Non-melanoma skin cancer

Question 1

most common skin cancer

Answer 1

basal cell carcinoma (BCC)

Question 2

where do BCCs arise from

Answer 2

keratinocytes in basal layer of epidermis

Question 3

prognosis of basal cell carcinoma

Answer 3

very good prognosis - locally invasive but rarely metastasise

Question 4

types of BCC

Answer 4

nodular

superficial spreading

infiltrative/morphoeic

Question 5

most common type of BCC

Answer 5

nodular

Question 6

presentation nodular BCC

Answer 6

slow growing shiny, pearly nodule with rolled edge, central ulceration, telangiectasia sun exposed sites

Question 7

where on body are superficial spreading BCCs often found

Answer 7

trunk

Question 8

gold standard treatment for BCC

Answer 8

excision biopsy with 4mm margins

Question 9

what surgical option can be used for difficult sites when tissue preservation is important e.g. eyelid

Answer 9

moh’s surgery

Question 10

what other treatment options may be appropriate for small BCC’s

Answer 10

curettage (<1cm)

cryotherapy

topical therapy - 5 fluorouracil / imiquimod

– incisional biopsy still needed to confirm diagnosis

Question 11

pre-malignant lesions for squamous cell carcinoma

Answer 11

actinic keratosis

bowens disease

Question 12

appearance of actinic keratosis

Answer 12

thick, rough, scaly, red/yellow lesions on sun exposed sites

Question 13

what things may raise suspicions of malignancy in actinic keratosis

Answer 13

>1cm

growing

thick

bleeding

painful

Question 14

treatment of actinic keratosis

1-2 lesions

>2 lesions

Answer 14

1-2: cryotherapy

>2: 5 fluorouracil cream (efudix)

Question 15

what is bowens disease

Answer 15

intra-epidermal squamous cell carcinoma

• SCC in situ

Question 16

presentation of bowens disease

Answer 16

well definied, red, scaly plaque

usually on leg / other sun exposed sites

Question 17

treatment of bowens disease

Answer 17

5-fluorouracil

cryotherapy

Question 18

what cancer is more common in immunosuppressed / transplant patients

Answer 18

SCC

Question 19

Presentation of SCC

Answer 19

rapily growing painful, ulcerated irregular lesion with hard raised edge

found on sun exposed sites

Question 20

what are SCC’s on the lip linked to

Answer 20

smoking

Question 21

Treatment of SCC

Answer 21

surgical excision 4mm margin

Question 22

what treatments can be used in superficial SCCs

Answer 22

topical 5-fluorouracil / imiquimod

Question 23

what antibiotic can be used in mild actinic keratosis treatment

Answer 23

topical diclofenac

Question 24

do invasive BCCs respond well to chemo or radiotherapy?

Answer 24

radiotherapy

Question 25

describe the dysplastic change in

1. actinic keratosis
2. bowens disease
3. SCC

Answer 25

1. AK = partial thickness dysplasia
2. bowens = complete thickness dysplasia
3. SCC = complete thickness dysplasia + invasive

Question 26

rapidly growing lesion over 6-8 weeks then disappears

suggestive of?

Answer 26

keratoacanthoma

• dont metastasise
• excised to check histology for SCC

Question 27

genetic mutation in 90% of BCCs

Answer 27

inactivating mutation in PTCH gene

Question 28

presentation of merkel cell tumour

Answer 28

raised, red rapidly growing lesion

• poor prognosis

Question 29

what is actinic cheilitis

Answer 29

actinic keratosis on the lips

Question 30

what can cutaneous horns be a feature of

Answer 30

SCC

seborrhoeic keratosis

HPV