Head and neck skin cancer Flashcards
describe 7 melanoma subtypes
MOLASNA
- superficial spreading (radial growth, can see spread under skin)
- nodular (vertical growth - more serious)
- lentigo maligna (diffuse appearance, varied colour/shape)
- amelanotic (pigmented)
- acral (in extremities. common in non white people)
- mucosal eg mouth
- occular
7 point checklist for suspected malignant melanoma
major signs: change in shape/ colour/ size
minor signs: inflammation, crusting/bleeding, sensory change inc itch, diameter >7mm
what is ABCDE of malignant melanomas
Asymmetry border colour diameter evolution (changed shape/ size/ colour or risen)
clinical stages of melanoma in terms of spread and 10 yr prognosis
I: local tumour, 81%
II: involvement of local lymph nodes, 47%
III: disseminated disease, 0%
resection margins for stage I cutaneous melanoma
a. melanoma in situ
b. melanoma 2mm
e. lentigo malignant melanoma
f. acral/ subungal melanoma
resection margins for stage I cutaneous melanoma
a. melanoma in situ: 0.5cm
b. melanoma 2mm: not known
e. lentigo malignant melanoma: usually 0.5-1cm, depends on tumour thickness
f. acral/ subungal melanoma: based on tumour thickness. may have to dislocate joint nr tumour
clarke’s level: define and levels
deepest portion of skin invaded by tumour, 5 layers of outermost epidermis under fat I: preinvasive II:thinly invasive III-IV: moderately invasive V: deeply invasive
are clarkes levels qualitative or quantitative? explain
qualitative
epidermis thickness varies all over body eg thicker on sole of foot
breslow thickness: define and levels
mm thickness of melanoma, reflects depth of penetration in to skin
0-0.99mm: lower risk
1-3.99mm: intermediate risk
4mm +: higher risk
7 reasons for urgent referral to LSMDT
- new mole after puberty which is changing shape/ colour/ size
- long standing mole changing shape/ colour/ size
- mole with or more colours and lost symmetry
- mole itching/ bleeding
- any new persistent skin lesion esp if growing/ pigmented/ vascular and if diagnosis not clear
- new pigmented damage to nail esp where there is associated damage to nail
- lesion growing under nail
what to include in HISTORY of malignant melanoma 5
- duration of lesion
- change in size
- change in colour
- change in shape
- symptoms eg itching, bleeding
what to include in EXAMINATION of malignant melanoma 4
- site
- size
- elevation
- description (margins, pigmentation,ulceration)
what is the least deadly skin cancer
basal cell carinoma
describe basal cell carcinoma 4
- slow growing
- locally invasive
- malignant
- epidermal
pattern of bcc tissue infiltration
3 dimensional contigious pattern
7 clinical appearances of bcc
- nodular
- cystic
- ulcerating
- superficial
- morphoeic/ sclerosing: spread out from margins
- keratotic
- pigmented
risk factors of bcc 4
UV sunlight exposure
inc age
male
gorlins sydrome (multiple keratinous tumours of jaws)
most common cancer in USA/ UK
2nd most common
basal cell carcinoma
2. squamous cell carcinoma
6 factors affecting prognosis of bcc
- tumour size
- tumour site
- tumour type/ definition of margins
- growth pattern
- recurrent tumours
- immunocompromised pts
6 surgical techniques used for bcc
destructive :
- currettage & cautery/ electrodisection
- cryosurgery
- carbondioxide laser
excisional: primary, recurrent, mohs’ micrographic surgery
what is mohs micrographic surgery and stages
maps tumour so no healthy tissue is removed
- saucer shaped patch of tissue removed
- removed tissue is cut in to sections, stained and marked on a detailed diagram (Mohs map)
- roots of cancer identified on undersurface/ edge of map. if residual cancer is found, mohs map used to guide removal
- when this is repeated so no cancer remains, surgical defect is ready for repair
bcc surgical margins mm margin and % cure
a. well-defined lesions
b. morphoieic lesions
a. 3mm surgical margin 85% cure
- -> 4-5mm surgical margin 95% cure
b. morphoeic lesions:
3mm margin 66%
5mm margin 82%
13-15mm margin >95%
7 non surgical techniques for bcc
- radiotherapy
- chemotherapy
- topical therapy
- intralesion interferon
- photodynamic therapy
- palliative therapy
- retinoids
causes of squamous cell carcinoma scc 3
- chronic sun exposure
- injuries to skin (burns, sores, chemicals eg arsenic, petroleum
- spontaneous on normal, healthy skin
people more at risk of scc
fair, blue/ green/ grey eye, light hair, spend a lot of time in the sun
6 factors affecting metastatic potential of cutaneous scc
- site
- size (diameter): >2cm more likely to recur locally
- size (depth/ invasion): >4mm depth or extending in to subcutaneous tissue more likely to recur/ metastasize
- histological differentiation/ subtype: more serious if poorly differentiated/ perineural involvment/ lymphatic/ vascular invasion
- host immunosuppression
- previous tx/ tx modality
order of common sites of scc 5
- sun exposed sites (not lip or ear)
- lip
- ear
- non sun exposed eg perineum, sacrum , sole of foot
- areas of radiation/ thermal injury/ chronic draining sinuses/ chronic ulcers/ chronic inflammation/ Bowens disease
describe low risk scc 5
- arising at sun exposed sites exluding lip or ear
- tumours up to 20mm diameter
- up to 4mm depth, confined to epidermis
- well-differentiated
- no evidence of immune dysfunction
surgical margins for cutaneous scc
2cm tumour/ poorly differentiated/ extending subcutaneous/ ear/ lip/ scalp/ eyelids/ nose: 6mm margin/ mohs micrographic surgery/ examine histologically
name and describe 2 pre-malignant conditions
- actinic/ solar keratosis: rough, scaly, slightly raised growths that range in colour brown - red and may be up to 2cm diameter
- actinic cheilitis: actinic keratosis in lips –> dry, cracked, scaly, pale, white. lower lip (more exposed to sun)
treatment of pre malignant conditions 8
- curettage/ electrodesiccation
- excisional surgery
- x ray
- mohs excisional surgery
- cryosurgery
- laser surgery
- photodynamic therapy
- imiquimod, 5 fluorouracil, topical diclofenac
prognosis of pre malignant conditions and issues
10% progression to scc (more likely in over 70s)
not cost effective to treat all pre malignant lesions
what things about a person increases risk of skin cancer
white 80%
freckles
family history
hair and eye colour
