SCC Flashcards
what is a SCC
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
describe a SCC lesion
- 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
causes of SCC
- 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
what clinical examination would one do
Full skin examination and lymph node examination.
DD for SCC
Bowens disease
BCC shiny nodule but does not have keratin and grwos very slowly
management for SCC
- 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.
what is actinic keratoses
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
management for actinic keratoses
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
what is bowens disease
intraepidermal squamous cell carcinoma
features of bowens disease
red, scaly patches
often occur on sun-exposed areas such as the lower limbs
management of SCC
- 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
does SCC after excision require a follow up
yes if its the ear or lips involved as they have a higher recurrence rate
where would an ear SCC spread
via the lymphatics - pre or post auricular lymph nodes
what advise would you give a SCC patient
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
what is BCC
A slow-growing, locally invasive malignant tumour of the
epidermal keratinocytes normally in older individuals, only rarely
metastasises
● Most common malignant skin tumour
risk factors for BCC
- 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
Types of BCC
- nodular (most common),
superficial (plaque-like)
morphoeic (sclerosing)
basosquamous
FEATURES OF BCC
- small, skin-coloured papule or nodule with - slow growing - surface telangiectasia - pearly rolled edge - necrotic or ulcerated centre (rodent ulcer) -pigmented or cystic
causes of BCC
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
management of BCC
- 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
complication of BCC
local tissue invasion and destruction
recurrent BCC
advacned BCC - large, deeply infiltrating, impossible/difficult to treat surgically
metastatic BCC - rare
Prognosis of BCC
depends on tumours sizw, site, type, growth pattern/histological subtypem failure of previous treatment/recurrence, and immunosuppression
nodular BCC features
- shiny/pearly nodule
- ulceration
- cystic
superficial BCC features
common in younger
- scaly, irregular plaque
- thin, translucent rolled border
- multiple microerosion
morphoeic BCC features
midfacial sites
- waxy, scar like plaque
- wide and deep subclinical extension
- infiltrate cutaneous nerves
basosquamous BCC features
mixed BCC and SCC
- infiltrative growth pattern
diagnosis of BCC
clincially - histological subtype is cinfimed pathologically by a diagnostic biopsy/following exicision
types of SCC
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
what is high risk SCC
-> 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
what is a mole
melanocytic naevus - benign overgrowth of melanocytes
DDx SCC BCC Seborrhoeic wart malignant melanoma
RFs of SCC
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
what is body map
photographs of the whole body are taken and used for comparison over time to look for new lesions or growing ones
