Non Melanoma Flashcards
BCC Lesions are also known as
rodent ulcers
BCC are characterised by?
slow-growth and local invasion
BCC mets common
false
Metastases are extremely rare.
BCC is the most common type of cancer in the Western world.
true
many types of BCC are described. The most common type is
nodular BCC
Features of BCC?
sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’
generally, if a BCC is suspected, a routine referral should be made
true
BCC mx?
surgical removal curettage cryotherapy topical cream: imiquimod, fluorouracil topical chemotherapy radiotherapy
What is Bowen’s disease?
precancerous dermatosis that is a precursor to squamous cell carcinoma. It is more common in elderly patients.
In bowen’s There is around a ?% chance of developing invasive skin cancer if left untreated.
There is around a 5-10% chance of developing invasive skin cancer if left untreated.
Features of Bowen’s disease?
red, scaly patches
often 10-15 mm in size
slow-growing
often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs
Management of Bowen;s is always in hospital
false
may sometimes be diagnosed and managed in primary care if clear diagnosis or repeat episode
Mx bowen’s
topical 5-fluorouracil typically used twice daily for 4 weeks often results in significant inflammation/erythema. Topical steroids are often given to control this cryotherapy excision
Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in ?% of patients.
Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.
Risk factors SSC
excessive exposure to sunlight / psoralen UVA therapy
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers
genetic conditions
Which conditions are precursors for SCC
actinic keratoses and Bowen’s disease
What are long-standing leg ulcers also called?
Marjolin’s ulcer
What genetic conditions are associated with SCC?
xeroderma pigmentosum, oculocutaneous albinism
What is actinic keratoses?
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure.
Features of actinic keratoses?
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
for actinic keratoses Management options include
prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream topical diclofenac topical imiquimod cryotherapy curettage and cautery
Points for using fluorouracil cream in actinic keratoses?
typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
When is topical diclofenac used in actinic keratoses?
may be used for mild AKs. Moderate efficacy but much fewer side-effects
In BCC you don’t need a diagnostic test for surgery
false
As a minimum a diagnostic punch biopsy should be taken if treatment other than standard surgical excision is planned.
What is Kaposi Sarcoma?
Tumour of vascular and lymphatic endothelium.
Purple cutaneous nodules.
Associated with immuno supression.
Kaposi sarcoma affects who?
Classical form affects elderly males
Kaposi sarcoma is slow growing
true
Kaposi sarcoma - Immunosupression form is much more aggressive
true
tends to affect those with HIV related disease.
The vast majority of NMSC’s are related to UV light exposure.
true
Describe pattern of different skin cancer NMSC & sun exposure
or SCC’s the major pattern is chronic long-term exposure.
For BCC’s, the pattern of sporadic exposure with episodes of burning is more important.
The incidence of NMSC’s increases with age and whilst there is a female preponderance in those under 40 years of age, in later life the sex incidence is roughly equal.
true
Organ transplant recipients have a markedly increased incidence of
SCC
In addition to this increased risk, transplant recipients are also more likely to develop locoregional recurrences following treatment.
Which virus DNA is found in the majority of transplant recipient SCC’s.
Human papilloma
Actinic keratosis is viewed as a premalignant lesion because?
there are atypical keratinocytes present in the epidermis. In a person with 7 actinic keratosis, the risks of subsequent SCC is of the order of 10% at 10 years. The primary lesion is a rough erythematous papule with a white to yellow scale. Lesions are typically clustered at sites of chronic sun exposure.
The commonest clinical presentation of SCC is
an erythematous keratotic papule or nodule on a background of sun exposure. Ulceration may occur and both exophytic and endophytic areas may be seen. Regional lymphadenopathy may be present.
Pathology SCC?
Pathologically there is a downward proliferation of malignant cells and invasion of the basement membrane. Poorly differentiated lesions may show perineural invasion and require immunohistochemistry with S100 to distinguish them from melanomas (which stain strongly positive with this marker).
Types of BCC?
Nodular BCC Superficial BCC Morpheaform BCC Cystic BCC Basosquamous carcinoma
Describe Nodular BCC?
Raised translucent papule
Usually affect the face
Large nodular BCC’s are locally destructive
Describe Superficial BCC?
Usually appears as superficial erythematous macule affecting the trunk
Younger age at presentation (mean 57)
May show areas of spontaneous regression
Horizontal growth patter predominates
High recurrence rate (due to subclinical lateral spread)
Describe Morpheaform BCC
Macroscopically resembles flat, slightly atrophic lesion or plaque without well-defined borders
Tumour has sub clinical lateral spread which increases recurrence rates
Describe Cystic BCC
Often have clear or blue-grey appearance
Cystic degeneration may not be clinically obvious and tumour may resemble nodular BCC
Describe Basosquamous carcinoma?
Atypical BCC
Basaloid histological BCC features with eosinophilic squamoid features of SCC
Biologically more aggressive and are more locally destructive
Rare lesion accounts for 1% of all non-melanoma skin cancers
Metastatic disease may occur in 9-10% of cases and resemble an SCC
Keratoacanthoma is usually premalignant
false
They are generally benign lesions although some do view them as precursors of malignancy.
Describe keratoacanthoma
Dome-shaped erythematous lesions that develop over a period of days and grow rapidly. They often contain a central pit of keratin. They then begin to necrose and slough off.
Mx keratoacanthoma
They may be treated by curettage and cautery. If there is diagnostic doubt (they can mimic malignancy) then formal excision biopsy is warranted.
Describe pyogenic granuloma
These present as friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common.
Mx pyogenic granuloma
They may be treated with curettage and cautery, formal excision may be used if there is diagnostic doubt.
What is Leukoplakia?
Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
Leukoplakia is said to be a diagnosis of exclusion. What should be considered?
Candidiasis and lichen planus should be considered, especially if the lesions can be ‘rubbed off’
Biopsies are usually performed to exclude alternative diagnoses such as squamous cell carcinoma
Why is Leukoplakia followed up?
regular follow-up is required to exclude malignant transformation to squamous cell carcinoma, which occurs in around 1% of patients.
Skin types may be classified according to Fitzpatrick classification:
I: Never tans, always burns (often red hair, freckles, and blue eyes)
II: Usually tans, always burns
III: Always tans, sometimes burns (usually dark hair and brown eyes)
IV: Always tans, rarely burns (olive skin)
V: Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)
VI: Black skin (e.g. Afro-Caribbean), never tans, never burns
