lesions may be wholly or partially pigmented. The diagnosis is histopathological and the treatment is preferably surgical. Basal Cell Carcinoma (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=52) 5 The World Book of Family Medicine – Iberoamericana Edition 2016 The SCC originates from the spinous cells of the skin and mucosa and has an invasive character, having a propensity to metastasize. It is the second most common skin cancer (15% of malignant epithelial neoplasms) and its risk factors are similar to those of basal cell, affecting predominantly men over 50 years. Tanning, smoking, HPV infection (6, 11 and 16) and prolonged contact with tar derivatives and hydrocarbons also represent important risk factors. It may occur on normal skin, but commonly originates from pre-malignant lesions. The most common locations are lower lip, ear, face, scalp, back of hands, oral mucosa and external genitals. Clinically it presents as: infiltrated and hardened area, or ulcerating nodule. Thus, an ulcerated or ulcerative vegetating lesion with infiltration at the border represents a red flag. Without treatment, it can quickly reach large dimensions. The diagnosis is histological and the treatment is surgical and/or radiotherapy. This one is indicated as exclusive treatment for very large tumours without surgical possibility. Squamous Cell Carcinoma (available at http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=430) Melanoma is the most serious form of skin cancer. It originates from melanocytes and may also affect eyes, ears, gastrointestinal tract, leptomeninges and oral, nasal, genital and rectal mucosa. It represents about 3 to 4% of malignant skin tumours. It has high mortality and mainly affects young adults from 20 to 50 years. Risk factors: genetics and family history, sun exposure, fair-skinned eyes and red hair. Precursor lesions: lentigo maligna, dysplastic naevus and congenital naevus (dark spots - from brown to black - flat or raised). The larger the number and size of the naevi, the greater the risk of developing melanoma. bleeding or ulceration, which may denote malignancy of the previously cited lesions. A useful resource for suspected melanoma is the ABCDE criteria (asymmetry, irregular border, colour variation, diameter ≥ 6 mm and evolving lesions). These ones represent the elements that must be followed in relation to the evolution of a naevus. In suggestive cases, the patient should be referred early to the
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