Skin Cancer

Question 1

Risk factors for SCC

Answer 1

Excessive exposure to sunlight
Bowen’s disease / Actinic keratoses
Smoking
long standing ulcers
Immunosuppresion (following transplant / HIV)
Phototherapy

Question 2

Treatment of actinic keratosis / Bowens?

Answer 2

Pre malignant small crusty lesions on sun exposed areas

prevention of further risk: e.g. sun avoidance, sun cream

fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation

topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects

topical imiquimod: trials have shown good efficacy

cryotherapy

curettage and cauter

Question 3

Treatment of SCC ?

Answer 3

Excision

(4mm margins if <2cm)

(6mm margin if >2cm)

Question 4

Appearance of SCC

Answer 4

Cauliflower appearance
Painful rapidly expanding ulcerating
Areas of bleeding

Question 5

What is also known as a rodent ulcer

Answer 5

Basal cell carcinoma

Question 6

Appearance of BCC?

Answer 6

Pearly rolled edged papule With telengectasia
May Ulcerate leaving central crater

Question 7

Most common type of skin cancer in western world

Answer 7

BCC

IF BCC Suspected - routine referral

Question 8

What determines prognosis of melanoma

Answer 8

Breslow thickness

<0.75mm depth = 95-100% 5 yr survival

> 4mm = 50% survival at 5 years

Question 9

Most common type melanoma?

Answer 9

Superficial spreading

2) Nodular

3)Lentigo maligna

4) Acral lentiginous