Derm - Malignancies Flashcards
Describe the typical appearance of a BCC.
Most common over head + neck:
- skin-coloured nodule with pearly rolled edge + surface telangiectasia
- +/- necrotic/ulcerated centre
Suggest risk factors for dev. of BCCs
- UV exposure and Hx of frequent/severe sunburn in childhood
- skin type I
- increased age
- male
- immunosuppression
- PMHx of skin cancer
- genetic predisposition e.g. xeroderma pigmentosum, albinism, basal cell naevus/Gorlin’s synd.
A 70yo man presents to derm 2ww clinic and is diagnosed with a BCC on his cheek.
What are the management options?
Surgery acceptable to pt:
- surgical excision (Tx of choice) with 4mm margins
- Mohs micrographic surgery: if high risk
Surgery not-acceptable:
3. RT: if high risk, high success rate but poorer cosmetic outcome and risk of complications
4. cyrotherapy or curretage + cautery
5. topical IMIQUIMOD for 6/52
topical FLUOROURACIL for 3-6/52
Describe the typical appearance of SCC.
Usually on sun-exposed areas:
- keratotic (e.g. scaly, crusty)
- ill-defined nodule
- may ulcerate
Describe 2 pre-malignant skin conditions that can lead to SCC.
- ACTINIC KERATOSIS
- pink, red brown or skin-coloured crusty or scaly lesions on sun exposed areas - BOWEN’S DISEASE (SCC in situ)
- slow-growing, erythematous, scaly irregular pink/brown patch
- dermoscopy: irregular clusters of coiled BVs (glomerular)
Suggest RFs for dev of SCCs
- excessive UV exposure
- immunosuppresion
- smoking
- chronic inflammation e.g. leg ulcers (Marjolin’s ulcer), wound scars
- genetic predisposition e.g. xeroderma pigmentosum, oculocutaneous albinism
A 50yo man presents to derm 2ww clinic and is diagnosed with an SCC on his cheek.
What are the management options?
- surgical excision
- Mohs microcraphic surgery: if tumour in sensitive location, >2cm diameter or any recurrent tumours
- RT: if large non-resectable tumours
A 60yo woman presents with a scaly irregular pink patch on her leg, present for 6/12. On dermoscopy, clusters of coiled blood vessels are seen.
What are the Tx options?
- topical FLUOURACIL (Efudex) for 3-4/52 (then topical fucidin to clear up side effects)
- cyrotherapy
2nd line (if recurrence or no response): 3. surgical excision or Mohs micrographic surgery
An 76yo man presents with 3x4cm red crusty lesion on his scalp. He is diagnosed with actinic keratosis.
What are the Tx options?
- crytotherapy OR
- topical IMIQUIMOD
topical FLUOROURACIL
Suggest risk factors for malignant melanoma.
- excessive UV exposure inc. sunbed use
- skin type 1
- > 100 common naevi or >2 atypical naevi
- FHx or previous Hx of melanoma
Where are melanomas most commonly located?
- trunk in men
- legs in women
A 35yo woman presents with a rapidly growing pigmented lesion on her leg.
How would you investigate?
- dermoscopy
- full-thickness excisional biopsy
Staging (do not offer if stage IA or IB with Breslow thickness <1mm):
- sentinel LN biopsy
- CT chest/abdo/pelvis +/- CT brain (if suspected stage 4)
- FBC + LDH (prognosis)
What is Breslow staging?
Thickness of melanoma, predicts recurrence rate:
- <0.76mm: low risk
- 0.76-1.5mm: medium risk
- > 1.5mm: high risk
What are the management options for melanoma?
- surgical excision: WLE with clinical margins at least
- 0.5 cm in stage 0
- 1 cm in stage I
- 2cm in stage 2 - lymphadenectomy, LN dissection or RT sometimes used in higher stage disease
- chemotherapy for metastatic disease
