S77 Malignant neoplasm of skin (ICD-10:C44.9)

Introduction

Malignant neoplasm of the skin, also known as skin cancer, is a condition characterized by the abnormal growth of skin cells. It is a significant health concern due to its potential to spread to other parts of the body if not detected and treated early^[1]. The aim of this guide is to provide healthcare professionals with a comprehensive overview of the diagnosis and management of malignant neoplasm of the skin.

Codes

• ICPC-2 Code: S77 Malignant neoplasm of skin^[2]
• ICD-10 Code: C44.9 Malignant neoplasm of skin, unspecified^[3]

Symptoms

• Change in the appearance of a mole or growth on the skin
• Development of a new mole or growth on the skin
• Itching, tenderness, or pain in a mole or growth on the skin
• Ulceration or bleeding from a mole or growth on the skin^[4]

Causes

• Exposure to ultraviolet (UV) radiation from the sun or tanning beds
• History of sunburns
• Fair skin, light-colored hair, and light-colored eyes
• Family history of skin cancer
• Weakened immune system
• Exposure to certain chemicals or substances, such as arsenic^[5]

Diagnostic Steps

Medical History

• Gather information about the patient’s risk factors, such as history of sun exposure, sunburns, and family history of skin cancer
• Inquire about any medical conditions or medications that may weaken the immune system
• Ask about the presence of symptoms, such as changes in the appearance of moles or growths on the skin^[6]

Physical Examination

• Perform a thorough examination of the skin, paying close attention to any moles or growths that appear suspicious
• Use the ABCDE rule to assess moles for signs of malignancy:
  • Asymmetry: One half of the mole does not match the other half
  • Border irregularity: The edges of the mole are not smooth and may be jagged or blurred
  • Color variation: The mole has different colors or shades within it
  • Diameter: The mole is larger than 6 millimeters in diameter
  • Evolution: The mole has changed in size, shape, or color over time^[7]

Determine Severity

• Classify the disease based on severity and depth, if applicable:
  • Stage 0: Carcinoma in situ, where the cancer cells are confined to the outermost layer of the skin
  • Stage I: The cancer is small and has not spread to nearby lymph nodes or other parts of the body
  • Stage II: The cancer is larger and may have spread to nearby lymph nodes, but not to other parts of the body
  • Stage III: The cancer has spread to nearby lymph nodes and may have spread to other parts of the body
  • Stage IV: The cancer has spread to distant parts of the body, such as the lungs, liver, or bones^[8]

Laboratory Tests

• Blood tests: Routine blood tests may be performed to assess overall health and detect any abnormalities that may be associated with skin cancer
• Biopsy: A sample of the suspicious mole or growth is taken and examined under a microscope to determine if it is cancerous
• Genetic testing: In some cases, genetic testing may be recommended to identify specific gene mutations that increase the risk of developing skin cancer^[9]

Diagnostic Imaging

• Imaging modalities, such as X-rays, ultrasound, CT scans, or MRIs, are not typically used in the initial diagnosis of skin cancer. However, they may be used to assess the extent of the disease if it has spread to other parts of the body^[10].

Other Tests

• Sentinel lymph node biopsy: If the cancer has spread to nearby lymph nodes, a sentinel lymph node biopsy may be performed to determine the extent of lymph node involvement
• Dermoscopy: A specialized tool called a dermatoscope is used to examine the skin in detail, allowing for a more accurate diagnosis of skin cancer

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the patient’s progress and assess for any signs of recurrence or new skin lesions
• Educate the patient about the importance of sun protection measures, such as wearing sunscreen, protective clothing, and avoiding excessive sun exposure
• Provide information about self-examination of the skin and encourage the patient to report any changes or new lesions to their healthcare provider

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Malignant neoplasm of skin:

1. Imiquimod:
   • Cost: $100-$300 for a 12-week supply
   • Contraindications: Hypersensitivity to imiquimod or any component of the cream
   • Side effects: Local skin reactions (redness, swelling, itching, burning), flu-like symptoms
   • Severe side effects: Severe skin reactions (ulceration, blistering, scabbing), allergic reactions
   • Drug interactions: None reported
   • Warning: Use with caution in patients with autoimmune conditions
2. 5-fluorouracil:
   • Cost: $100-$300 for a 4-week supply
   • Contraindications: Hypersensitivity to 5-fluorouracil or any component of the cream
   • Side effects: Local skin reactions (redness, swelling, itching, burning), flu-like symptoms
   • Severe side effects: Severe skin reactions (ulceration, blistering, scabbing), allergic reactions
   • Drug interactions: None reported
   • Warning: Use with caution in patients with impaired liver or kidney function
3. Diclofenac gel:
   • Cost: $50-$100 for a 4-week supply
   • Contraindications: Hypersensitivity to diclofenac or any component of the gel
   • Side effects: Local skin reactions (redness, swelling, itching, burning), flu-like symptoms
   • Severe side effects: Severe skin reactions (ulceration, blistering, scabbing), allergic reactions
   • Drug interactions: None reported
   • Warning: Use with caution in patients with a history of asthma or other allergic disorders
4. Ingenol mebutate:
   • Cost: $500-$1000 for a 2-week supply
   • Contraindications: Hypersensitivity to ingenol mebutate or any component of the gel
   • Side effects: Local skin reactions (redness, swelling, itching, burning), flu-like symptoms
   • Severe side effects: Severe skin reactions (ulceration, blistering, scabbing), allergic reactions
   • Drug interactions: None reported
   • Warning: Use with caution in patients with a history of photosensitivity reactions
5. Interferon alfa-2b:
   • Cost: $1000-$2000 for a 4-week supply
   • Contraindications: Hypersensitivity to interferon alfa-2b or any component of the solution
   • Side effects: Flu-like symptoms, fatigue, injection site reactions
   • Severe side effects: Severe allergic reactions, depression, suicidal thoughts
   • Drug interactions: None reported
   • Warning: Use with caution in patients with a history of depression or other psychiatric disorders

Alternative Drugs:

• Photodynamic therapy: A light-activated drug is applied to the skin and activated with a specific wavelength of light to destroy cancer cells. Cost: $500-$1000 per session.
• Chemotherapy: Systemic medications are used to kill cancer cells throughout the body. Cost: Varies depending on the specific chemotherapy drugs used.
• Radiation therapy: High-energy radiation is used to kill cancer cells. Cost: $10,000-$50,000 for a course of treatment.
• Surgical excision: The cancerous lesion is surgically removed. Cost: $1000-$5000, depending on the size and location of the lesion.
• Mohs surgery: A specialized surgical technique that involves removing the cancerous lesion layer by layer until no cancer cells remain. Cost: $2000-$10,000, depending on the size and location of the lesion.

Surgical Procedures:

• Excisional biopsy: The entire suspicious mole or growth is surgically removed and sent for pathological examination. Cost: $1000-$5000, depending on the size and location of the lesion.
• Lymph node dissection: If the cancer has spread to nearby lymph nodes, the affected lymph nodes may be surgically removed. Cost: $5000-$10,000, depending on the extent of lymph node involvement.

Alternative Interventions

• Acupuncture: May help improve overall well-being and reduce stress. Cost: $60-$120 per session.
• Herbal supplements: Some herbal supplements, such as green tea extract and curcumin, may have potential anti-cancer properties. Cost: Varies depending on the specific supplement.
• Mind-body techniques: Practices such as meditation, yoga, and tai chi may help reduce stress and improve quality of life. Cost: Varies depending on the specific practice and location.
• Dietary modifications: A healthy diet rich in fruits, vegetables, and whole grains may help support overall health and reduce the risk of cancer. Cost: Varies depending on individual food choices.
• Topical creams: Some topical creams containing natural ingredients, such as aloe vera or chamomile, may provide relief from skin irritation caused by cancer treatments. Cost: Varies depending on the specific product.

Lifestyle Interventions

• Sun protection: Encourage the patient to use sunscreen with a high SPF, wear protective clothing, and seek shade during peak sun hours. Cost: $10-$30 for a bottle of sunscreen.
• Avoidance of tanning beds: Educate the patient about the risks of using tanning beds and discourage their use. Cost: Varies depending on individual choices.
• Regular self-examination: Teach the patient how to perform regular self-examinations of their skin to detect any changes or new lesions. Cost: None.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – S77 Malignant neoplasm of skin (ICD-10:C44.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Malignant neoplasm of skin effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Malignant neoplasm of skin. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Skin cancer – Symptoms and causes – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/skin-cancer/symptoms-causes/syc-20377605
2. ICPC-2 – English. https://www.gesy.org.cy/el-gr/annualreport/icpc-2-english1-10.pdf
3. 2024 ICD-10-CM Diagnosis Code C44.9. https://www.icd10data.com/ICD10CM/Codes/C00-D49/C43-C44/C44-/C44.9
4. 9 Top Skin Cancer Symptoms & Signs. https://www.mdanderson.org/cancer-types/skin-cancer/skin-cancer-symptoms.html
5. Risks and causes | Skin cancer. https://www.cancerresearchuk.org/about-cancer/skin-cancer/risks-causes
6. Skin cancer – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/skin-cancer/diagnosis-treatment/drc-20377608
7. Skin cancer symptoms – Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/skin-cancer/symptoms
8. Skin Cancer: Symptoms, Types & Treatment – Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15818-skin-cancer
9. Diagnosis and management of skin cancer – ScienceDirect.com. https://www.sciencedirect.com/science/article/pii/S1357303921000967
10. Skin Cancer – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK441949/