Skin cancer Flashcards
Important history
- History of skin cancer 2. FHx of melanoma, death from skin cancer 3. Past/present occupation 4. Outdoor interests 5. >5 blistering sunburns 6. PMHx Skin conditions Medication Allergies Immunosuppression 7. Current skin lesions of cancer 8. Exposure-> UV, ionising radiation, chemicals, chronic irritation, hyperthermia, tobacco, HPV
Types of skin cancer
- BCC 2. SCC 3. Melanoma 4. Keratocanthoma 5. Benign nevi 6. Malignant melanoma 7. Appendageal Ca 8. Actinic keratoses
Features of SCC, risks, metastatic risk
- Pearly edge 2. Pink, scaly 3. Keratin production 4. Sun damage (cumulative), chronic inflammation, viruses, chronic ulcers, previous Xrays, chemicals, immune suppression, genetic (xeroderma pigmentosum) 1% metastasise: highest risk on the ear, lower lip and scalp
- Can include: actinic keratosis, Bowens (IEC), infiltrating, exophytic/fungating and keratoncanthoma
Treatment of SCC
- Surgical excision with a 3 to 5 mm margin is the treatment of choice for SCC.
- Curettage and diathermy may be considered in patients with low-risk lesions.
- Radiotherapy may be used for a primary tumour when surgery is likely to produce severe scarring or is unsuitable (eg for an elderly or infirm patient). Adjuvant radiotherapy is recommended following excision of a high-risk primary tumour (eg presence of perineural spread on histopathology).
Follow up in SCC
- F/U 6 monthy for 2 years
- Examination for signs of secondary tumours
What is keratocanthoma
- Well differentiated SCC, resolves after 3 months
- Treat as SCC
Types of BCC
- Noduloulcerative
Telangiectasia, glistening, transluscent
- Cystic
- Morphoiec
Appears as scar, slowly expanding
- Pigmented
- Superficial
Differential for superficial BCC
- Solar keratosis
- Bowen’s
- SCC in situ
- Psoriasis
Management of BCC
- Surgery
Wide excision 3-4 mm or +if aggressive->micronodular, infiltrative, morphoiec, recurrent/large
- Curettage/cautery
Well demarcated, superficial
Not for aggressive, recurrent
Skill required
- Cryotherapy
Well defined on the trunk
For primary
Histological confirmation required prior
- Radiotherapy
When surgery likely to be very destructive/surgery contraindicated
- Topical imiquimod
Good histo clearance for superficial
Need biopsy proven
Imiquimod 5% topically, at night 5 times/week for 6 weeks
- Photodynamic
- Mohs microscopically controlled
High risk recurrenct, eyelid, centrofacially, when tissue conservation is critical
Allows histo confirmation of clearance before wound closure
Management of aktinic keratosis
- Premalignant->erythematous, scaly
- Cryotherapy 5-10 seconds
- If IEC 30 seconds with 3mm margin
- Imiquimod and efudix (5FU) if histoL confirmed IEC
Biopsy options
- Incisional
- Excisional
- Shave
- Punch
Risk factors for malignant melanoma
Specific risk factors for malignant melanoma include:
- age over 40
- Australian born
- family history
- fair complexion/light hair and eye colour
- freckles (sign of sun sensitivity)
- tendency to burn
- high number of common acquired naevi (>50)
- large congenital naevi
- dysplastic naevus syndrome (>5 dysplastic naevi)
- solar skin damage
- severe childhood sunburn (2+ episodes)
- recreational exposure
- mutations in CDKN2A/CDK4 genes (genetic traits associated with MM)
- immunosuppression
Specific risk factors for BCC/SCC
- age
- male
- sun-sensitive skin
- burn easily and tan poorly
- sun-related skin damage (incl. freckles)
- cumulative long-term exposure (SCC)
- high recreational exposure, or ‘binging’ (BCC)
- frequent sun exposure
