Dermatology - malignant skin conditions Flashcards
What is this?
Squamous cell carcinoma
Name some features of SCCs
- Locally invasice and tend to metastasise to regional LNs and beyond
- Warty nodule
- Polypod mass
- Cutaneous ulcer
- Fragile tissue with oozing and bleeding
Name some risk factors for SCCs
- Excessive exposure to sunlight
- Actinic keratosis and bowen’s disease
- Immunosuppression: renal transplant/HIV
- Smoking
- Longstanding ulcers
What is the treatment for SCCs?
- Surgical excision: treatment of cjoice
- Mohs microcraphic surgery: may be necessary for ill-defined, large recurrent tumours
- Radiotherapy: for large non-resectable tumours
What is this?
Basal cell carcinoma
Name some features of BCCs
- Slow growing locally invasice malignant tumour of teh epidermal keratinocytes normally in older individuals, rarely metastatsises
- Various morphological types including nodular (most common), superficial (plaque-like), cystic, morpheic (sclerosing), keratotic and pigmented.
- Nodular: small, skin coloured papule or nodule with surface telangiectasia, pearly rolled edge and may have a necrotic or ulcerated centre
- Most common over the head and neck
- Almsot never metastatise but spread by local invasion
How are BCCs managed?
- Surgical excision: 1st line - allows for histological examination and margins
- Mohs micrographic surgry: for high risk and recurrent tumours
- Radiotherapy: where surgery not appropriate
- Other: cryotherapy, curettage and cautery, topical treatments (eg fluorouracil and imiquimod) - small and low risk lesions
What is malignant melanoma? Name some risk factors
-Invasive malignant tumour of the epidermal melanocytes which has the potential to metastasise
Risk factors:
- Excessive UV exposure
- Skin type I (always burns, never tans)
- History of multiple moles or atypical oles
- Family hustory or previous history of melanoma
Name some suspicious features which should prompt investigations for melanoma (using ABCDE)
-Asymmetrical shape
-Border irregularity
-Colour irregularity
-Diameter > 6 mm
-Evolution of lesions: change in size or shape
-Symptoms: eg bleeding/itching
*More common on the legs in women and trunk in men
What is this? Name the main features of this condition
Superficial spreading melanoma
Features
- 70% of melanomas (most common in UK)
- Related to intermittent high intensity UV exposure
- Arms, legs, back and chest of young people
- Looks like growing mole with features of ABCDE mentioned previously
What is this? Name the main features of this condition
Nodular melanoma
Features
- Second most common
- Sun exposed areas in middle aged people
- Related to intermittent high intensity UV exposure
- Invades from outset
- Red or black lump or lump that bleeds and oozes
What is this? Name the main features of this condition
Lentigo malignant melanoma
Features
- Common on the face (chronically sun exposed areas) in elderly population
- Slow growing macula with irregular border with a distinct edge and various shaged of tan/brown/black
- May be confined to epidermis for many years before developing an invasive nodule
What is this? Name the main features of this condition
Acral lentiginous melanoma
Features
- Rare
- Common on the palms, soles and nail beds in elderly population (African-American and Asian)
- No clear relation with UV exposure
- Subungal pigmentation
Outline the management for malignat melanoma
- Definitive treatment: surgical excision
- Radiotherapy
- Chemotherapy: metastatic disease