Skin cancer Flashcards
Epidemiology of Skin cancer
Skin cancer is the most common type of cancer
Skin cancer is the most common cancer in New Zealand. In 2012, 486 New Zealanders died from skin cancer.
Types of Skin cancer
3 main types
Basal cell carcinoma (about 80%) the most common and least dangerous skin cancer. BCC can be serious, requiring surgery if left untreated.
Squamous cell carcinoma (about 16%) easily treated if found early but can be fatal if left untreated.
Melanoma (about 4%) - the most serious form of skin cancer, causing over two thirds of total skin cancer deaths
Moles that are new or changing does not heal
that looks different from others around it
has changed in size, thickness, shape, colour or has started to bleed.
Aetiology of skin cancer
The most common cause of skin cancer is too much exposure to ultraviolet (UV) radiation from the sun. Overexposure to UV radiation causes the skin permanent damage.
high risk:
fair skin and red or fair hair
fair skin that burns easily no matter what hair colour
had one or more severe sunburns—especially in childhood and adolescence
used sunbeds, particularly at a young age
had previous skin cancers
a family history of melanoma (parent, brother, sister or child)
large, irregularly shaped and unevenly coloured moles
a large number of moles
Pathogenesis
damage/dna/proliferative cell mutation
Diagnosis is with Biopsy is essential
Basal Cell Carcinoma
Basal cell carcinomas, the most common skin cancers, are particularly common among fair-skinned, sun-exposed people. Develop from the keratinocytes of basal layer.
Consider the diagnosis with typical lesions (eg, shiny, slowly enlarging papule, often with a shiny, pearly border) and lesions that alternately crust and heal.
Refer patients to specialists for treatment, usually by locally destructive methods.
Squamous cell carcinoma?
highly variable in appearance, outer epidermis
appear often from precursor actinic keratoses
2 types
invasive,
intraepidermal -
because of its high frequency should be considered in any nonhealing lesion in a sun-exposed area
Metastases are uncommon but are more likely in cancers involving the lingual or mucosal surfaces; that occur near the ears, or in scars;
Melanoma
causes most skin cancer deaths.
can develop in the skin, mucosa, conjunctiva, choroid layer of the eye, leptomeninges, and nail beds.
Although melanoma can develop from a typical or atypical mole, most do not.
monitor moles for changes in size, shape, borders, color, or surface characteristics and for bleeding, ulceration, itching, and tenderness.
Biopsy even slightly suspect lesions.
Excise melanomas whenever feasible, particularly when melanomas have not metastasized.
Consider immunotherapy (eg, pembrolizumab, nivolumab), targeted therapies (eg, ipilimumab, vemurafenib), radiation therapy, and excision if melanoma is unresectable or metastatic
Lentigo Malignant Melanoma
4-10% of melanomas
• Occurs in older people with skin that has
been damaged by the sun.
• Occurs in areas such face & hands
• Resembles a light brown or black freckle
with a central nodule
biphasic
Superficial spreading Melanoma?
70% of melanomas
• Extends across the skin horizontally
before invading the body (biphasic)
naeves with raised edge/odd colour or outline
irregular patch of skin
in shades of black, grey, red, tan, blue or
white
Typically asymptomatic but can ulcerate and bleed, it occurs most commonly on women’s legs and men’s torsos.
Acral Lentiginous Melanoma?
2-8% of Melanomas • Least common form • Appears as a black discolouration on fingers, palms, soles and toes • African-Americans and Asians are more likely to develop this form of tumour
similar in lentigo in appearance
Nodular Melanoma
15-30 % of all melanomas are nodular
monophasic
• Dome shaped bumps that can occur
anywhere on the body
• They can be red, black, dark brown or blue
• They can have a shint or scaly texture
• These tumours rapidly infiltrate the body
• They have the lowest cure rate
Nodular Basal Cell Carcinoma
most common
over 50
forehead/face (rare trunk/limbs)
firm raised nodule - usually shiny raised spot or nodule.
central ulceration with raised pearly edges + telangiatactic vessels
dark cells like the basal layer
morphoeic BCC
rare/aggressive - flat thickened yellow/white plaques sucken or firm, focal ulceration edges indistinct, tumour may extend beyond the visible borders dermis pale scare difficult to detect clinically
Superficial
appears as a flat red plague, irregular edges
slightly dry scaly - but eroded/crusted
on face but limbs also
can have raised parts - i.e. nodular BBCs from in the lesion
not deep only outside of dermis
looks like psoriasis,dermatitis,tine
assymptomatic
Intraepidermal SCC
Bowen disease slowly enlarging red plaque scaling and crusting can develop to invasive SCC can arise anywhere but usually sun seen spots.
