7. Skin Tumours Flashcards
= Salmon plaque with silvery scales
= Topical doxycycline
= He has a BCC which should be managed with surgical excision.
= SCC
= Tumours in people of older age.
Outline the changes associated with actinic damage?
What are the causes of Actinic Damage?
What is Sun Sensitivity?
- Who are the sun sensitive patients?
- What causes abnormal photosensivity?
- Sun sensitivity describes how susceptible an individual is to the effects of solar radiation.
- It is genetically determined and is measured by how quickly an individual develops redness (or sunburn) on exposure to ultraviolet light.
- Patients who are genetically predisposed show signs of sun damage at an early age.
What is Sunburn?
- Skin Phenotypes?
Solar Keratoses
- Description?
- Location?
- Variation?
- Risks?
- Treatments? (6)
Basal Cell Carcinoma
- 6 Clinical variants?
- Epidemiology?
Basal Cell Carcinoma
- BCC is the most common skin cancer found in the Australian population.
- It is a locally invasive non-melanocytic cancer with low potential to metastasize.
What type of BCC is this?
- 6 Clinical Features?
= Nodular BCC
What type of BCC is this?
- 5 Clinical Features?
= Superficial BCC
What type of BCC is this?
- 4 Clinical Features?
= Ulcerative BCC
What type of BCC is this?
- 6 Clinical Features?
= Morphoeic BCC
What type of BCC is this?
- 4 Clinical Features?
= Pigmented BCC
What type of BCC is this?
- 3 Clinical Features?
= Recurrent BCC
List 4 Differentials for Nodular BCC?
List 5 Differentials for Superficial BCC?
List 4 Differentials for Pigmented BCC?
List 1 Differential for Morphoeic BCC?
= Scar tissue
List 4 Differentials for Ulcerative BCC?
Describe the Assessment of BCC as either High or Low Risk.
- 5 Clinical Risk Factors?
- 2 Pathological Risk Factors?
List the 7 Treatment options for BCC?
Management of BCC
- Surgical Excision?
- Liquid nitrogen cryotherapy?
- Curettage and Cautery?
- Topical Imiquimod (Aldara cream)?
- Photodynamic therapy (PDT)?
- Mohs Micrographic surgery?
Radiation treatment
- Suitable for definitive treatment of high-risk tumours and also as adjunctive treatment following surgical treatment of high-risk tumours.
- The main high-risk tumour indications are recurrent BCCs and SCCs, incomplete excision, perineural invasion, and where surgery would produce more disfigurement than radiation.
- Also suitable for lower risk tumours in certain situations, especially older patients who are unfit for surgery.
Squamous Cell Carcinoma
- Background?
- Epidemiology & Risk Factors?
Squamous Cell Carcinoma
- Clinical Features?
- Pathogenesis: Sun exposure? Viral transformation? Rare causes of cutaneous SCC?
Squamous Cell Carcinoma
- List 8 Differential diagnoses for well to moderately differentiated SCCs?
- List 5 Differential diagnoses for poorly differentiated SCCs?
- Outline the management of Cutaneous SCC?
- Outline the management of Advanced SCC?
- Follow-up?
Management – Follow-up
- Regular follow up of SCC patients is necessary to examine the scar for recurrence, to palpate the draining lymph nodes, and to check for new, unrelated lesions.
- If draining lymph nodes are enlarged, fine needle aspiration may confirm metastasis.
- However, if this investigation is inconclusive, excisional lymph node biopsy is required.
- The management of lymph node metastases involves surgical excision and/or wide field radiotherapy.
Keratoacanthoma
- Definition?
- Clinical Features?
- Treatment?
Bowen’s Disease (SCC In-Situ)
- Background?
- Clinical Features?
- Pathogenesis?
Pathogenesis
- Related to excessive UV exposure and is relative to skin type.
- If lesions are multiple or seen in relatively sun-protected skin, consider the possibility of past exposure to arsenic, radiation, or an underlying genetic disorder.
Bowen’s Disease (SCC In-Situ)
- Diagnosis?
- 9 Differentials?
- Prognosis?
- Treatment?
Diagnosis
- Histological diagnosis
- All layers of the epidermis are dysplastic in Bowen’s disease.
- In actinic keratosis, there is only partial thickness dysplasia within the epidermis.
Prognosis
- Bowen’s disease is a slow progressive condition.
- Up to 10% of lesions of Bowen’s disease may progress to SCC if left untreated, although this invasive transformation may take many years to occur.
= It is a rare form of skin cancer (FALSE)
= Keratoacanthoma
= SCC
= Pityriasis versicolour
= SCCs on the arm are more likely to metastasize than SCCs on the lip (FALSE)
= Nodular melanoma
= She will require a wide local excision with a surgical margin of 2cm.
= Nodular melanoma can often be misdiagnosed as non-melanoma skin cancer (FALSE)
= Hair follicles
= Dysplastic neavus carries a small individual risk of transformation into melanoma.
Epidemiology of Melanoma?
4 Clinical Variants of Melanoma?
Superficial Spreading Melanoma
- Epidemiology?
- Risk Factors?
- Clinical Features?
Lentigomaligna Melanoma
- Epidemiology?
- Risk Factors?
- Clinical Features?
Acral Lentiginous Melanoma
- Epidemiology?
- Risk Factors?
- Clinical Features?
Nodular Melanoma
- Epidemiology?
- Risk Factors?
- Clinical Features?
What history are you going to take from a patient with suspected melanoma?
What are Radial Growth Phase Melanomas?
- Which 3 types begin with this?
- ABCDEs of melanoma?
What are Vertical Growth Phase Melanomas?
- Which types begin with this?
- EFGs?
Common Acquired Melanocytic Naevi
- Differentiating features from Melanoma?
- Clinical features?
- Classification?
Spitz Naevi
- Description?
- Clinical features?
Congenital Naevi
- Differentiating Features/Description?
- Clinical Features?
Halo Naevi
- Differentiating Features/Description?
- Clinical Features?
Solar Lentigines
- Differentiating Features/Description?
- Clinical Features?
Freckles (Ephelides)
- Differentiating Features/Description?
- Clinical Features?
Blue Naevi
- Differentiating Features/Description?
- Clinical Features?
Dysplastic Naevi
- Description?
- Clinical Features?
- Treatment?
Seborrhoeic Keratosis
- Description?
- Clinical features?
- Treatment?
Skin Tags
- Description?
- Clinical features?
- Treatment?
Dermatofibroma
- Description?
- Clinical features?
- Treatment?
Sebaceous (Epidermoid) Cyst
- Description?
- Clinical features?
- Treatment?
Sebaceous Hyperplasia
- Description?
- Clinical features?
- Treatment?
Campbell de Morgan spots
- Description?
- Clinical features?
- Treatment?
How are suspicious lesions diagnosed?
What is Breslow thickeness?
What are the different surgical margins required depending on Breslow thickness?
Outline the treatment options for melanoma.
- When would you consider a sentinel lymph node biopsy?
Which sunscreen ingredients are:
a. Reflective?
b. Absorptive?
What is SPF?
= She will require a wide local excision with a surgical margin of 2cm
= Lentigo maligna melanoma occur in the elderly and are associated with cumulative sun exposure.
