Dermatological Malignancies Flashcards
Main diagnostic features of malignant melanoma
Change in size
Change in colour
Change in shape
Secondary features of malignant melanoma (minor criteria)
Diameter >/=7mm
Inflammation
Oozing or bleeding
Altered sensation
What is the most common form of malignant melanoma?
Superficial spreading
Who does superficial spreading malignant melanoma most commonly effect?
Arms, legs, back and chest, young people
Who does nodular malignant melanoma most commonly effect?
Sun exposed skin, middle-aged people
Who does lentigo maligna melanoma most commonly effect?
Chronically sun-exposed skin, older people
Who does acral lentiginous malignant melanoma most commonly effect?
Nails, palms or soles, African Americans or Asians
Appearance of superficial spreading malignant melanoma
Growing mole with diagnostic features listed
Appearance of nodular malignant melanoma
Red or black lump or lump which bleeds/oozes
Appearance of lentigo maligna malignant melanoma
Growing mole with diagnostic features listed
Appearance of acral lentiginous malignant melanoma
Subungal pigmentation (Hutchinson’s sign) or on palms of feet
Investigations in malignant melanoma
If the lesion has any suspicious features it should be referred under 2WW pathway
ABCDE of malignant moles
Asymmetry
Border irregularity (melanoma often has a ‘scalloped’ border)
Colour variation (a variegated lesion is one that consists of many colours)
Diameter >6mm
Evolves over time
What is “ugly duckling sign”?
Any lesion that sticks out from the others should be suspected for malignancy
What is “Breslow thickness”?
Breslow thickness is the depth of the tumour and is a strong predictor of outcome
What is the significance of Breslow thickness <1mm
Sentinel node biopsy should be carried out
This looks for evidence of metastases and stage the cancer
Management of malignant melanoma
Referral to dermatology under 2WW
Suspicious lesions should undergo excision biopsy
Lesion should be removed completely
Sentinel lymph node mapping
Isolated limb perfusion
Block dissection of regional lymph node groups
What is the single most important factor in determining malignant melanoma prognosis?
Breslow thickness
Define basal cell carcinoma
Locally invasive tumour of epidermal keratinocytes
Risk factors for basal cell carcinoma
Type I or II skin
History of frequent or severe previous sun burn
Outdoor occupation or hobbies
Personal or family history of skin cancer
Immunosuppression
Increasing age
Male sex
Clinical features of basal cell carcinoma
Small, skin-coloured or pink nodule with central depression
Often have pearly rolled edge and surface telangiectasia
In older lesions, centre can become necrotic/ulcerated
Located on sun exposed areas of skin, especially head and neck
Do not cause pain or bleeding
Typically very slow growing
Management of basal cell carcinoma
Dependent on size, location, type and local guidelines
Majority surgical excision with a 4mm margin
Curettage and cautery
Mohs micrographic surgery if in a cosmetically sensitive area or appears ill-defined
Cryotherapy
Photodynamic therapy
Radiotherapy as adjunct or if surgery inappropriate
Topical therapies such as Imiquimod or 5-Fluorouracil
What is the most common type of skin cancer?
Basal cell carcinoma
What does mohs surgery involve?
Examining excised tissue under the microscope as it is removed to ensure all the cancerous cells are removed whilst preserving the maximum amount of healthy tissue
Define squamous cell carcinoma
Locally invasive malignant tumour of epidermal keratinocytes
Risk factors for squamous cell carcinoma
Type I or II skin
History of frequent or severe previous sun burn
Outdoor occupation or hobbies
Personal or family history of skin cancer
Immunosuppression, especially following organ transplant
Smoking
Premalignant skin conditions such as Actinic Keratosis or Bowen’s Disease
Increasing age
Male sex
What is Bowen’s disease?
aka intraepidermal SCC or SCC in situ
Pre-malignant
Tumour cells are confined to the epidermis
Appears as an irregular, red, keratinised, scaly plaques classically located on areas of sun exposed skin
Clinical features of squamous cell carcinoma
Can cause pain, tenderness or bleeding
Grow over weeks or months
Often occur on sun exposed areas of skin e.g. face, scalp, ears, hands and shins
Management of squamous cell carcinoma
Surgical excision
Curettage and cautery
Mohs micrographic surgery if the SCC is in a cosmetically sensitive area, is ill-defined or recurrent
Cryotherapy
Radiotherapy if surgery is inappropriate
What is actinic keratosis?
A premalignant skin condition which can precede the development of SCC
Risk factors for actinic keratosis
Thickened papules or plaques surrounding erythematous skin and a keratotic, rough, warty surface
Commonly found on sun exposed areas of skin e.g. back of hands or face
Management of actinic keratosis
Managed to prevent development into SCC
Localised lesions are managed suing cryotherapy, curettage or surgical excision
Larger lesions are managed with topical therapies e.g. 5-Fluorouracil (a cytotoxic agent), NSAID or Imiquimod (which modifies immune response)
What topical agents are used in dermatological malignancies?
5-Fluorouracil (a cytotoxic agent)
Imiquimod (modifies immune response)
What is Kaposi sarcoma?
A high-grade B cell non-Hodgkin’s lymphoma and invasive cervical cancer
