cancer and actinic damage皮肤癌和皮肤光化性损伤课件.ppt

Actinic damage:When to treat in the clinic Diagnosis- must be made Epidermal proliferation/ Lesion thickness AK or SCC- can be hard to tell clinically Thickness of scale Any erosion Location Lips- high risk -always refer Lower legs -often poor response AKs: When to treat Malignant transformation of solar keratoses to squamous cell carcinoma. Marks R et al Lancet 1988 1689 people (40yrs), 21,905 AKs, over 5 years Transformation risk within one year less than 1 in 1000 Spontaneous remission of solar keratoses: the case for conservative management. Marks R et al Brit J Dermatol 1986 1040 people (40yrs) 224 (36.4%) had lesoins that spontaneously resolved SCC incidence 0.24% for each solar keratosis present Treatment Nothing, emollients, sun protection Liquid nitrogen Curettage and cautery Excision Topical Efudix Imiquimod (Solaraze) Solaraze Does it work? Diclofenac sodium 3% gel Trials have very short follow up – 30days Int J Dermatol 2002 Complete clearance 47% vs 19% (placebo) Well tolerated 5-flurouracil- Effudix Inhibition of thymidylate synthase Interference with pyrimidine synthesis Apoptosis of rapidly dividing cells Patient education is crucial Appropriate review appointments Imiquimod 5% cream Immune response modifier Binds Toll like receptor 7 (TLR-7) Increased INFγ, IL-6, TNFα Activation of immune system Innate adaptive Apoptosis Potential problems of topical treatment Inflammation Education Patient expectations Infection Polyfax ointment antibiotics Treatment failure Compliance ? Wrong diagnosis SCC and AK referrals SCC 2 week wait SCC clinic Faxed referrals to RVI AK GP treatment South of Tyne Community Dermatology service Routine choose and book referral to RVI. Summary Pigmented lesions ABCD If in doubt refer Non pigmented BCC -referral needs Precise site, size, eroded Y/N, recurrent Y/N SCC -2ww clinic Actinic damage If thin, widespread or localised Try efudix If thicker Liquid nitrogen or curettage * Squamous cell carcinoma in situ: Bowen’s dis