Skin Cancer Flashcards
Melanocytic and non melanocytic pigmented lesions
Melanocytic:
Melanocytic naevi
Solar lentigo
Lentigo maligna
Malignant melanoma
Non Melanocytic
Seborrhoeic keratosis
Dermatofibroma
Skin tags
Melanocytic arise from melanocytes and non Melanocytic arise from other cells such as keratinocytes
Non pigmented lesions
Acitinic keratosis
Bowens
Squamous cell carcinoma
Basal cell carcinoma
Intradermal naevi
Clear cell acanthoma
Porokeratosis
Psoriasis
Epidermis layers superficial to deep
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Dermis
Types of skin cancer
Squamous cell carcinoma(epidermis-stratum spinosum)
Basal cell carcinoma(epidermis and begins to enter dermis-stratum basale)
Melanoma (epidermis and enters dermis-melanocytes )
Malignant melanoma
Melanocytes become abnormal
They start proliferating
-atypical cells
-atypical architecture
Subtypes
superficial spreading (most common), nodular, lentigo maligna, acral lentiginous, unclassifiable
Lentigo maligna
Melanoma in situ
Proliferation of malignant melanocytes within the epidermis
How does lentigo maligna present
Irregular shape
Light and dark brown colors
Size usually >2cm
Usually on skull face or scalp
How does a malignant melanoma develop from a junctional naevus
Horizontal then vertical growth
(Melanoma is where it travels deeper into dermis)
Superficial spreading. MM
Lateral proliferation of malignant melanocytes
(Middle becomes skin color again-regression)
Diagnosis of superficial spreading melanoma
ABCD
A for asymmetry
B is for border (irregular scalloped or poorly defined border)
C is for color (varying colors from one area to the next eg shades of tan,brown,black or areas of white red or blue)
D js for diameter (white melanomas are greater than 6mm can be smaller when diagnosed
E it evolves
Nodular malignant melanoma
Vertical proliferation of malignant melanocytes within
No previous horizontal growth
Commonly found on head neck and trunk
Appear blue blah but can be pink or red
Nodular melanoma arising within a superficial spreading melanoma
Downward proliferation of malignant melanocytes following previous horizontal growth
Does the prognosis get better for Nodular melanoma arising within a superficial spreading melanoma
Prognosis becomes worse
Types of malignant melanomas
Lentigo malignant melanoma
Superficial spreading
Nodular
Acral lentiginous
Subungal
Amelanotic melanoma
Breslow thickness
Measurement from granular layer to bottom of tumour
Risk factors for developing melanoma’s
Genetic markers
Family history of dysplastic nevi or melanoma
Ultraviolet irradiation
Sunburns during childhood
Intermittent burning exposure in unacclimatized fair skin
Number>50 or size >5mm of Melanocytic nevi
Congenital nevi
Atypical/dysplastic nevus syndrome
Personal history of melanoma
High sociecinmic stays
Skin type I,II
equatorial latitudes
DNA repair defects
Immunosuppresion
Melanoma management
1)Primary excision down to subcutaneous fat
2mm peripheral margin
2)Wide excision
-margin determined by breslow depth
-5mm for in situ (superficial)
Cut 10mm for melanoma less than <=1mm (deeper)
Prevents local recurrence of persistent disease
Other management
Excision and wide local excision to all melanomas
Sentinel lymph node biopsy if breslow thickness >0.8mm
PET CT (if stage III,IV)
MRI BRAUN SCAN (if stage III,IV)
LDH major prognostic indicator
Acintic keratosis
Progressed to scquamous cell carcinoma
It’s the precancerous stage
Primary invades epidermis
Bowens disease
Squamous cell carcinoma in situ
erythematous scaly patch, possibly slightly elevated plaque
Non invasive skin cancer which involves the epidermis due to presence of atypical keratinocytes
Treatment for AK and Bowens
5 fluorouracil cream
Cryotherapy
Imiquimod cream
Photodynamic therapy
Curretage and cautery
Excision
Clinical appearance of squamous cell carcinoma
Arises within background of sun damaged disease
Erythematous to skin coloured
Papule
Plaque like
Exophytic
Hyperkeratotic
Ulcerated
Ill defined margins and localized on head and neck (1cm) trunk (2cm) and periorificial
Poorly differentiated invasion beyond subcutaneous fat/peruneural lymphatic vascular invasion possible
Keratoacanthoma
rapidly enalarging papule that evolves j to a sharply circumscribed crateriform nodule with a keratotic core
Resolves slowly over months
Most occur in head or neck/sun exposed areas
Difficult to distinguish clinically and histologically from squamous cell carcinoma It’s
Basal cell carcinoma
Superficial Well focused arborising vessels and occasional small blue globule
Typically presents as shiny pearl papule or nodule (Nodular)
Does not metastasis
Most common type of cancer
Treatment for basal or squamous cell carcinoma
Surgery
MOHS surgery at high risk sites
Radiotherapy
MOHS surgery
- First thin layer removed
2.ankterh thin mater removed
3.another then layer removed
4.final layer of cancer removed
What is a melanoma
Malignant tumour arising from melanocytes
Can occur on skin mucosal surfaces eg oral vaginal
Acral lentiginous melanoma
Rare but aggressive melanoma that occurs on the palms soles and under the nails
Longitudinal melonychia
Pigmented band forms in length of nail
Subungual melanoma
Dark stripe on nail
Rare aggressive for
Basiqumous cell carcinoma
Pearly or waxy bump with visible blood vessels
Combination of basal and squamous cell carcinoma
Dermascopw
Tool used to help see clearly
What is a major prognostic factor in melanoma
LDH in metastatic melanoma
BRAF mutation status can also inform
What can be used for unresectable bcc
Vismodegib
What is indicated for unresectable scc
Cemiplimab
