Benign and malignant skin lesions

Question 1

Basal Cell carcinoma?

Answer 1

a slow growing, locally invasive malignant tumour of the epidermal keritinocytes normally in older individuals.
(rarely metastesises)

Question 2

what is the most common malignant skin tumour?

Answer 2

basal cell carcinoma

Question 3

what are the risk factors for basal cell carcinoma

Answer 3

• UV exposure
• frequent sunburn in childhood
• skin type 1 (always burns never tans)
• increasing age
• male
• immunosuppression
• genes

Question 4

what are the different types of basal cell carcinoma?

Answer 4

• nodular (most common)
• superficial (plaque like)
• cystic
• morphoeic (sclerosing)
• ketatotic
• pigmented

Question 5

how do nodular basal cell carcinomas present?

Answer 5

• small, skin coloured papule or nodule with telangiectasia and a pearly rolled edge.
• may have a necrotic or ulcerated centre (rodent ulcer)
• most common on head / neck

Question 6

what is the management of basal cell carcninomas / squamous cell carcinomas?

Answer 6

1) surgical excision (allows histological examination of tumour and margins)
2) Mohs micrographic surgery ( progressive excision of lesion until tumour free specimens found - done for recurrent / high risk tumours)
3) Radiotherapy (when surgery inappropriate)
4) other e.g. cryotherapy, curettage, cautery

Question 7

squamous cell carcinoma?

Answer 7

• locally invasive malignant tumour of the epidermal keratinocytes
• can metastesise

Question 8

What are the risk factors for squamous cell carcinoma?

Answer 8

• UV exposure
• actinic keratoses
• chronic inflammation e.g. wounds, ulcers
• immunosupression
• genes

Question 9

How do squamous cell carcinomas present?

Answer 9

• keratotic (e.g. scaly , crusty)

- ill defined nodule which may ulcerate.

Question 10

Malignant melanoma?

Answer 10

invasive malignant melanoma of epidermal melanocytes which has potential to metastasise.

Question 11

what are the risk factors for melanomas?

Answer 11

• UV
• skin type 1
• multiple moles / atypical moles
• family history
• previous melanoma

Question 12

What is the “ABCDE Symptoms”

presentation of melanomas

Answer 12

Asymmetrical shape
Border irregularity
Colour irregularity
Diameter > 6mm
Evolution of lesion (change in size or shape)
Symptoms = bleeding, itching

Question 13

how is the prognosis of melanomas assessed?

Answer 13

• Breslow thickness
• < 0.76 mm then low risk
• 0.76 to 1.5mm thick medium risk
• > 1.5mm thick = high risk

TNM for 5 yr survival