Lumps & Bumps Flashcards
Features of Basal cell carcinoma
- sunexposed and hair bearing areas
- pearly rolled edges
- irregular pigmentation w telangiectasia
- central ulceration
RF of Basal cell carcinoma
Sun exposure Fitzpatrick skin type I and II immunosuppression genetic syndrome (nevoid BCC, xeroderma pigmentosum) ionizing radiation carcinogens (arsenic) psoralen and UV A light
Subtypes of BCC
Raised lesions - nodular/ nodulo-ulcerated - cystic Flat lesions - pigmented - sclerosing/ morpheaform - superficial
- Origin of BCC
- risk of mets
- from pluripotent epithelial cells of basal layer of the epidermis and its appendages
- low risk, but locally invasive
Tx of BCC
- margins
- type of sx
- alternative and limitations
wide local excision with negative margins +/- reconstruction/ skin flap/ graft
raised: 0.5cm margin
not raised: wider margin. check frozen section for clearance.
Moh’s micrographic sx
Alt: radiotherapy (if CI to sx, usually as adjuvant therapy)
Classical description of squamous cell carcinoma
raised/ heaped edges with central ulceration, irregular margins
granulation tissue: pale, unhealthy
+/- discharge
non tender
usually mobile over underlying structures
RF for squamous cell carcinoma
sun damage, actinic keratosis, radiation, immunosuppression (post transplant, HIV), smoking, arsenic, irradiation, HPV
chronic ulcers: old burns, venous ulcers
Ix and tx of SCC
Ix:
- punch biopsy/ incisional biopsy (inc borders)
- stage: CT head: depth of invasion, LN involvement
Tx: wide local resection (small: 5mm margin, large:10mm) with reconstruction
+/- neck dissection (if CT shows LN positive)
offer sentinel LN biopsy
Moh’s micrographic sx for anatomically challenging areas
Pre malignant conditions that progress to SCC?
actinic keratosis, bowen disease, leukoplakia, keratoacanthoma
Pre malignant conditions that progress to SCC?
actinic/ solar keratosis, bowen disease, leukoplakia, keratoacanthoma
Description of keratoacanthoma
elevated, nodular lesion with central hyperkeratotic core/ crater
dome shaped, symmetrical, surrounded by smooth wall of inflammed skin
grows rapidly in days/ weeks
Associations of marjolin ulcer
burns scar, chronic venous ulcer
name of Bowen disease located on penis, vulva, oral cavity
erythroplasia of Queyrat
Types of melanoma
1 superficial spreading: legs F/backs M, red/white/blue
2 nodular: trunk, raised, ulcerated
3 lentigo maligna: face/ dorsum of hand and forearms. thickers and darker (in caucasians)
4 acral lentiginous: hairless areas, peripheral - palms, soles
Features suspicious of malignant mole
ABCDE Asymmetry Borders/ bleeding/ulceration Change: colour, size, shape, surface, number Diameter >6mm Elevation
RF of malignant melanoma
Congenital:
- light skinned
- xeroderma pigmentosum
- dysplastic naevus syndrome
- large congenital naevi
- fam hx
Acquired:
- sunlight
- pre-existing skin lesions: lentigo, multiple pigmented naevi
- previous melanoma
What affects tx management in melanoma
staging - degree of invasion
- Clark’s level of invasion (I to V)
- Breslow thickness
Poor prognostic factors of malignant melanoma
elderly, male, lesions on trunk, ulceration, depigmentation
Malignant melanoma
- ix
- tx
- f/u
Ix: whole excision biopsy (assess depth), assess LN involvement/ distant spread with PET scan
excision with wide margins (2cm)
+ sentinel LN biopsy
f/u 3 mthly - recurrence at same site/ draining basin
What is a dermoid cyst
Ectodermal sequestration at line of fusion during embryonal development with cyst of epithelial lining
(note: do CT imaging to evaluate CNS involvement)
What to evaluate in a parotid mass
- PE
- Ix
- facial n
- bimanual palpation – superficial/ deep
- opening of stensen duct – stones, pus
- cervical LN
- contralateral parotid, check behind/ around ear lobe
FNAC, CT
What is a sebaceous horn
- cx
Keratin outgrowth from sebaceous cyst
- risk of malignant transformation at base of horn to SCC (10%)
- trauma, bleeding
