Derm- skin cancer Flashcards
what is basal cell carcinoma
a skin cancer originating from the basal keratinocytes within the epidermis, usually secondary to DNA damage caused by UV radiations
what is the most common malignant skin tumour
basal cell carcinoma
most commonly involved sites of basal cell carcinoma
sun-exposed areas of head and neck
risk factors for basal cell carcinoma
family history/previous history
genetic syndromes
pale skin/light hair- Fitzpatrick type I/2
high levels of sun/UV exposure
immunosuppression
chronic inflammation
smoking
old age and male sex
is basal cell carcinoma slow/fast growing?
slow growing
does basal cell carcinoma often mestastesize?
rarely- almost never
what do nodular basal cell carcinomas look like
shiny
pearly nodule
superficial telangiectasia
may be ulcerated
what do superficial basal cell carcinomas look like
erythematous
well-demarcated
scaly plaques
often larger than 20mm at presentation
what are infiltrative basal cell carcinomas characterised by
thickened yellowish plaques
typical management of nodular basal cell carcinoma
excise
typical management of superficial basal cell carcinoma
non-surgical
typical management of infiltrative basal cell carcinoma
Mohs surgery
which type of basal cell carcinoma may be ulcerated
nodular basal cell carcinoma
what is squamous cell carcinoma
malignant tumour that arises from supra-basal keratinocytes
what is the most common skin cancer in the immunosuppressed population
squamous cell carcinoma
which type of skin carcinoma may be painful and/or bleed
squamous cell carcinoma
what factors determine a poor prognosis in squamous cell carcinoma
metastases
size- diameter >20mm
depth- >4mm
poorly differentiated
immunocompromised
what is malignant melanoma
proliferation of atypical melanocytes with potential for dermal invasion and widespread metastasis
abcde checklist for skin cancer
a- asymmetry
b- irregular Border
c- variable Colour
d- diameter >6mm
e- evolution/elevation
what is the Breslow depth
measured from the granular layer of the epidermis down to the deepest point of invasion
Smaller the depth = better prognosis
what is the most aggressive type of melanoma
nodular melanoma
where does nodular melanoma often present
trunk
how does nodular melanoma usually present
rapidly growing pigmented nodule, which bleeds or ulcerates
what are acral malignant melanomas
subtype of melanoma that arise as pigmented lesions on the palm or sole or under the nail, and usually present late
what is different about the way nodular melanomas grow compared to other melanomas that make them more aggressive
grow vertically from the outset
breslow thickness-
confined to epidermis (in-situ) 5 year survival rate?
100% 5 year survival
breslow thickness- <0.76mm 5 year survival rate?
90% 5 year survival
breslow thickness-
>3mm 5 year survival rate?
60% 5 year survival rate
when breslow thickness is >1mm what investigation should be carried out?
sentinel node biopsy
what is the most common type of melanoma
superficial spreading melanoma
what are Actinic (solar) keratoses
partial thickened dysplasia of epidermal keratinocytes
A small minority (<1%) of actinic keratoses undergo malignant transformation into what type of skin cancer?
squamous cell carcinoma
what do Actinic (solar) keratoses look like
scaly, erythematous papules/patches that feel gritty and rough
where do Actinic (solar) keratoses appear
sun exposed skin- marker of chronic skin damage
what is Bowens disease
squamous cell carcinoma in situ- full thickness dysplasia of epidermal keratinocytes
where does Bowens disease typically occur
lower legs in fairer skin women
torso in men
what is Keratoacanthoma
Rapidly growing epidermal tumours
what is the management of keratoancanthoma
surgical excision- may spontaneously resolve within a few months but can be difficult to distinguish between SSC
what is cryotherapy
extreme cold, liquid nitrogen, applied to tumour to destroy tumour
what is curretege
use of a curette to scrape or remove tissue from the body
what is cautery
the use of heat or chemicals to destroy or remove abnormal tissue
what is the downside of using cryotherapy in patients with darker skin
may cause hypopigmentation in long term
weaknesses of using curretege to remove tumour
possibly painful
risk dyspigmentation scarring
MUST AVOID SUN
topical therapies used to treat dysplastic/pre-malignant skin lesions
fluorouracil cream
imiquimod cream
what should patients be warned about before using fluoroucil cream
lesion may erupt and become worse before it gets better
avoid sun exposure
squamous cell carcinoma in situ can also be referred to as what
Bowens disease
actinic keratosis is the result of DNA damage by which type of UV rays?
UVB rays
when surgically excising a lesion how much do you excise
all of it- 1cm laterally for every 1mm depth
what skin cancer looks like a picket fence with a pearly border
basal cell carcinoma
