Skin cancer Flashcards
Pre-melanoma lesion
Lentigo maligna
- flat pigmented lesion
- where it shows evidence of growth/change, it should be referred for excision (or if not suitable, cryotherapy or radiotherapy)
BCC
a) Appearance
b) Types
c) Treatment
a) - Pearly nodule in sun-exposed areas
- Surface telangiectasia
b) - Nodular - most common
- Morphoiec - scar like, flatter
- Pigmented
c) Moh’s surgery, with 4mm margin
Pre-SCC lesions
- give 2 and their appearances
- treatment for each
Actinic keratosis
- Scaly nodules in sun-damaged areas
- Rx: topical fluorouracil 5% cream (5-FU)
Bowen’s disease
- Red/brown lesions on sun-exposed areas (e.g. face, ears, legs)
- <10% transform to malignancy (ulceration may indicate SCC)
Melanoma
a) 7-point checklist (max score = 10). Mnemonic: CBS SOIL
b) Chemo/immunotherapy - BRAF positive vs BRAF negative
a) 2 points each for: irregular Colour, irregular Border, enlarging Size
1 point each for: Sensation change (e.g. itch), Oozing/crusting, Inflammation, Largest diameter >7mm
Refer for scores 3 or more
b) If BRAF gene positive (50%):
- BRAF inhibitors e.g. daBRAFenib
(often with MEK inhibitor)
If BRAF negative:
- Immunotherapy, e.g. ipilimumab
Melanocytes
a) Type of cell
b) Position in skin
a) Dendritic cell
b) Basal layer of the epidermis
Melanoma
a) Clark staging
b) Breslow thickness
Clark scale:
Level 1 is also called melanoma in situ – epidermis
Level 2 - papillary dermis (superficial dermis)
Level 3 - deep dermis
Level 4 - reticular dermis
Level 5 - subcutaneous fat
Breslow thickness:
Tis = melanoma in situ.
T0 means no melanoma cells can be seen where the melanoma started (primary site).
T1 means the melanoma is 1 mm thick or less. It is split into T1a and T1b.
T1a: <0.8 mm thick and not ulcerated
T1b: <0.8 mm thick but ulcerated, or up to 1mm and ulcerated or not
T2: 1-2 mm thick.
T3: 2-4 mm thick.
T4: > 4 mm thick.
Subungual melanoma - common sign
Hutchinson’s sign - pigmentation extends beyond nail
