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DVA skin cancer management 
There are many types of skin cancers including BCCs or basal cell cancers, SCC or squamous cell cancers as well as melanomas. Todays review is on Bowen disease or Intraepidermal Squamous Cell Carcinoma. This is a common non-invasive cancer of the skin affecting the epidermal layers of skin. IECs most frequently occur on sun-exposed areas and present as red, scaly and persistent patches. IECs may arise de-novo, or from lesions of solar keratosis. If left untreated, Bowen disease may progress to an invasive Squamous Cell Carcinoma. This is one of the most common skin cancers I see in DVA or Department of Defence patients in Australia, and is due to the high UV radiation we have in cities like Brisbane. 

Clinical Features
Bowen disease most frequently presents as a persistent red scaly patch that slow grows over time. The most commonly affect areas include the legs, arms, and face- areas of sun exposure. Bowen disease or IECs can also affect the lips, oral mucosa, or even genital areas. As Bowen Disease is asymptomatic there is often a delay in the diagnosis, as it may mimic conditions such as dermatitis, psoriasis, tinea, and sun-spots. 


Associations
Most cases of Bowen disease arise from sun-damaged skin, including areas of actinic keratosis. The most common associations include-

UV radiation. This plays a major contributing factor in the development of IECs.
Immunosuppression. Patients on certain immunosuppressive medications are more likely to develop IECs. 
Arsenic exposure. This was a common cause of Bowen Disease in the past, as arsenic was frequently used in medicines during the 60s and 70s including Bells Asthma Mixture, sheep dip, and as pesticides. Arsenic induced IECs-Bowen disease is a rare event today, as occupational safety has increased. A time lag of 10-20 years is seen between exposure and cancer. 
Human Papilloma virus infections.
Other associations include genetic diseases, radiotherapy and skin lesions such as porokeratosis, and solar keratosis.


Investigations
Bowen’s Disease can be suspected clinically, however in the majority of cases, a biopsy should be performed to confirm the diagnosis. 


Treatment 
There are multiple ways to manage Bowens/IECs. Treatment modalities will depend on the location and size of the cancer, the number of lesions, the degree of functional impairment.  Each modality has both advantages and disadvantages. 

Cryotherapy or liquid nitrogen 
Liquid nitrogen can be an excellent method of treating IECs. Most cases will require a double –freeze cycle of cryotherapy. This treatment is not recommended for IECs below the knee, as poor healing may occur. 

Creams 
Imiquimod, or 5-fluorouracil are effective in the treatment of Bowen disease. Clinical studies have shown cure rates approaching 80-90%. Treatment appears to be most successful when these creams are applied for 6-16 weeks.  

Curettage and Electrocautery
When small patches of IECs are present they may be treated via curettage and cautery. A local anaesthetic is given prior to the procedure to prevent pain and discomfort. 

Photodynamic therapy 
Photodynamic therapy or PDT can be an excellent non-surgical method of treating skin cancers such as Bowen’s/ IEC’s. PDT uses  a photosensitive cream called 5-aminolevulinic acid or methyl aminolevulinate, that is applied to the skin cancer. The cancerous cells of Bowens/ IEC take up this chemical over a period of 3 hours. A low-level laser light then activates the chemical, and destroys the skin cancer cells. Patients will require two treatments spaced a week or two apart. DVA or the Department of Veteran Affairs in Brisbane, covers PDT for both sunspots on the face and also IECs on all areas. PDT can also be used for multiple or large IECs. The benefit of PDT is that it selectively targets neoplastic cells without affecting the surrounding epidermis. This results in improved cosmetic outcomes, and faster healing times. 

Surgery 
Surgery is the ideal method of treating IECs in certain areas including recurrent IEC or ones that dwell in hair follicles. Surgery has the highest cure rate for Bowens/ IECs.

For the majority of patients, especially DVA patients in Australia, non surgical methods, including the use of photodynamic therapy, is the future. Dr Davin Lim, Dermatologist. Brisbane Australia. 


Recommended pimple popping video for the week below

A Goldmine of Blackheads and Whitehead Extractions
in a man with a history of skin cancers- by Dr. Sandra Lee (aka Dr.Pimple Popper)
https://www.youtube.com/watch?v=4daKOqHkDbU


Dear 16 -year-old Me by DCMFCanada
https://www.youtube.com/watch?v=_4jgUcxMezM

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Basal Cell Carcinoma

Surgery for Medical Students

Prof. Ashraf Khater
professor of surgery and onco-surgery , Mansoura university , Egypt

https://www.facebook.com/SurgeryEdu/
أ.د/ أشرف خاطر
أستاذ جراحة الأورام - كلية الطب جامعة المنصورة

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Operative Surgery for Undergraduates
Basic trays for surgery. Need to know all of them.
This is just a small percentage of instruments that you need to know if you are going into the surgery field.
A guide to surgical instruments - what's on a basic surgical tray and what are they for?
When you are doing surgery you need to know what the instruments are called and what they are used for. In this easy to follow guide. You'll learn the names of the instruments, why there are that shape, what they are used for, and some top tips on how to use them. Essential for medical students, people starting surgical training and student nurses on theatre placement.
Scalpel & Blades - Essential Surgical Skills


The VIDEO also offers individuals with a basic knowledge of instruments further information about the instruments and the correct way of passing a surgical instruments. This DEMONSTRATION is just only one way of how to pass the instruments. you as a SURGICAL TECH OR FIRST ASSIST can improvise on however you want to pass the surgical instrument according to the surgeon's preference. BASIC KNOWLEDGE OF HOW TO PASS THE SURGICAL INSTRUMENTS.

SURGICAL TECH
Surgery (Medical Specialty), Surgical, Instruments,
surgery, instuments, surgical instruments, jon lund, school of surgery, scissors, retractor, forceps, operation, basic, sucker,

PASSING OF SURGICAL INSTRUMENTS, HOW TO PASS THE SURGICAL INSTRUMENTS

To learn more about skin cancer (Basal Cell Carcinoma and Squamous Cell Carcinoma) and how we treat it, please visit my website at https://readingdermatology.co.....uk/basal-cell-carcin and https://readingdermatology.co.....uk/squamous-cell-car Basal Cell Carcinoma and Squamous Cell Carcinoma are non-melanoma types of skin cancer. Both conditions can be caused by a combination of fair skin and sun exposure. Take the first step to feel in charge of your skin and book a free consultation at https://readingdermatology.co.....uk/book-a-consultati

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Learn with Dr. Wahdan 2
You can download the lecture from this link
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Basal Cell Carcinoma is the most common type of skin cancer, making up about 75% of all non-melanoma skin cancers diagnosed. BCC tends to grow slowly; however, if left untreated, they can invade other tissues beneath the skin and can spread to other parts of the body.

Download our Basal Cell Patient Support Guide
https://www.melanomanetwork.ca..../wp-content/uploads/

Melanoma Canada
https://www.melanomanetwork.ca/BCC/

Dr. Meredith Overholt, Board Certified Dermatologist explains more in depth about Basal Cell Carcinoma, what it can look like, and how it can be treated. For more health information visit http://www.drbobshow.com/ and our DrBobShow1 YouTube channel at http://www.youtube.com/user/DrBobShow1.