Skin Cancer Flashcards
what type of sun burn causes the biggest risk of skin cancer?
blistering burns
esp during childhood
describe BCC?
telangectasia
can have rolled edge
pearlescent
locally invasive but doesnt tend to spread distantly
sub-types of BCC?
nodular (raised but well defined)
superficial (flat and well defined)
infiltrative (less well defined)
how is each sub-type of BCC managed?
nodular = surgical excision superficial = topical cream or cryotherapy or photodynamic therapy infiltrative = mohs surgery
what topical creams can be used in superficial BCC?
5-FU
imiquimod
what is Mohs surgery?
surgical excision of cancer with small margin, then look at sample under microscope to check youve got all the cancer call (can go back and take more if needed)
how might superficial BCCs appear?
red
irregular
can have some crusting and pinpoint bleeding
what is actinic keratosis?
partial thickness dysplasia of keratinocytes
what is bowens disease?
full thickness dysplasia of keratinocytes
what is SCC?
full thickness dysplasia of keratinocytes + invasion of basement membrane
how is actinic keratosis managed?
topical creams
photodynamic therapy
cryotherapy (good for solitary lesion)
what does the term field exposure mean?
large area of skin all dysplastic from sun exposure
can be a mixture of SCC, actinic keratoses etc
how is field exposure managed?
surgical excision of SCCs
topical therapy for actinic keratoses
how is bowens disease managed?
topical therapy
where are SCCs likely to occur in smokers?
lips
SCCs in which areas are most likely to metastasise?
ears and lips
what is a keratoacanthoma?
skin lesion which occurs in sun-damaged skin
grows very quick over a few weeks-months then regresses
are typically well defined growths with a central keratin plug (look like a volcano)
can have features of SCC (keratin) and BCC (rolled edges and telangectasia)
SCCs can complicate chronic wounds, what might indicate that theres an SCC present?
wound not healing becomes exophytic (growing outwards)
immunocompromised people more likely to get SCC or BCC?
SCC
where do most melanomas occur?
back in men
legs in women
risk factors for melanoma?
same as BCC and SCC
but also having large number of moles increases chances of one becoming malignant
major criteria indicating a malignant mole?
change in shape
change in size
change in colour
minor criteria indicating a malignant mole?
diameter >6mm
bleeding
sensory change
inflammation
biggest risk of malignant evolution in a mole?
changing mole
ABCDE of assessing moles?
A = asymmetry B = border C = colour (Multiple colours) D = diameter (>6mm) E = elevation or evolution
standard practice if you think its a melanoma?
excise with 2mm margins
how are people with multiple atypical moles or a family history of atypical moles monitored?
initially monitor every 3 months, then 6 monthly, then yearly
always look for the “ugly duckling”
types of melanoma?
superficial spreading nodular lentigo maligna acral amelanotic (dont produce any pigment)
which type of melanoma has the worst prognosis?
nodular
doesnt have a radial growth phase, just immediately vertical growth
melanoma growth phases?
radial (in dermis, no metastatic potential, melanoma in situ)
vertical (growing down the way, able to metastasise)
what is the best predictor of prognosis in skin cancer?
breslow thickness
what is breslow thickness?
depth from granular layer
how does lentigo maligna commonly present?
often on the face in elderly people
can look like brown patch in radial phase, only really known as lentigo maligna once in vertical growth phase
how is lentigo maligna managed in radial growth phase?
can be managed topically with imiquimod
but still need to do punch biopsy of worst looking bit to check its not in vertical growth phase as topical therapy wont work in vertical phase
acral melanoma is more common in which skin types?
darker skin
what signs can indicate active growth?
starburst pattern
satellite lesions
amelanotic melanomas are more common in which skin types?
people who dont produce much eumelanin (brownish one)
ie - celtic skin types (1 and 2)
how is malignant melanoma managed?
surgical excision +/- sentinel node biopsy
role of chemotherapy, radiotherapy and immunotherapy
advanced malignant melanomas difficult to treat
what determines the size of excision?
breslow thickness
how does breslow thickness affect survival?
confined to epidermis (in situ) = 100% 5 year survival
thickness <0.76mm = 90% 5 year survival
thickness >3mm = 60% 5 year survival
