6) common malignant tumours Flashcards
Who gets melanoma?
pale people increasing age previous skin malignancy many moles >5 atypical naevi strong FHx
What causes melanoma?
Uncontrolled proliferation of malnocytic stem cells
genetic transformation of these cells give different growth phases
superficial forms have a radial/ horizontal phase
nodular has a vertical growth phase
What are precursor lesions to melanoma?
benign melanocytic naevus
atypical/dysplastic naevus
atypical lentiginous junctional naevus (flat on sun damaged skin)
large congenital melanocytic naevus
What are the clinical features of melanoma?
-can occur anywhere, rarely mucus membanes, eye etc
-unusual looking freckle/mole
normally flat in early stages
some may be itchy or tender, advanced lesions may bleed
what are the ABCDEs of melanoma?
Asymmetry Border irregularity Colour variation Diameter over 6mm Evolving
What is the glasgow 7 point checklist?
Major: change in size, irregular shape, irregular colour
Minor features: diameter >7, inflammation, oozing, change in sensation
How are melanomas classsified?
Superficial spreading
lentigo maligna melanoma
acral lentigious melanoma (soles/palms)
bad ones: nodula, mucosal. ocular
How is melanoma diagnosed?
suspected on clinical features
dermatoscopic appearance is helpful
dermal invasion can show melanocytes in the dermis/ deeper in the fat on pathology
earlier ones may have atypical melanocytes
What features should be included on the path report?
Diagnosis of primary melanoma
Breslow thickness to the nearest 0.1 mm
Clark level of invasion
Margins of excision i.e. the normal tissue around the tumour
Mitotic rate – a measure of how fast the cells are proliferating
Whether or not there is ulceration
What is a breslow thickness/clark level?
breslow thickness= thickness of the lesion
clark is anatomical plane of invasions- epidermis to subcut tissue
Treatment for melanoma?
WLE +- LN removal after sentinal node biopsy
experimental treatments include immunotherpaies, BRAF inhib, MEK inhib, CTLA4 antagonists, PD1 blocking antibodies
Why are pts with melanoma followed up?
look for relapse but also high rate of new primaries (5-10%)
What advice should you offer people with melanoma?
Skin checks
follow up
professional skin checks
education/support
What is squamous cell carcinoma?
Non melanotic skin cancer
derived from cells that make keratin, invasive and can occasionally metastasise
RF for squamous cell carcinoma?
Age and gender: elderly males previous SCC actinic keratoses outdoor occupation smoking fair skin previous injury inherited syndromes: xeroderma pigmentosum/albinism raidation/immunosuppression
