malignant skin disease

Question 1

types of skin disease

Answer 1

Skin malignancies include

• basal cell carcinoma,
• squamous cell carcinoma and
• malignant melanoma.

Question 2

Basal Cell Carcinoma

Answer 2

• Most common form of skin cancer.
• Commonly occur on sun exposed sites apart from the ear.
• Sub types include nodular, morphoeic, superficial and pigmented.
• Typically slow growing with low metastatic potential.
• Standard surgical excision, topical chemotherapy and radiotherapy are all successful.
• As a minimum a diagnostic punch biopsy should be taken if treatment other than standard surgical excision is planned.

Question 3

Squamous Cell Carcinoma

Answer 3

1. Again related to sun exposure.
2. May arise in pre - existing solar keratoses.
3. May metastasize if left.
4. Immunosupression (e.g. following transplant), increases risk.
5. Wide local excision is the treatment of choice and where a diagnostic excision biopsy has demonstrated SCC, repeat surgery to gain adequate margins may be required.

Question 4

Malignant Melanoma- diagnostic major + minor criteria..

Answer 4

The main diagnostic features (major criteria):

• Change in size
• Change in shape
• Change in colour

Secondary features (minor criteria)

• Diameter >6mm
• Inflammation
• Oozing or bleeding
• Altered sensation

Question 5

malignant melanoma- ix

Answer 5

Treatment

• Suspicious lesions should undergo excision biopsy. The lesion should be removed in completely as incision biopsy can make subsequent histopathological assessment difficult.
• Once the diagnosis is confirmed the pathology report should be reviewed to determine whether further re-excision of margins is required (see below

Question 6

malignant melanoma, margins of excision:

Answer 6

Margins of excision-Related to Breslow thickness

Lesions 0-1mm thick1cm

Lesions 1-2mm thick1- 2cm (Depending upon site and pathological features)

Lesions 2-4mm thick2-3 cm (Depending upon site and pathological features)

Lesions >4 mm thick3cm

Further treatments such as sentinel lymph node mapping, isolated limb perfusion and block dissection of regional lymph node groups should be selectively applied.

Question 7

kaposi sarcoma

Answer 7

• Tumour of vascular and lymphatic endothelium.
• Purple cutaneous nodules.
• Associated with immuno supression.
• Classical form affects elderly males and is slow growing.
• Immunosupression form is much more aggressive and tends to affect those with HIV related disease.