Non-Melanoma skin cancers and benign skin tumours Flashcards
What are some examples of premalignant lesions
actinic keratosis
intraepidermal carcinoma /bowens/SCC in-situ
whats another name for actinic keratosis
solar keratosis
what % of people are affected by actinic keratosis
20%
what is the risk of progression to SCC for actinic keratosis
<1:1000 p/y
what are features of actinic keratosis
single or multiple lesions, macular/patches of scaling skin with erythema, usually in sun exposed areas in older people
what symptoms to actinic keratosis have
usually asymptomatic
may be sore/itch
what are the treatment options for AK
do nothing - 25% resolve spontaneously cryotherapy - 95-100% cure rate 5FU cream curettage and cautery PDT diclofenac gel imiquimod
how do you choose first line treatment for AK
discrete lesions = cryotherapy
5-FU for diffuse lesions
what is intraepidermal carcinoma
dysplasia extending through the full thickness of the epidermis
where is IEC/Bowens usually found
lower legs of elderly women
whats the risk of malignant transformation for IEC/Bowens
3-5%
whats the treatment option for IEC/Bowens
5-FU cream cryotherapy curettage/cryotherapy excision PDT imiquimod
when is cryotherapy avoided for IEC/Bowens
if on lower legs to avoid ulceration
what is preferred when treating Bowens/IEC if ulceration is particularly risky (IE cryotherapy is contraindicated)
PDT (photodynamic Therapy)
what are some examples of non-melanocytic malignant lesions
BCC
SCC
what proportion of non-melanocytic malignant lesions are BCCs
80%
what are features of BCCs
slow growing, asymptomatic lesion with a rolled/pearled edge , usually on sun exposed areas
what are the subtypes of BCCs
nodular
superficial
morpheic/sclerosis
pigmented
what are most common areas for BCCs to be on
trunk
face
what are features of BCCs at high risk of recurrence
increased size central face poorly defined margins morpheic-subtype histological invasion previous treatment failure
whats the first line treatment for BCC
surgical excision with 5mm margins
whats the treatment success for first-line intervention for BCC + whats the recurrence rate
95% , 2%
what is done for BCCs with high risk of recurrence + whats the success rate of that surgery
moh’s micrography, 99% BCC, 95% for high risk recurrence BCCs
what is moh’s micrography surgery
bulk of tumour is excised
margins removed carefully with a biopsy punch and each punch is quickly examined with reports giving histological analysis in 4 directions (e.g. 12 clear, 3,6,9 tumour)
what are risks of radiotherapy for BCC
radionecrosis and possible SCC at the site
what is imiquimod - + how useful is it
topical immune modulator, good for low risk tumours, increased recurrence rates compared to surgery but decreased cosmetic damage
what should always be done if a BCC is suspected
confirm with biopsy
which non-melanocytic malignant lesion has the highest risk for metastasis
SCC
whats the 5 year survival for SCC
75-90%
what factors increase the risk for mets for SCCs
ear/lip SCC >2cm increased depth non sun exposed areas poor differentiation immunosuppresion mucosal subtype perineural invasion
what are features of SCCs
much shorter timeframe (weeks) , firm skin coloured nodule with keratinised surface/soft fleshy nodule with eroded surface and a non healing wound
what is the best treatment for SCCs +whats its success
Excision with a 4mm margin, 95%
what can be used for small primary SCC
curettage and cautery
what are some examples of non-melanocytic benign lesions
dermatofibroma neurofibroma epidermoid and pilary cysts keratocanthoma strawberry naevus cherry angioma pyogenic granuloma seborrhoeic keratosis viral warts cutaneous horn
what is a dermatofibroma
benign discrete solitary dermal nodules on the extermities of young adults
overlying epidermis pigmented
what is the iceberg effect
a nodule feels bigger than it is
how do you manage a dermatofibroma
leave alone unless there is diagnostic doubt
what is a neurofibroma
PNS neural sheath tumour
what is the aetiology of neurofibroma
90% stand alone tumours
10% in NF-1
what are some features of neurofibromatosis-1
cafe au lait patches
axillary freckling
lisch nodules
what are epidermoid/pilar cysts
common swelling with a central punctum what ruptures with a foul-smelling material
histologically lined with epidermis or outer sheath or hair follicle (hence epidermoid/pilar)
how do you treat epidermoid/pilar cysts
excision
what are keratocanthomoas
rapidly enlarging pink papule that then forms a crater in the center, rapidly resolves in 6-12 months but leaves an ugly scar
who tends to get a keratocanthoma + where does it tend to be
fair individuals, on sun exposed areas
what other dermatological lesion does a keratocathoma look like + how is it different
an SCC- but its quite symmetrical and faster growing
what is a strawberry naevus
haemangioma present within a few weeks of birth
raised compressible swelling with bright red surface
how is a strawberry naevus managed
do nothing as usually spontanteously resolves - 50% by 5, 90% by 9
what are complications with strawberry naevus and how do you manage
bleed/ulceration following trauma = observe/reassure
functional issues = high dose systemic steroids
plastic surgery rarely done
what is a cherry angioma
benign red papules seen on the trunks of middle-aged + eldery people
what is a pyogenic granuloma
common benign acquired haemangioma developing at sites of trauma most commonly in kids-young adults
bright red raised lesions
whats an important differential for a pyogenic granuloma
amelanotic malignant melanoma
how do you remove a pyogenic granuloma
curettage and cautery
what is seborrhoeic keratosis
common benign epidermal tumour found usually in >50s on the face/trunk
looks like ‘stuck on’ yellow/brown macules/plaques +/- scaling
what % of schoolchildren have a viral wart at any one time
4-5%
what virus is most commonly associated with viral warts
HPV, (1,2,4)
what are the types of viral wart
common plantar mosaic plane facial anogenital
what are the features of a common wart
smooth initially, eventually hyperkeratotic
on face/genitals
often multiple
pain is rare
what are the features of a plantar wart
rough surfaces surrounded bt a horny collar, bleeding capillary loops (black dots) distiguish from corns, usually in multiples and painful
what are the features of a mosaic wart
rough plawues of individual warts, most commonly on soles, palms and around fingers/
not painful
what are features of plane warts
smooth flat-topped papules, found on face brow and back of hand, become inflamed then resolve spontaneously, skin coloured/light brown
usually multiple
usually painless
what are features of facial warts
in breard area of males most commonly
spread by shaving
ugly but painless
what are features of anogenital warts
papillomatous cauliflower-like lesions with moist macerated vascular surface
they may coalesce to form giant lesions
vaginal/anorectal mucosa may be affected
what should be suspected if there is anogenital warts in kids
sexual abuse
but usually, it is autoinoculation from other areas
what is a cutaneous horn + how should it be managed
compacted keratin - always do histology as there may be an AK/IEC/SCC at the base
may also be seborrheic keratosis
what are some risk factors for skin cancer
long term UV exposure fair skin type increased age immunosuppression genetic site of chronic inflammation HPV (SCC)
what genetic syndromes are higher risk for skin cancer development
gorlin’s syndrome for BCC
Xeroderma Pigmentosum
