Plastics skin cancer Flashcards
Pearly raised rolled ages with blood vessels visible and central ulceration. Patient noticed it getting bigger recently but thinks its been there a while, it started bleeding recently though
Nodular basal cell carcinoma
What part of skin does melanoma occur?
Basal layer of epidermis at the demo-epidermal junction
common sites of melanoma in men v women
Males 40% on trunk
females 40% on legs
dark skinned - more on paln, sole, nailbed
What % of melanoma arise form a pre-exsiting lesion, List those lesions
25% - Benign melanocytic naevus - Atypical or dysplastic naevus Atypical lentiginous junctional naevus - Large or giant-sized congenitalmelanocytic naevus
What skin phototype is more prone to ephelides?
Freckles - type 1
there is no increase in melanocytes here
Difference between ephelides and lentigo simplex?
Lentigo simplex is not caused by sun exposure
Difference between solar actinic lentigo and ephelides?
Solar lentigo are caused by sun exposure later in life
What are melanocytic naevi and when is there a risk
Benign proliferation of melanocytes
1 in 100,000 risk of change to melanoma.
That risk is increased by increased number of naevi or an increased number of dysplastic naevi
What mutation typically causes acquired melanocytic naevi?
BRAF mutation
criteria for dysplastic naevus syndrome
All 3:
>100 naevi
> 6 dysplastic naevi
one naevus > 8mm diameter
T/F Melanoma in situ increases the risk fo developing another primary melaona
True
What is lentigo maligna
A variant of melanoma in situ on chronically sun damaged skin
Commonly on head an neck
Often large with indistinct margins
Gorlin syndrome is a risk factor for what
BCC
Thin translucent rolled border with microerosions over scaly pink patch of skin on the face
Superficial BCC
Tx options for BCC
Surgical excision / Moh’s micrographic sx
Radiotherapy
topical 5 GU/imiquimod
Precursor to 60% of SCC
Actinic keratosis
cells involved in actinic keratosis
Proliferation of atypical epidermal keratinocytes
Tx of actinic keratosis
Why treat actinic keratosis?
Cryotherapy
typical 5FU
surgical excision
Tx because risk of progression to SCC
How does BCC spread?
Locally invasive
How does SCC spread?
Can metastasise via lymphatics so must examine the draining lymph nodes
cells involved in SCC
Epidermal keratinocytes
Tender, ulcerated scaly / crusted lesion on lips
SCC
lips - poor prognosis
SCC in situ aka
Bowen’s disease
what percentage of melanoma arise de novo
75%
what diameter of a naevus is a characteristic that may be suspicious of melanoma
> 6mm
Most common type of melanoma
Superficial spreading
will have irregular asymmetric borders
Rate of growth of nodular melanoma
rapid - weeks or months
Acral lentiginous melanoma is most common in what skin types
Types 5 and 6
On palmar, plantar an subungual surfaces
excision biopsy taken of a skin lesion and comes back as invasive melanoma or bcc, next step?
Sentinel LN biopsy
How is melanoma staged?
Breslow thickness and lymph node involvement with TNM staging
What is the breslow thickness?
A prognostic factor used in staging of melanoma to determine the 5yr survival and also to decide on the excision margin needed.
It is the depth of tumour measured from the epidermis to the thickest part of the lesion.
Breslow thickness and excision margins
in situ = 5mm <1mm = 1cm 1.01-2mm = 1-2cm 2.1-4mm = 2-3cm >4mm = 3cm
What melanomas require SLNB?
T1b ( <0.8 with ulceration) and greater
so also anything greater than 1mm with or without ulceration
Who gets chemo with melanoma?
Patients with disease progression after optimal tx with other systemic therapies
Breslow thickness and 5yr survival rates
in situ = 95-100% <1mm = 95-100% 1-2mm = 80-95% 2-4mm = 60-75% >4mm = 50%
