Dermatology - malignant skin conditions

Question 1

What is this?

Answer 1

Squamous cell carcinoma

Question 2

Name some features of SCCs

Answer 2

• Locally invasice and tend to metastasise to regional LNs and beyond
• Warty nodule
• Polypod mass
• Cutaneous ulcer
• Fragile tissue with oozing and bleeding

Question 3

Name some risk factors for SCCs

Answer 3

• Excessive exposure to sunlight
• Actinic keratosis and bowen’s disease
• Immunosuppression: renal transplant/HIV
• Smoking
• Longstanding ulcers

Question 4

What is the treatment for SCCs?

Answer 4

• Surgical excision: treatment of cjoice
• Mohs microcraphic surgery: may be necessary for ill-defined, large recurrent tumours
• Radiotherapy: for large non-resectable tumours

Question 5

What is this?

Answer 5

Basal cell carcinoma

Question 6

Name some features of BCCs

Answer 6

• 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

Question 7

How are BCCs managed?

Answer 7

• 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

Question 8

What is malignant melanoma? Name some risk factors

Answer 8

-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

Question 9

Name some suspicious features which should prompt investigations for melanoma (using ABCDE)

Answer 9

-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

Question 10

What is this? Name the main features of this condition

Answer 10

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

Question 11

What is this? Name the main features of this condition

Answer 11

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

Question 12

What is this? Name the main features of this condition

Answer 12

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

Question 13

What is this? Name the main features of this condition

Answer 13

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

Question 14

Outline the management for malignat melanoma

Answer 14

• Definitive treatment: surgical excision
• Radiotherapy
• Chemotherapy: metastatic disease