Skin cancer

Question 1

What is the most common malignant skin tumour?

Answer 1

Basal cell carcinoma

Question 2

What is a basal cell carcinoma?

Answer 2

A slow growing, locally invasive malignant tumour of the epidermal keratinocytes, normally in older individuals and very rarely metastasises.

Question 3

What are the risk factors for basal cell carcinoma?

Answer 3

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

Question 4

What are the different morphological types of BCC?

Answer 4

superficial (plaque like) 
nodular (most common) 
cystic 
morphoeic (sclerosing) 
keratotic 
pigmented

Question 5

How would you describe how a Nodular basal cell carcinoma looks?

Answer 5

Small skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge
The lesion may have a necrotic or ulcerated centre

Question 6

Where is nodular basal cell carcinoma normally found?

Answer 6

It is most common over the head and the neck

Question 7

How do you treat basal cell carcinoma?

Answer 7

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

Question 8

What are the complications of BCC?

Answer 8

Local tissue invasion and destruction

Question 9

What is squamous cell carcinoma?

Answer 9

This is a locally invasive malignant tumour of the epidermal keratinocytes or its appendages which have the potential to metastatise

Question 10

What is the presentation of squamous cell carcinoma?

Answer 10

Keratotic- scaly, crusty

ill defined nodule which may ulcerate

Question 11

What is the management of squamous cell carcinoma?

Answer 11

Surgical excision- this is the treatment of choice
MOHS micrographic surgery
Radiotherapy- for large, non resectable tumour
Chemotherapy for metastatic disease

Question 12

What is a malignant melanoma?

Answer 12

An invasive malignant tumour of the epidermal melanocytes, has the potential to metastasise

Question 13

What are the risk factors for malignant melanoma?

Answer 13

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.

Question 14

What is the presentation of malignant melanoma?

Answer 14

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

Question 15

What are the types of malignant melanoma?

Answer 15

Superficial spreading melanoma (70% of all melanomas)

Nodula melanoma

Lentigo maligna melanoma

Acral lentiginous melanoma

Question 16

Where does superficial spreading melanoma usually occur and in what age range?

Answer 16

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

Question 17

Where does nodular melanoma usually occur?

Answer 17

Common on the trunk, in young and middle aged adults

It is related to intermittent high intensity UV exposure

Question 18

Where does lentigo maligna melanoma usually occur?

Answer 18

Common on the face, in the elderly population

It is related to long term cumulative UV exposure

Question 19

Where does acral lentiginous melanoma usually occur?

Answer 19

Common on the palms, soles and nail beds, in the elderly population
It actually has no clear relation with UV exposure

Question 20

What staging system is used for melanoma in the UK?

Answer 20

2018 American Joint Committee of cancer staging system (AJCC)

Question 21

How is melanoma stage?

Answer 21

It is based on lymph node involvement, evidence of mets, primary tumour breslow thickness

Question 22

How is melanoma treated?

Answer 22

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

Question 23

What important questions should you ask about a suspicious looking lesion?

Answer 23

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?

Question 24

What is the most important risk factor for recurrence of the malignant melanoma?

Answer 24

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