6- Dermatology (skin cancer) Flashcards
BCC RF
Risk factors
- Caucasian (type I and II)- fair
- Sun exposure (UV)/ sun burn
- Older age
- Previous skin cancer
- Immunosuppression
- Albinism
- Inherited syndrome e.g. Gorlin syndrome
BCC presentation
- Slow growing plaques or nodules
- Early lesions are small, translucent or pearly and have raised areas with telangiectasia
- Varies in size
- Spontaneous bleeding
- Occurs in sun exposed sites apart from the ear
- Indurated edge and ulcerated centre
- Slow growing but can spread deeply to cause considerable destruction
investigations for BCC
- Visual inspection
- Punch biopsy if treatment other than standard surgical excision is planned
BCC management
Depends on size, type and location.
- Can be managed in primary care as long as GP trained to perform skin surgery
Surgical excision is the mainstay of treatment
1) Normal surgical excision of cancer
2) Mohs micrographic surgery (4mm margins) Best treatment: gold standard but not used that often
–> Involves examining carefully marked excised tissue under microscope later by layer to ensure complete excision
->Very high cure rates
Non-surgical
e.g. superficial BBC or if they decline or unfit for surgery
- Curettage and cautery
- Cryotherapy (liquid nitrogen)
- Imiquimod cream
- 5-Fluorouracil
- Radiotherapy if margins incomplete
management of advanced or metastatic BCC
- Surgery
- Radiotherapy
- Target therapy
Prevention of BCC
- Avoid sunburn esp in fair skinned
- Oral nicotinamide (vitamin B3)
Prognosis for BCCs
- Most BCCs cured by treatment
- 50% develop second one within 3 years of first
o At increased risk of melanoma - Advanced BCC very rare- often neglected tumours
- Metastaic BCC very rare
squamous cell carcinoma
Squamous cell carcinoma
Background
- Malignant tumour arising from keratinising cells of the epidermis
- Locally invasive (passes basement membrane) and has the potential to metastasise
- Types e.g.
o Cutaneous horn
o Keratoacanthoma
SCC causes
- Older patients
- Previous skin cancer
- Smoking
- Inherited syndromes e.g. xeroderma pigmentosum
- Related to sun exposure (UVR)
- Fair skin
- Chemical carcinogens- arsenic
- HPV
- Chronic inflammation
- May arise in pre-existing solar keratoses
- Immunosuppression after transplant
SCC presentation
- Grow quickly over weeks to months (much faster than BBC)
- Indurated nodular keratinising or crusted tumour that may ulcerate without evidence of keratinisation
- Non healing ulcer or growth in one of the highest risk sun exposed area
- Centre becomes necrotic and becomes an ulcer
- Ulcer with hard, raised edges
- Bleeding
- Size varies from a few mm to several CM
Investigations for SCC
- Visual inspection
- Biopsy for histology
- If high risk: imaging using US, Xray, CT, MRI, lymph node biopsy
Classification of SCC
Based on low-risk or high-risk, depending on the chance of the tumour recurrening or metastasing
High-risk SCC
- Diameter greater than or equal to 2 cm
- Location on the ear, vermilion of the lip, central face, hands, feet, genitalia
- Arising in elderly or immune suppressed patient
- Histological thickness greater than 2 mm, poorly differentiated histology, or with the invasion of the subcutaneous tissue, nerves and blood vessels.
SCC staging
Staging: TNM
management of SCC
1) Nearly always treated surgically
- Wide local excision – repeat surgery to gain adequate margins may eb required
- Mohs’ micrographic surgery- precise technique in which excision of skin lesion is carried out in stages and checked histologically
Other non-surgical procedures
- Curettage and cautery
- Crytotherapy
- Imiquimod cream
- Photodynamic therapy (PDT)
- Electrochemotherapy
- Radiotherapy