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DERMATOLOGY > SCC > Flashcards

SCC Flashcards

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Dermatology Board Prep flashcards
1
Q

what is a SCC

A

A locally invasive malignant tumour of the epidermal keratinocytes or its appendages which has the potential to metastasise

from cells within the epidermis that make keratin

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2
Q

describe a SCC lesion

A
  • keratotic
  • grow over weeks to months
  • tender or painful
  • An irregular asymmetrical nodular lesion on the face with an erythematous base.
  • ulcerated
  • pre-existing actinic keratosis
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3
Q

causes of SCC

A
  • UV exposure
  • history of frequent or sever sunburn in childhood
  • skin type 1 - always burns - never tans
  • increasing age
  • male sex
  • immunosuppression - Renal transplant, HIV
  • previous history of skin cancer
  • genetic predisposition - xerdoerma pigmentosum, oculocutaneous albinism
  • actinic keratoses
  • smoking
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4
Q

what clinical examination would one do

A

Full skin examination and lymph node examination.

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5
Q

DD for SCC

A

Bowens disease

BCC shiny nodule but does not have keratin and grwos very slowly

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6
Q

management for SCC

A
  • surgical excision
    <20mm in diameter - 4mm margins
    >20mm in diameter - 6mm margins
  • mohs’ micrographic surgery (i.e excision of the lseion and tissue borders are progressively excised until specimens are miscroscopically free of tumour) - high risk, recurrent tumours
  • radiotherapy - for large, non-resectable tumours
  • chemotherapy - metastatic disease

management of the any actinic keratosis found on
examination is with topical treatment (5FU, solaraze, actikerall, picato), cryosurgery
or photodynamic therapy.

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7
Q

what is actinic keratoses

A

premalignant skin lesion that develops as a consequence of chronic sun exposure

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8
Q

features of actinic keratoses

A

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

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9
Q

management for actinic keratoses

A

prevention of further risk: e.g. sun avoidance, sun cream

fluorouracil cream: 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

topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects

topical imiquimod: trials have shown good efficacy
cryotherapy
curettage and cautery

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10
Q

what is bowens disease

A

intraepidermal squamous cell carcinoma

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11
Q

features of bowens disease

A

red, scaly patches

often occur on sun-exposed areas such as the lower limbs

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12
Q

management of SCC

A
  • surgically - excised
    Low risk= or > 4mm
    High risk = or > 6 mm
    Very high risk= or > 10 mm
OTHERS
- shave, curretage for low risk
- aggressive cryotherapy
- Mohs
topical 5-fluorouracil or imiquimod
topical diclofenac
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13
Q

does SCC after excision require a follow up

A

yes if its the ear or lips involved as they have a higher recurrence rate

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14
Q

where would an ear SCC spread

A

via the lymphatics - pre or post auricular lymph nodes

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15
Q

what advise would you give a SCC patient

A

if tumor on ear tell them to check for any lumps

risk factor for developing subsequent new primary tumours

report any new nodule or sores

sun protection

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16
Q

what is BCC

A

A slow-growing, locally invasive malignant tumour of the
epidermal keratinocytes normally in older individuals, only rarely
metastasises

● Most common malignant skin tumour

17
Q

risk factors for BCC

A
  • elderly males
  • UV exposure
  • history of frequent or severe sunburn in childhood
  • previous history of
    skin cancer
  • skin type I (always burns, never tans),

immunosuppression

genetic predisposition

18
Q

Types of BCC

A
  • nodular (most common),
    superficial (plaque-like)
    morphoeic (sclerosing)

basosquamous

19
Q

FEATURES OF BCC

A 
- small, skin-coloured papule or
 nodule with 
- slow growing
- surface telangiectasia
- pearly rolled edge
- necrotic or ulcerated centre (rodent ulcer)
-pigmented or cystic
20
Q

causes of BCC

A

multifactorial.

Most often, there are DNA mutations in the patched (PTCH) tumour suppressor gene, part of hedgehog signalling pathway
These may be triggered by exposure to ultraviolet radiation
Various spontaneous and inherited gene defects predispose to BCC

21
Q

management of BCC

A
  • surgical removal - allows hostological examination of the tumour and margins
  • Mohs micrographic surgery (excision of the lesion and tissue borders are progressively excised until specimens are microscopically free of tumour) - HIGH RISK, RECURRENT TUMOURS
  • radiotherapy

OTHERS
- curettage
- cryotherapy - freezing w liquid nitrogen
- topical cream: imiquimod - immune modifier, <2cm
fluorouracil - topcal cytotoxic agent

22
Q

complication of BCC

A

local tissue invasion and destruction

recurrent BCC

advacned BCC - large, deeply infiltrating, impossible/difficult to treat surgically

metastatic BCC - rare

23
Q

Prognosis of BCC

A

depends on tumours sizw, site, type, growth pattern/histological subtypem failure of previous treatment/recurrence, and immunosuppression

24
Q

nodular BCC features

A
  • shiny/pearly nodule
  • ulceration
  • cystic
25
Q

superficial BCC features

A

common in younger

  • scaly, irregular plaque
  • thin, translucent rolled border
  • multiple microerosion
26
Q

morphoeic BCC features

A

midfacial sites

  • waxy, scar like plaque
  • wide and deep subclinical extension
  • infiltrate cutaneous nerves
27
Q

basosquamous BCC features

A

mixed BCC and SCC

- infiltrative growth pattern

28
Q

diagnosis of BCC

A

clincially - histological subtype is cinfimed pathologically by a diagnostic biopsy/following exicision

29
Q

types of SCC

A

cutaneous horn - excessive production of keratine

keratocanthoma - rapidly growing keratinising nodule that may resolve without treatment
carcinoma cuniculatum - warty tumour on the sole of the foot

30
Q

what is high risk SCC

A

-> diameter >= 6mm
-> location on the ear, vermilion of the lip, central face, hands, feet, genitalia
-> arising in elderly or immune suppressed pt
histology thickness >2mm, poorly differentiated
invasion

31
Q

what is a mole

A

melanocytic naevus - benign overgrowth of melanocytes

DDx
SCC
BCC
Seborrhoeic wart
malignant melanoma
32
Q

RFs of SCC

A

Hx of sun exposure
prolonged periods of immunosuppressants
smokers
pts who have received PUVA therapy
actinic keratoses and Bowen’s disease
long-standing leg ulcers (Marjolin’s ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

33
Q

what is body map

A

photographs of the whole body are taken and used for comparison over time to look for new lesions or growing ones

DERMATOLOGY (21 decks)

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