Skin Cancer Flashcards
What are features of BCC?
Most common skin malignancy
Nodular BCC= most common
- pearly pink/flesh coloured papule with telangiectasia
- may ulcerate in the centre or bleed
- often have rolled edges with presence of central depression/ulceration
What are management options of BCC?
Surgical removal
Curettage
Cyrotherapy
Topical cream
Radiotherapy
What are features of SCC?
Locally invasive malignancy of keratinocytes
Enlarging crusty or scaly lumps appear over weeks to months
Typically arise from premalignant lesions e.g. actinic keratosis or Bowens- sun exposed areas
May ulcerate
Can be painful
Can have cauliflower appearance
Risk factors- immunosuppression, smoking, sun exposure
How do you determine a bad prognosis for SCC?
Poorly differentiated
>20mm in diameter
>4mm deep
Immunosuppression
What are the 4 main subtypes of malignant melanoma?
Superficial spreading
Nodular
Lentigo
Acral Lentiginous
What is superficial spreading?
Most common subtype
Slow growing, flat, pigmented lesions which spread horizontally
Have asymmetrical or irregular borders
What is nodular?
2nd most common
Usually appear as a dome shaped nodule which grows rapidly over a few weeks to months
Lesions bleed and ulcerate
Can be pigmented or non pigmented
What is Lentigo?
Slow growing pigmented/brown macule
May be asymmetrical with multiple colours
Often on chronically sun exposed areas in older people
What is Acral?
Usually occurs on nails/palms/soles
Slow enlarging lesions which may bleed or ulcerate
Seen in people with darker skin pigmentation
How are people referred?
7 point checklist
Major criteria- 2 pts each
- change in size
- irregular colour
- irregular borders/shape
Minor criteria- 1pt each
- Diameter >7mm
- Oozing
- Abnormal sensation e.g. itchiness
- Inflammation
> 3 points for urgent referral
Consider urgent referral if 1 major feature
What is the management of MM?
Any concern/uncertainty then 2WW referral
Excision biopsy normally performed and further re-excision depends on Breslow thickness
What are the margins of excision based on Breslow thickness?
Lesion 0-1mm thick= 1cm
Lesion 1-2mm thick= 1-2 cm
Lesion 3-4mm thick= 2-3 cm
Lesion >4mm thick= 3cm
What are features of Actinic Keratosis?
Premalignant skin lesions occur due to sun exposure
Increases risk of SCC as they can evolve
What are clinical features of AK?
Flat or thickened plaques which are scaly or crusty
Vary in colour- pink/red/brown
Normally on sun exposed areas
What is the management of AK?
Avoid sun exposure/sun cream
Topical
- Fluorouracil cream 2-3 week course, skin will become red and inflammed
- diclofenac- for mild
- topical imiquimod
Cryrotherapy
Curettage and Cautery
What is Xeroderma Pigmentosum?
A rare autosomal recessive disorder of DNA repair which stops DNA being repaired from sun damage
More common in Japanese
Massively increased risk of BCC and skin cancer at young age
Severe cases- avoid sunlight completely
