Skin Cancer Flashcards
What is the most common skin cancer in humans?
Basal Cell Carcinoma (BCC)
What is the lifetime percentage risk of developing BCC?
30%
What are the known risk factors for developing BCC?
- Increasing age
- Fair skin
- High-intensity UV exposure
- Radiation
- Immunosuppression
- Previous Hx of BCC
- Congenital disorders e.g. Gorlin’s syndrome
What appearance can a BCC have?
A pearly shiny translucent quality
What is a basal cell carcinoma?
Masses of basal cells are dividing and have lost the capacity to further differentiate. This means that there is no epidermal formation over the basal cells and this leads to an ulcer formation.
Describe the following skin type using the Fitzpatrick scale; type I
Always burns, never tans
Very pale white skin
Blue/hazel eyes
Red/blonde hair
Describe the following skin type using the Fitzpatrick scale; Type II
Usually burns, tans poorly
Pale white skin
Blue eyes usually
Describe the following skin type using the Fitzpatrick scale; Type III
Tans after initial burn
Darker white skin
Describe the following skin type using the Fitzpatrick scale; IV
Tans easily
Burns minimally
Light brown skin
Describe the following skin type using the Fitzpatrick scale; Type V
Tans darker, brown, rarely burns
Brown skin
Describe the following skin type using the Fitzpatrick scale; Type VI
Always tans darkly, never burns
Dark brown/black skin
When examining a skin lesion that you may be suspicious of cancer in, where else should you examine?
- Draining lymph nodes
- The liver - for hepatomegaly
What are the other common names for Basal Cell Carcinoma (BCC)?
- Non-melanoma cancer
- Rodent ulcer
- Basalioma
What are the clinical features of a BCC?
- Slow growing plaque or nodule
- Skin coloured, pink or pigmented
- Varied in size
- Spontaneous bleeding or ulceration
What cell is squamous cell carcinoma (SCC) derived from?
Keratinocytes
What is worrying about SCC?
It can deeply penetrate the epidermis and metastasise
What are the risk factors for developing SCC?
- Increasing age
- Most common in elderly males
- Previous SCC or BCC
- Actinic keratoses
- Outdoor occupation or recreation
- Smoking
- Fair skin, blue eyes or blonde and red hair
- Previous cutaneous insult
- Inherited syndrome
- Immunosuppression
What are the clinical features of SCC?
- Grow over weeks-months
- Ulceration
- Tender/painful
- Located on sun-exposed sites (face, lips, ears, hands, forearms, lower legs)
- Size variable
When should a patient with a skin lesion clinically suspicious of cancer be referred via the 2ww pathway?
The patient must score 3 or more in total on the 7 point checklist; MAJOR FEATURES (2points each) - Change in size - Irregular shape - Irregular colour
MINOR FEATURES (1point each)
- Largest diameter 7mm<
- Oozing/crusting
- Inflammatory response
- Altered sensation
How many melanomas of the skin are diagnosed annually in the UK?
13,000
How many SCC are diagnosed annually in the UK?
25,000 cases
How many BCC are diagnosed annually in the UK?
75,000
How does melanoma of the skin present clinically?
Pigmented lesion of the skin
How is melanoma diagnosed?
Excision biopsy
Non-melanoma skin cancer is more common in one gender, which gender is it?
Males
What is the hallmark feature of SCC?
Malignant transformation of normal epidermal keratinocytes
In people with skin of colour, where is the most common sites for a SCC to develop?
Areas of UV protected sites
In those who are immunosuppressed
Which clinical features of SCC indicate a poorer prognosis?
- Tumours >2cm in size are twice as likely to metastasise
- Lesions on the lip or ear
- Immunosuppression
Which histological features of SCC indicate a poorer prognosis?
- Invasion >4mm
- Perineural invasion (nerve invasion of the tumour)
- Nuclear atypia (poorly differentiated cells)
What is the treatment of choice for a high risk SCC?
Surgical excision with adequate margins
What are acceptable approaches to managing BCC?
- Photodynamic therapy
- Surgical excision
- Radiotherapy
- Leave them alone
- Imiquimod cream 5%
