Skin cancer Flashcards
What is the most common malignant skin tumour?
Basal cell carcinoma
What is a basal cell carcinoma?
A slow growing, locally invasive malignant tumour of the epidermal keratinocytes, normally in older individuals and very rarely metastasises.
What are the risk factors for basal cell carcinoma?
UV exposure History of frequent or severe sunburn in childhood Skin type 1 (always burns, never tans) Increasing age Male sex Immunosuppression Previous hx of skin cancer Genetic predisposition
What are the different morphological types of BCC?
superficial (plaque like) nodular (most common) cystic morphoeic (sclerosing) keratotic pigmented
How would you describe how a Nodular basal cell carcinoma looks?
Small skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge
The lesion may have a necrotic or ulcerated centre
Where is nodular basal cell carcinoma normally found?
It is most common over the head and the neck
How do you treat basal cell carcinoma?
Surgical excision- treatment of choice because it allows histological examination of the tumour and the margins
Radiotherapy is used when surgery is not appropriate
Other options; cryotherapy, curettage and cautery, topical photodynamic therapy and topical treatment (eg: imiquimod cream)- for small and low risk lesions
MOHS- micrographic surgery ie: excision of the lesion and tissue borders are progressively excised until specimens are microscopically free of the tumour
This is done for high risk, recurrent tumours
What are the complications of BCC?
Local tissue invasion and destruction
What is squamous cell carcinoma?
This is a locally invasive malignant tumour of the epidermal keratinocytes or its appendages which have the potential to metastatise
What is the presentation of squamous cell carcinoma?
Keratotic- scaly, crusty
ill defined nodule which may ulcerate
What is the management of squamous cell carcinoma?
Surgical excision- this is the treatment of choice
MOHS micrographic surgery
Radiotherapy- for large, non resectable tumour
Chemotherapy for metastatic disease
What is a malignant melanoma?
An invasive malignant tumour of the epidermal melanocytes, has the potential to metastasise
What are the risk factors for malignant melanoma?
Excessive UV exposure
Type 1 skin
History of >100 moles or atypical neavus syndrome moles, family history in first degree relative or previous history of melanoma.
What is the presentation of malignant melanoma?
Asymmetrical shape Border irregularity Colour irregularity Diameter (>7mm) Evolution of lesion (change in size and/or shape) Symptoms- bleeding, itching
More common on the legs in women and the trunk in men
What are the types of malignant melanoma?
Superficial spreading melanoma (70% of all melanomas)
Nodula melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Where does superficial spreading melanoma usually occur and in what age range?
This is common on the lower limbs, in young and middle aged adults
It is related to intermittent high intensity UV exposure
Around 70% of melanoma
Where does nodular melanoma usually occur?
Common on the trunk, in young and middle aged adults
It is related to intermittent high intensity UV exposure
Where does lentigo maligna melanoma usually occur?
Common on the face, in the elderly population
It is related to long term cumulative UV exposure
Where does acral lentiginous melanoma usually occur?
Common on the palms, soles and nail beds, in the elderly population
It actually has no clear relation with UV exposure
What staging system is used for melanoma in the UK?
2018 American Joint Committee of cancer staging system (AJCC)
How is melanoma stage?
It is based on lymph node involvement, evidence of mets, primary tumour breslow thickness
How is melanoma treated?
In general, surgical excision is the definitive treatment , often a second surgery, wide local excision is needed after the initial excision biopsy
Radiotherapy may sometimes be useful
Chemotherapy is used for metastatic disease
What important questions should you ask about a suspicious looking lesion?
How long has the lesion been present and how has it changed? Has it increased in size? Has it changed shape? Has it changed colour? Does it bleed or weep? Does it itch?
What is the most important risk factor for recurrence of the malignant melanoma?
Breslow thickness
This is the single most important risk factor for melanoma
This is the depth of the tumour
It is measured on histology in mm from the granular cell layer to the deepest point of the tumour
