Skin cancer Flashcards
What is Breslow thickness and why is it important?
T0- still in the epidermis
T1- less than 1mm thick
T2- melanoma is between 1.1mm and 2mm thick
T3- melanoma is between 2.1mm and 4mm thick
T4- melanoma is more than 4mm thick
What is the pathway from being diagnosed with a melanoma to treatment?
- GP referral to Dermatology as 2 week wait
- Biopsy- incisional or excision biopsy
- MDT discussion
- Further surgery
- Investigations
- Referral to oncology
Treatment for melanoma summarised
Early stages- WLE
More advanced- WLE and SLNB
Advanced or metastatic- palliative treatment
How do you identify sentinel lymph node?
- Preoperative Lymphoscintigraphy
- Intraoperative Gamma Probe
- Use of Blue Dye
- Sentinel Lymph Node Biopsy (SLNB)
- Dual Modality Approach
What is the BRAF mutation?
Leads to constitutive activation of the MAPK/ERK signalling pathway, promoting unchecked cell growth and division.
Not genetic
Identified to use more targeted treatment
In some cases, the BRAF mutation may arise as the melanoma progresses. This means that while a melanoma may start without a BRAF mutation, it could develop one as it evolves. This is part of the tumour’s adaptation and response to the environment.
Who is in a skin MDT?
- Oncologist
- Surgeon
- Dermatologist
- Plastic surgeon
- Clinical oncologist
- Medical oncologist
- Specialists nurses
- Radiotherapy
- Histologists
Questions to ask in a skin history
- Evolution (increasing in size)
- Erythema
- Sun exposure/sunbeds/suncream
- Red flag symptoms- bleeding, itching, ulceration
- Personal history of skin cancer
- Family history of skin cancer
- Any lumps in axilla/groin
Assessing a pigmented lesion
Asymmetry
Border
Colour
Diameter
Evolution
Ill-defined borders
- Invading surrounding tissue
- More likely to be aggressive/metastatic/malignant
Describing colour of lesions
Variable pigmentation or uniform colour
Hyperpigmentation- adjacent areas of hypopigmentation
Acral melanoma is more likely to appear in patients with darker skin
Over what diameter is worrying?
6-7mm
NICE guidelines for recognising malignant skin lesions
Major criteria
- Change in size-
- Irregular shape
- Irregular colour
(2 points each)
Minor criteria
- Largest diameter 7mm or more
- Inflammation
- Oozing
- Change in sensation
(1 point each)
Refer for an appointment within two weeks… if they have a score of 3 or more
Different types of biopsies
- Shave- (+ve) if it is benign, you don’t need to do anything else, doesn’t need a suture, quick. (-ve) can’t see breslow thickness
- Punch ( +ve- more depth)
- Excision (wide margin, can be treatment too)
- Incision
What is a skin scrape used for
Impetigo- cutaneous infections
What is the difference between primary and secondary intention of healing wounds?
Primary intention- suturing essentially (bringing the edges closer together)r
Secondary intention- purposefully let the wound heal by itself, can’t put the edges together
