Skin Cancer

Question 1

Basal cell carcinoma risk factors

Answer 1

increasing age
previous BCC / skin cancers
chronic sun exposure
repeated episodes of sunburn
skin type (fair, fitzpatrick 1)
inherited conditions

Question 2

BCC clinical features

Answer 2

slow growing plaque / nodule
skin coloured- pink, brown, pigmented
spontaenous bleeding or ulcerated

*non melanoma skin cancer
*most common cancer worldwide

Question 3

types of BCC

Answer 3

1. nodular BCC
2. superficial BCC
3. morphoeic BCC
4. basosquamous BCC

Question 4

nodular BCC

Answer 4

most common facial type
shiny/pearly nodule with a smooth surface and central depression / ulceration
blood vessels across the surface
can have variants

Question 5

superficial BCC

Answer 5

common in younger adults
upper trunk / shoulders
slightly scaly, irregular plaque
thin, translucent rolled border
multiple microerosions

Question 6

morphoeic BCC

Answer 6

mild facial sites
waxy, scar like plaque
indsitinct burers
can infliatrate cutaenous nerves

Question 7

Basosqumous BCC

Answer 7

mixed basal and squamous cell carcinoma
infilatrative growth pattern

Question 8

layers of the skin

Answer 8

1. epidermis
2. dermis
3. hypodermis

layers of the epidermis
1. stratum corneum
2. stratum lucideum
3. stratum granulosum
4. stratum spinosum (SCC)
5. stratum basale (BCC)

Question 9

investigations of BCC

Answer 9

1. biopsy
2. histopathological examination

Question 10

management of BCC

Answer 10

complete removal of the tumor

topical flurouracil (5-FU), cryotherapy, photodynamic therapy

Question 11

SCC (squamous cell carcinoma) pathophysiology

Answer 11

second most common skin cancer (after BCC)
malignant transformation of the stratum spinosum of the epidermis

Question 12

SCC risk factors

Answer 12

exposure to sunlight
chemical carcinogens
precancerous lesions- actinic keratosis
skin damage- scars, burns, ulcers

Question 13

SCC presentation

Answer 13

painless
non-healign
bleeding ulcers
crusting, itching
everted edges

*can also present as plaques, nodules, warty lesions

*all forms eventually ulcerate

most commonly on face, neck, lower lip, ears, hands

RED FLAGS- malaise, weight loss, lympadenopathy

Question 14

investigations / diagnosis of SCC

Answer 14

1. biopsy (punch biopsy / wedge / excisional)
2. urther imaging- CT, MRI
3. lymph node biopsies, FNAC

Question 15

morphology of SCC lesions

Answer 15

firm to palpate (nodular/plaque)
ulcerate , bleed
tender / painful
crusty keratotic top with a nodular base
variable size

Question 16

melanoma

Answer 16

highly malignant tumor arising from melanocytes
risk factors- UV radiation exposure, sunburn, age, fhx, immunosupression

Question 17

melanoma clinical features

Answer 17

itchy (pruritic)
persistently bleeding skin lesion
assymetry
irregular border
color
diameter >6mm
evolving

Question 18

diagnosis / investigation for melanoma

Answer 18

full thickness excisional biopsy
staging test (USS, MRI)

Question 19

melanoma vs SCC vs BCC

Answer 19

melanoma: brown/black, irregular macule/nodule, commonly on trunk or extremitis, slow gorwth

SCC: red, scaly plaque like, rough texture, all eventually ulcerate

BCC: pink, pearly nodular lesion, superficial veins, central dimpling, slow growth

Question 20

melanoma treatment

Answer 20

surgical excision
medical therapy - BRAF kinase inhibitor