Head and Neck Skin Cancer

Question 1

what is the epidemiology of malignant melanoma ?

Answer 1

80% white skinned people,
rising incidence in past three decades,
UV light,
suppressed immunological surveillance,
family history,
freckling,
hair and eye colour

Question 2

what are the melanoma subtypes ?

Answer 2

superficial spreading (radial growth),
nodular (vertical growth),
lentigo maligna melanoma,
amelanotic (non pigmented),
acral (extremitites),
mucosal,
occular

Question 3

what is the 7 point checklist for malignant melanoma ?

Answer 3

major signs - change in shape, size and colour

minor signs - inflammation, crusting or bleeding, sensory change including itch, diameter >7mm

Question 4

describe the clinical staging of melanoma

Answer 4

stage I - local tumour
stage II - involvement of local lymph nodes
stage III - disseminated disease

Question 5

define Clarke’s level

Answer 5

refers to the deepest portion of the skin invaded by tumour

5 layers - the outermost epidermis to the underlying fat

Question 6

what are Clarke’s levels ?

Answer 6

level I - pre-invasive
level II - thinly invasive
level III-IV - moderately invasive
level V - deeply invasive

Question 7

define Breslow thickness

Answer 7

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

Question 8

what is the Breslow thickness scale ?

Answer 8

low risk -

Question 9

which two descriptors are used to define a melanoma ?

Answer 9

Clarke’s level and Breslow thickness

Question 10

what is the LSMDT ?

Answer 10

Local hospital Skin Cancer Multidisciplinary Team

Question 11

when is urgent referral to the LSMDT indicated ?

Answer 11

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

Question 12

what information should be recorded when examining a new lesion ?

Answer 12

history - duration, change in size, change in colour, change in shape, symptoms
examination - site, maximum diameter, elevation (flat, palpable, nodular), description eg irregular margins

Question 13

what is basal cell carcinoma ?

Answer 13

slow growing locally invasive malignant epidermal skin tumour
infiltrates tissue in a 3D continuous pattern
metastasis rare
mortality related to local invasion

Question 14

what are the clinical appearances of BCC ?

Answer 14

nodular, cystic, ulcerating, superficial, morphoeic, keratotic, pigmented

Question 15

what is the most common cancer in the UK and USA ?

Answer 15

BCC

Question 16

what re the risk factors for BCC ?

Answer 16

chronic exposure to UV light
Gorlin’s syndrome
increasing age
male tendency to freckle

Question 17

what factors affect the prognosis of BCC ?

Answer 17

size, site and type of tumour,
definition of tumour margins,
growth pattern,
recurrent tumours,
immunocompromised patients

Question 18

what are the surgical techniques for treating BCC ?

Answer 18

destructive - curettage and cautery, cryosurgery (freezing), carbondioxide laser
excisional - primary, recurrent, Moh’s micrographic surgery

Question 19

what are the non surgical techniques used to treat skin cancer ?

Answer 19

radiotherapy, topical therapy, intralesion interferon, photodynamic therapy, chemotherapy, palliative therapy, retinoids

Question 20

what is SCC ?

Answer 20

skin cancer arising from the epidermis resembling squamous cells

Question 21

what causes SCC ?

Answer 21

chronic exposure to sunlight,
where skin ha suffered injury e.g. burns, scars, x ray exposure,
spontaneously

Question 22

which factors affect the metastatic potential of SCC ?

Answer 22

site, diameter, depth, level of invasion, histological differentiation and subtype, host immunosuppression, previous treatment and treatment modality

Question 23

what are the pre-malignant conditions to skin cancer ?

Answer 23

actinic (solar) keratosis

actinic cheilitis

Question 24

what is actinic keratosis ?

Answer 24

rough, scaly, raised growths ranging from brown to red in colour up to 2 cm diameter

Question 25

what is actinic cheilitis ?

Answer 25

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

Question 26

what is the treatment for SCC?

Answer 26

curettage and electrodesiccation, 
excisional surgery,
x ray,
mohs micrographic surgery,
cryosurgery,
laser surgery,
photodynamic therapy,
imiquimod