Head and Neck Skin Cancer Flashcards
what is the epidemiology of malignant melanoma ?
80% white skinned people, rising incidence in past three decades, UV light, suppressed immunological surveillance, family history, freckling, hair and eye colour
what are the melanoma subtypes ?
superficial spreading (radial growth), nodular (vertical growth), lentigo maligna melanoma, amelanotic (non pigmented), acral (extremitites), mucosal, occular
what is the 7 point checklist for malignant melanoma ?
major signs - change in shape, size and colour
minor signs - inflammation, crusting or bleeding, sensory change including itch, diameter >7mm
describe the clinical staging of melanoma
stage I - local tumour
stage II - involvement of local lymph nodes
stage III - disseminated disease
define Clarke’s level
refers to the deepest portion of the skin invaded by tumour
5 layers - the outermost epidermis to the underlying fat
what are Clarke’s levels ?
level I - pre-invasive
level II - thinly invasive
level III-IV - moderately invasive
level V - deeply invasive
define Breslow thickness
a measurement in mm of the actual thickness of the melanoma which is a reflection of the depth of penetration of the tumour into the skin
what is the Breslow thickness scale ?
low risk -
which two descriptors are used to define a melanoma ?
Clarke’s level and Breslow thickness
what is the LSMDT ?
Local hospital Skin Cancer Multidisciplinary Team
when is urgent referral to the LSMDT indicated ?
a new mole after onset of puberty changing in shape, size or colour,
a long standing mole changing in shape, size or colour,
any mole with 3 or more colours or has lost its symmetry,
a mole that is itching or bleeding,
a new pigmented line in a nail esp with associated damage to the nail,
a lesion growing under a nail
what information should be recorded when examining a new lesion ?
history - duration, change in size, change in colour, change in shape, symptoms
examination - site, maximum diameter, elevation (flat, palpable, nodular), description eg irregular margins
what is basal cell carcinoma ?
slow growing locally invasive malignant epidermal skin tumour
infiltrates tissue in a 3D continuous pattern
metastasis rare
mortality related to local invasion
what are the clinical appearances of BCC ?
nodular, cystic, ulcerating, superficial, morphoeic, keratotic, pigmented
what is the most common cancer in the UK and USA ?
BCC
what re the risk factors for BCC ?
chronic exposure to UV light
Gorlin’s syndrome
increasing age
male tendency to freckle
what factors affect the prognosis of BCC ?
size, site and type of tumour, definition of tumour margins, growth pattern, recurrent tumours, immunocompromised patients
what are the surgical techniques for treating BCC ?
destructive - curettage and cautery, cryosurgery (freezing), carbondioxide laser
excisional - primary, recurrent, Moh’s micrographic surgery
what are the non surgical techniques used to treat skin cancer ?
radiotherapy, topical therapy, intralesion interferon, photodynamic therapy, chemotherapy, palliative therapy, retinoids
what is SCC ?
skin cancer arising from the epidermis resembling squamous cells
what causes SCC ?
chronic exposure to sunlight,
where skin ha suffered injury e.g. burns, scars, x ray exposure,
spontaneously
which factors affect the metastatic potential of SCC ?
site, diameter, depth, level of invasion, histological differentiation and subtype, host immunosuppression, previous treatment and treatment modality
what are the pre-malignant conditions to skin cancer ?
actinic (solar) keratosis
actinic cheilitis
what is actinic keratosis ?
rough, scaly, raised growths ranging from brown to red in colour up to 2 cm diameter
what is actinic cheilitis ?
type of actinic keratosis on the lips causing them to be dry, cracked, scaly and white
mainly occurs n lower lip due to greater sun exposure
what is the treatment for SCC?
curettage and electrodesiccation, excisional surgery, x ray, mohs micrographic surgery, cryosurgery, laser surgery, photodynamic therapy, imiquimod
