Head and neck skin cancer Flashcards
What are the predispositions to a malignant melanoma?
UV lights Suppressed immune surveillance Family history Freckling Skin, hair and eye colour
What are the 7 subtypes of melanoma?
Superficial spreading (radial growth) Occular Mucosal Acral (extremities) Lentigo malignant (more diffuse) Amelanotic (non - pigmented) Nodular (vertical growth, high risk, often deep)
What are the major signs to look for?
changes in shape, size and colour
What are the minor signs to look for?
inflammation, crusting, bleeding, sensory change (itch)
What changes occur to moles? (ABCDE)
Asymmetrical Borders become jagged Colour change Diameter change >o.5cm Evolution - change in size or shape or colour
Describe the clinical staging of tumours?
Stage 1 = local tumour
Stage 2 = involves local lymph nodes
Stage 3 = disseminated disease
What are Clarkes levels and Breslows thickness used to describe?
Both are used to define melanoma
What are Clarkes levels?
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
What is Breslows thickness?
Measurement in mm of the actual thickness of the melanoma, which is a reflection of the depth of tumour into skin
4mm = high risk
What is a basal cell carcinoma? (BCC)
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
How does a BCC present?
nodular cystic ulcerating superficial pigmented
What are the risk factors for BCC?
chronic exposure to UV light
increased age
freckling
Gorlins syndrome
What affects to prognosis of BCC?
size, site, type, margins, growth pattern, recurrence, immune state of host
What 2 surgical techniques are used to remove BCC?
DESTRUCTIVE - laser, curettage
EXCISIONAL - surgery (risk incomplete excision)
What non surgical techniques are used to remove BCC?
Radiotherapy photodynamic therapy chemo palliative therapy retinoids
What are the 2 types of keratinosinic malignancy?
BCC or SCC
What is a squamous cell carcinoma (SCC)?
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
What are the causes of SCC?
Chronic exposure to sunlight
Chronic inflammation or conditions that suppress the immune system
Where skin has suffered injury - burns, sores, chemical
What are 2 premalignant conditions?
Actinic / solar keratosis
Actinic cheilitisis
What is Actinic / solar keratosis?
Rough, scaly, raised growths that range in colour fro brown to red.
What is actinic cheilitisis?
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
What is the treatment for pre malignant conditions?
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
What is the prognosis of pre malignant conditions?
Slow progression to SCC
malignant transformation is often low aggression and distant metastasis are rare.
