basal cell carcinoma and squamous cell carcinoma

Question 1

Squamous cell carcinoma Risk factors

Answer 1

excessive exposure to sunlight / psoralen UVA therapy

actinic keratoses (most common)
and Bowen’s disease

immunosuppression e.g. following renal transplant, HIV

smoking

long-standing leg ulcers (Marjolin’s ulcer)

genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

Question 2

Features of SCC

Answer 2

sun-exposed sites such as the head and neck or dorsum of the hands and arms

rapidly expanding painless, ulcerate nodules
with raised edge

may have a cauliflower-like appearance

there may be areas of bleeding

lower lip - linked to smoking

Question 3

tx of scc?

Answer 3

Surgical excision with 4mm margins if lesion <20mm in diameter.

If tumour >20mm then margins should be 6mm.

Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

Question 4

prognosis of scc ?

Answer 4

Good Prognosis
<20mm diameter
<2mm deep
No associated diseases

Poor prognosis
>20mm in diameter
>4mm deep
Immunosupression for whatever reason

20 percent have 2nd SCC in 3 years

Question 5

x

Question 6

what is actinic keratosis ?

Answer 6

premalignant skin lesion that develops as a consequence of chronic sun exposure

Question 7

actinic keratosis features ?

Answer 7

small, crusty or scaly, lesions

may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present

Question 8

Management options include

Answer 8

prevention of further risk: e.g. sun avoidance, sun cream

fluorouracil cream: typically a 2 to 3 week course.
The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation

topical diclofenac: may be used for mild AKs.

topical imiquimod: trials have shown good efficacy

cryotherapy

curettage and cautery

Question 9

Basal cell carcinoma features ?

Answer 9

slow-growth and local invasion

sun-exposed sites, especially the head and neck account for the majority of lesions

most common type is nodular BCC - initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’

almost never mets

Question 10

Management of basal cell carcinoma ?

Answer 10

excision biopsy with 4 mm margin is gold

mom’s micrograph surgery - segments are excised in stages and examined

curettage - - <1cm

topical cryotherapy or medications
5-fluorouracil
imiquimod

radiotherapy - alternative to surgery
may have poor cosmetic outcome