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Non-Melanoma Skin Cancer: Basal & Squamous Cell Lisa Publicover August 2005 Introduction Skin cancer can be conceptually divided into melanoma and non-melanoma. The two forms of non-melanoma skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Together, BCC and SCC comprise the majority of skin cancers, however, melanoma is much more aggressive and fatal. BCC is more common than SCC, accounting for ~70% of non-melanoma carcinomas; However, of the two, SCC is more dangerous because of its potential to metastasize1. Risk Factors Sunlight (UVB particularly) Male Age Celtic Descent Fair Skin Tendency to Sunburn Outdoor Occupation Exposure to Industrial Toxins Cigarette Smoking Immunosuppression Sun exposure is the most significant factor in the development of BCC and SCC and most tumors develop on sun exposed areas of the body. Basal Cell Carcinoma There are 4 variants of BCC defined by the appearance of the lesion: – Superficial BCC – Nodular BCC (most common) – Pigmented BCC – Morphoeic /Sclerosing BCC Clinical Characteristics: Superficial BCC - Plaque Erythematous Scaly Fine Telangiectasias at the margins - Slowly enlarging Clinical Characteristics: Nodular BCC Pearly Telangiectasias on its surface Nodular Small & Slow growing Depressed/Ulcerated centre Clinical Characteristics: Pigmented BCC - Same as Nodular BCC, but with Melanin present - Often misdiagnosed as melanoma Clinical Characteristics: Morphoeic/Sclerosing BCC Plaque Poorly defined borders Flat or slightly depressed Indurated White or Yellowish Squamous Cell Carcinoma Clinical Characteristics: – Nodule or Plaque – Erythematous – Indurated – Eventual Ulceration – Scaly or Crusty – Possibly ill-defined borders Clinical Pearl Surface telangectasias are rare in SCC, differentiating it from BCC Treatment Options Excision Electrodesiccation and curettage (ED&C) Cryosurgery Radiation therapy Laser therapy Mohs micrographic surgery (MMS) Topical 5-fluorouracil Topical immunomodulators Treatment The most common treatment are ED&C for low risk lesions and excision for more aggressive lesions or those in high risk areas. Excision is preferred for high risk lesions because it offers greater histologic control. The best treatment for all types of skin cancer is prevention