Key Points

• Actinic keratosis is a scaly macule on sun-damaged skin and often easier to feel than to see.

• Topical 5-FU therapy is used for patients with multiple AKs rather than treating each lesion with cryotherapy.

• Bowen's disease (squamous cell carcinoma in situ) and superficial basal cell carcinoma look more like patches of dermatitis than tumors.

• The typical nodular basal cell carcinoma presents as a pearly-colored papule with overlying telangiectasias and a central depression or ulcer.

• Left untreated, local destruction from BCC can be extensive.

• Most SCCs arise from AKs, radiation dermatitis, leukoplakia or erythroplakia, and burn scars or chronic ulcers.

• Organ transplant recipients have a 5% to 10% greater risk of developing BCC and a 40 to 250 times greater risk of developing SCC.

• Risk factors for melanoma include fair skin, red or blond hair, no tan/easily burns, freckles, excessive childhood sun exposure, blistering childhood sunburns (>3), moles (nevi) or dysplastic nevi, family or personal history of melanoma, immunosuppression, and older age.

• One third of melanomas arise in a preexisting nevus.

• Depth of tumor invasion is the most important prognostic indicator for melanoma; most patients with thin tumors (<1 mm) have over 90% 10-year survival.

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