Head and neck skin cancer

Question 1

What are the predispositions to a malignant melanoma?

Answer 1

UV lights
Suppressed immune surveillance
Family history
Freckling
Skin, hair and eye colour

Question 2

What are the 7 subtypes of melanoma?

Answer 2

Superficial spreading (radial growth)
Occular
Mucosal
Acral (extremities)
Lentigo malignant (more diffuse)
Amelanotic (non - pigmented)
Nodular (vertical growth, high risk, often deep)

Question 3

What are the major signs to look for?

Answer 3

changes in shape, size and colour

Question 4

What are the minor signs to look for?

Answer 4

inflammation, crusting, bleeding, sensory change (itch)

Question 5

What changes occur to moles? (ABCDE)

Answer 5

Asymmetrical
Borders become jagged
Colour change
Diameter change >o.5cm
Evolution - change in size or shape or colour

Question 6

Describe the clinical staging of tumours?

Answer 6

Stage 1 = local tumour
Stage 2 = involves local lymph nodes
Stage 3 = disseminated disease

Question 7

What are Clarkes levels and Breslows thickness used to describe?

Answer 7

Both are used to define melanoma

Question 8

What are Clarkes levels?

Answer 8

5 layers of the outermost epidermis (level I) to the underlying fat (level V)
Clarkes level refers to the deepest portion of skin involved with the tumour
I = pre invasive
II = thinly invasive
III
IV= moderately invasive
V = deeply invasive

Question 9

What is Breslows thickness?

Answer 9

Measurement in mm of the actual thickness of the melanoma, which is a reflection of the depth of tumour into skin
4mm = high risk

Question 10

What is a basal cell carcinoma? (BCC)

Answer 10

A slow growing locally invasive malignant epidermal skin tumour.
Infiltrates tissue in a 3D pattern
Metastasis is very rare
Mortality related to local invasion
Most common cancer in UK and USA

Question 11

How does a BCC present?

Answer 11

nodular
cystic
ulcerating
superficial
pigmented

Question 12

What are the risk factors for BCC?

Answer 12

chronic exposure to UV light
increased age
freckling
Gorlins syndrome

Question 13

What affects to prognosis of BCC?

Answer 13

size, site, type, margins, growth pattern, recurrence, immune state of host

Question 14

What 2 surgical techniques are used to remove BCC?

Answer 14

DESTRUCTIVE - laser, curettage

EXCISIONAL - surgery (risk incomplete excision)

Question 15

What non surgical techniques are used to remove BCC?

Answer 15

Radiotherapy
photodynamic therapy
chemo
palliative therapy
retinoids

Question 16

What are the 2 types of keratinosinic malignancy?

Answer 16

BCC or SCC

Question 17

What is a squamous cell carcinoma (SCC)?

Answer 17

Arises from the epidermis and resembles squamous cells
Can occur all areas of the body, most commonly on areas exposed to the sun (face, neck, hands, shoulders, ears, back
2nd most common skin cancer

Question 18

What are the causes of SCC?

Answer 18

Chronic exposure to sunlight
Chronic inflammation or conditions that suppress the immune system
Where skin has suffered injury - burns, sores, chemical

Question 19

What are 2 premalignant conditions?

Answer 19

Actinic / solar keratosis

Actinic cheilitisis

Question 20

What is Actinic / solar keratosis?

Answer 20

Rough, scaly, raised growths that range in colour fro brown to red.

Question 21

What is actinic cheilitisis?

Answer 21

A type of actinic keratosis that occurs on the lips, causing them to be cracked, dry, scaly, pale, white.
Mainly affects lower lip which receives more sun

Question 22

What is the treatment for pre malignant conditions?

Answer 22

Curettage
electrodissection
excisional surgery
x ray
laser surgery
Head and neck are well vascularised so flaps of skin heal well over vascular network not specific to certain areas

Question 23

What is the prognosis of pre malignant conditions?

Answer 23

Slow progression to SCC

malignant transformation is often low aggression and distant metastasis are rare.