CBL - Skin Lesion Assessment & Skin Cancer Flashcards
Give examples of skin lesions [9]
- moles,
- viral warts,
- seborrhoeic warts,
- haemangiomas,
- actinic keratoses,
- skin cancers (melanoma, BCC, SCC)
- epidermoid “sebaceous” cysts/tricho cysts,
- Bowen’s Disease,
- lipomas
List some cell types that are commonly involved in skin lesions [3]
- squamous keratinocyte cells,
- basal epithelial keratinocytes,
- melanocytes
Give a list of skin lesions which could present in an older man (over 70yrs) in the…
- Back [5]
- Scalp [6]
(Older man, likely to have sun damage, may be balder)
- Back
- seborrhoeic wart,
- fleshy mole,
- pigmented dermatofibroma,
- melanoma,
- pigmented BCC
- Scalp
- actinic keratosis,
- irritated haemangiomas,
- Bowen’s Disease,
- melanoma,
- BCC,
- SCC
Give a list of relevant risk factors that may be implicated in lesion development in an older patient including areas such as previous occupations, associated medical conditions [9]
- natural UV sun exposure,
- sun beds,
- photosensitising drugs,
- radiotherapy,
- immunosuppression
- outdoor workers,
- pilots,
- armed forces,
- gardeners
List the 3 main skin cancers [3]
- basal cell carcinoma
- squamous cell carcinoma
- melanoma
List the diagnostic clinical features and symptoms which can occur with each type of skin cancer:
- basal cell carcinoma [5]
- squamous cell carcinoma [5]
- melanoma [3]
- Basal cell carcinoma:
- ulceration,
- telangiectasia,
- pearly margin, red/pink,
- crusting,
- bleeding
- Squamous cell carcinoma:
- keratotic,
- crusting,
- bleeding,
- scaly,
- pain
- Melanoma:
- normally hyperpigmentation,
- irregular macule sometimes nodule,
- rarely ulcerated
Describe the typical presentation for basal cell carcinoma:
- onset/fast or slow growing? [2]
- anatomical locations [4]
- typical age of onset [1]
- size [2]
- shape [2]
- very slow growing, often many months even years
- occurs in sun exposed sites, often:
- head and neck,
- nose,
- paranasal areas
- can occur at any age with significant sun exposure late 20’s onwards.
- starts small, a few mms and expands,
- can be flat superficial type or start as small elevated papule becoming a nodule
Describe the typical presentation for squamous cell carcinoma:
- onset/fast or slow growing? [3]
- anatomical locations & higher risk zones [7]
- typical age of onset [1]
- potential spread? [1]
- can be mixed onset,
- sometimes slow insidious onset,
- occasionally rapidly progressive
- occurs in any sun exposed site, but can also develop on other areas e.g.
- chronic ulcers,
- burns,
- trauma,
- radiation treatment zones
- higher risk zones:
- ears,
- lips
- usually middle age to elderly
- metastatic LN spread can occur
Describe the typical presentation for melanoma:
- anatomical locations generally [1]
- males tend to get it on… [1]
- females tend to get it on… [2]
- unusual sites? [3]
- onset [1]
- presentation [2]
- complications/spread? [3]
- most melanomas don’t originate in pre-existing melanocytic naevi, rather in normal sun damaged skin.
- men tend to get it on upper back,
- females tend to get it on lower posterior legs, but any site, usually sun damaged areas
- Unusual sites:
- genitals,
- acral,
- nails
- relatively slow growing over months
- presentation:
- area of pigmentation rarely not pigmented
- can become nodular or ulcerated.
- metastatic spread, lymph nodes, organomegaly
For the 3 main skin cancers consider the initial diagnostic tests taken (if needed):
- basal cell carcinoma [3]
- squamous cell carcinoma [4]
- malignant melanoma [4]
- Basal cell carcinoma:
- often clinical,
- sometimes biopsy
- e.g. punch biopsy or curette or excise whole
- Squamous cell carcinoma
- often clinical,
- sometimes biopsy
- e.g. punch biopsy or curette or excise whole
- check lymph nodes
- Malignant melanoma:
- photography,
- ideally full excision
- (except in large lesions, smaller diagnostic incisional)
- lymph node assessment
Discuss the prognosis of each type of skin cancer and diagnostic measurements/markers or tests:
- basal cell carcinoma [3]
- squamous cell carcinoma [6]
- melanoma [2]
- Basal Cell Carcinoma
- most treatment curative,
- good prognosis,
- highest risk separate second new lesion
- Squamous Cell Carcinoma
- most surgical excision curative
- risk of recurrence,
- metastatic spread
- staging: risk assessment to guide prognosis:
- thickness of tumour,
- size,
- lymphatic invasion
- Melanoma:
- most melanomas in good prognosis category with a thin histological Breslow thickness
- In high risk, thicker melanomas, may carry out sentinel lymph node studies, CT scans, blood LDH
What is the most appropriate further management for basal cell carcinoma? [1]
full surgical excision with 4mm margin
What is the most appropriate further management for squamous cell carcinoma? [2]
- full surgical excision with 4-5 mm margin,
- consideration of radiotherapy
What is the most appropriate further management for melanoma? [4]
- wide margin wide local excision (1-2 cm),
- lymph node assessment,
- BRAF genetic status,
- targeted anti BRAF treatment e.g. debrafanib or
- immunotherapies e.g. nivolumab
What are the different skin cancer staging tools and the UK guidelines on skin cancer management? [3]
- SIGN Guidelines Melanoma
- AJCC 8 Staging for Melanoma
- BAD Guidelines on management of melanoma
