"CLINICAL
� 70% appear on head and neck(sun-exposed areas)
� Appear as either:
1. slow growing ulcer with everted and indurated edges. OR
2. hard papule
DIFFERENTIAL DIAGNOSIS
Other skin ulcers:
� Venous
� Arterial disease
� Neuropathic
� Sickle cell leg ulcers
� Pressure sores
Other nodules:
� Basal cell carcinoma
� Malignant melanoma
� Solar keratosis
� Keratoacanthoma
� Pyogenic granuloma
TREATMENT:
Excisional biopsy:
� Full thickness of skin taken to determine depth of spread.
� Excise well wide of the margins (2cms) to achieve clearance.
OTHER PROCEDURES:
1. Mohs surgery.
For lesions larger than 3/4 of an inch located on the face.
Remove tumor layer by layer.
Examine each layer under microscope until no abnormal cells remain.
Allows for removal of with very narrow surgical margin and a high cure rate.
2. Curettage and cautery:
For lesions less than 1 cm
in situ lesions
& precancerous lesions.
3. Cryotherapy/cryosurgery.
4. Topical Flurouracil 5%:
5. Radiotherapy:
� for patients who cannot or prefer not to be treated by surgery.
� when the margins of excision appear to be incomplete at histology.
PROGNOSIS.
Early stage tumours = 90% 5 year survival.
Metastatic lymph node disease = 30% 5 year survival
"