Signs And Symptoms Flashcards
Clinical presentation
Signs and symptoms, appearance by eye or on diagnostic imaging
Histology
The study of cells at a microscopic level
Pathology
The study of cause and effects of disease through examination of surgically removed organs, tissues, body fluids or autopsy
What is a sign?
It is objective evidence of a disease that can be observed by others
What are symptoms?
They are subjective and are only apparent to the patient. Ex- fatigue
Signs and symptoms of prostate cancer
Sign - haematuria
Symptoms - nocturia, urinary, frequency
Signs and symptoms of breast cancer
Signs - lump, nipple discharge/ needing, nipple inversion
Symptoms - none
Signs and symptoms of lung cancer
Signs - persistent cough and haemptosis
Symptoms- none
Signs and symptoms of oesophageal cancer
Signs- haematemesis
Symptoms- Dysphagia, dyspepsia
Signs and symptoms of rectal cancer
Signs- diarrhoae/constipation , rectal bleeding
Symptoms - none
Signs and symptoms of oral cancer
Signs - mouth ulcers, lump
Symptoms - none
How are BCCs presented?
The affect the basal cells of the base of the epidermis. They’re slow growing and can vary in size (mm-cm in diameter). Bccs rarely metastasis
Diagnostic factors of bccs
Pearly papules
Plaques, nodules, tumours with rolled borders
Scaly raised patch of irritated skin
Small crusts and non healing wounds
Spontaneous bleeding
Percentage of treated NMSCs at different anatomical locations, by sex, England 2011
Male → 78% head and neck, 7% upper limbs, 10% trunk, 4% lower limbs
Females → 73% head and neck, 6% upper limbs, 8% trunk, 13% lower limbs
What is noduloulcerative?
Macroscopically look translucent
Pearly while nodule with prominent telangiecstasia
Sometimes ulcerated area
What are superficial bccs?
They’re important to distinguish clinically, from other types of bccs because they can frequently be managed medically avoiding excision
Presentation of superficial bccs
Usually on upper trunk and shoulders
Erythematous, well demarcated scaly plaques
> 20mm
Often multicentric
Slow growing
Can be confused with Bowen’s disease, psoriasis, or eczema
Particularly responsive to medical rather than surgical treatment
What is Morphoeic ?
Histologically part of the infiltrative group of bcc
Have poorly defined edges
Plaque of scar like tissue
Predominantly found on the face
Yellow-white waxy patch will ill defined edge
Infiltrating bccs
They’re clinically a whitish, compact, not well defined plaque
Most common on upper trunk and face
Clinically often underestimated in size
Pigmentation
Brown, blue or greyish lesions
•Nodular or superficial histology
•Pigmented basal cell cancers have dark areas and can look like warts or sometimes melanoma.
What is basosquamous carcinoma?
Mixed BCC and SCC
•Basosquamous carcinoma is a rare malignancy
•Potentially more aggressive than other forms of BCC
Rare diagnostic factors
•Local destruction with advanced lesions
Several centimetres in diameter and deeply eroding into the surrounding tissue
•Metastases associated with large or neglected BCC
Metastases are uncommon, but may occur in the lungs and bones, typically in association with a large long-standing neglected BCC
What is primary cutaneous squamous cell carcinoma?
A malignant tumour → may arise from the keratinising cells of the epidermis or it’s appendages
It’s locally invasive
Potential to metastasise
Key diagnostic factors ( of CSCC )
1.Growth over weeks/months
2.Indurated nodular keratinising or crusted tumour
3.Ulceration
4.Tenderness/pain
5.Small crusts and non-healing wounds
6.Non-healing scabs /spontaneous bleeding
7.A scar like area
Presence of risk factors of a tumour
Age
Sex
Previous SCC, BCC or MM
Smoking
Actinic keratosis
UV radiation
Sun exposure /damage
Fair skin
Radiation exposure
Arsenic exposure
Xeroderma pigmentosum
Gorlin-Goltz syndrome
Transplant patients
What is the presentation of CSCC
cSCC usually presents as an indurated nodular keratinising or crusted tumour that may ulcerate, or it may present as an ulcer without evidence of keratinisation.
What is keratoacanthoma ?
rapidly growing, cutaneous rumour → generally presents as crateriform nodules in elderly, fair -skinned people
What are the 3 clinical stages of keratoacanthoma?
Proliferation – sudden appearance of erythematous to flesh coloured papule with telangectasia and rapid enlargement (up to 2cm or more)
•Maturation – becomes dome shaped with central keratinous core
•Involution - resulting in a depressed hypopigmented scar
What is verrucous carcinoma
Low grade variant of SCC with little potential for distant metastases
•Although the pathogenesis of verrucous carcinoma remains unknown, HPV, chronic irritation, and chemicals have been implicated.
•Bland histologic features make diagnosis challenging – superficial biopsy not usually sufficient to distinguish tumour type.
What is acantholytic SCC?
A rare variant of SCC
•Also referred to as adenoid, adenoacanthoma, or pseudoglandular SCC.
•Composed of both solid and gland-like epithelial proliferations extending into the dermis.
•Most commonly seen on sun exposed areas of the head and neck of elderly patients.
•Most likely arises from acantholytic actinic keratoses
•Significant male predominance.
What are spindle cells?
Rare
A exophytic tumour or an ulcerated mass
on sun-exposed skin areas
Typical for elderly population
Arranged in a whorled pattered
Are aggressive
What are actinic keratosis/ solar keratosis?
Common pre-cancerous lesion
Appears on skin frequently exposed to sun or artificial sources of UV
•Mostly appear on sun exposed areas such as face, bald scalp, ears, shoulder, neck, back of hands and forearms.
•Elevated, rough in texture and resemble warts
What is Bowen’s disease?
Bowen’s disease, Usually seen in sites of chronic sun exposure – hands, neck and head, but can occur on any mucosal surface.
If not treated, it can progress to invasive SCC typically 3-5%
