Skin cancer

Question 1

List these in order from most to least common skin cancers of the face, scalp and neck: malignant melanoma, Basal Cell Carcinoma, Squamous Cell carcinoma

Answer 1

Basal (most often on face) > SCC > MM

Question 2

Which cancer typically looks like a nodular lesion with a raised, pearly white border?

Answer 2

Basal cell carcinoma

Question 3

Does basal cell carcinoma metastasize?

How to tx?

Answer 3

1. no

2. freeze/curette with 3-4mm margin (may require rotation or advancement flap

Question 4

What kind of cancers is Moh’s surgery done on? Where on the body ?

Answer 4

Basal cell, SCC, morpheaform basal cell carcinoma

Cosmetically and functionally sensitive structures (eyelids, nose, ears)

Question 5

Why does Moh’s surgery take longer than other methods to remove cancers?
What are the benefits of this surgery?

Answer 5

1. requires tumor mapping (using small, sequential tumor resection in layers with immediate pathologic examination under a microscope to ensure complete removal)
2. Low recurrence

Question 6

Why is morpheaform basal cell carcinoma difficult to excise without real-time histo feedback from Moh’s surgery?

Answer 6

Indistinct borders

Question 7

Why is squamous cell carcinoma worse than basal cell?

Answer 7

More aggressive and may metastasize (setting of deep-lesion ulceration and recurrent lesions)

Question 8

What margins do you need for basal cell carcinoma vs SCC vs malignant melanoma?

Answer 8

Basal: 3-4mm
SCC: 5-6mm
MM: 2cm (wide surgical resection)

Question 9

Larger SCC tumors are treated how?

Answer 9

Wide excision (5-6mm) and ND to remove mets

Question 10

What age group does malignant melanoma affect?

Is the mortality rate high or low?

Answer 10

All

High

Question 11

RF for malignant melanoma

Answer 11

Sun exposure in childhood. Common in australia

Question 12

T/F melanomas of head and neck display the same way as in other areas of the body

Answer 12

F

Question 13

Which cancer presents as a pigmented lesion, often a mole, that has advanced through radial and vertical growth, color, margin integrity, ulceration, or bleeding?

Answer 13

Malignant melanoma

Question 14

How does melanoma invade?

Explain correlation bw invasion depth and risk of mets

Answer 14

Epidermis to derms
Breslow classification states thin (1mm invasion) has less than 10% risk of mets
thick (more than 4mm) has over 90% risk of mets

Question 15

Surgical techniques to remove malignant melanoma

Answer 15

initial treatment of cutaneous melanomas after diagnosis and determination of depth is wide (2 cm) surgical resection
Sentinel node lymphoscintigraphy
parotidectomy, selective nodal dissection, bioimmunotherapy, and radiation.