Skin Cancer Flashcards
What are the 4 types of malignant melanoma?
Superficial spreading
Nodula
Lentigo maligna
Acral lentiginous
What is a superficial spreading melanoma?
A large flat lesion that grows laterally before invading vertically. i.e. a growing mole
It is the most common
What is a nodular melanoma?
Rapidly growing aggressive pigmented (red or black) nodule that bleeds and ulcerates
What is a lentigo maligna melanoma?
Who is it often seen in?
A patch of lentigo maligna grows a papule or nodule. i.e. a growing mole
Elderly people with chronic sun exposure
What is a lentigo maligna?
It is an area of “sun damaged skin” that is a melanoma in situ
What is an acral lentiginous melanoma?
Who is it often seen in?
Lesion under the nail (black patch on nail) , on the sole of the foot or palm of the hand. It is the most common type for dark skinned people
What are the risk factors for developing skin cancer?
Naevi > 100 (>5x increased risk) Bursts of sun exposure Severe sunburn Sun bed use <30y/o Family history Immunosuppression Fitzpatrick skin type 1 or 2
What is the system used to describe a skin lesion?
A - asymmetry B - border irregularity C - colour (varies) D - diameter (greater than 6mm) E - evolving (change in shape, size or shade) F - funny looking
What are the major and minor criteria of signs and symptoms for malignant melanoma?
2 points each for:
change in colour
change in size
change in shape
1 point each for: >7mm Inflamed Sensation change Oozing
What is the criteria for referring a suspected skin cancer?
3 points or more - refer
Where do malignant melanomas metastasise?
Bone, brain, lung, liver
Describe the parts of TNM Staging for malignant melanomas
0 - confined to epidermis
1a - <1mm non ulcerating
1b - <1mm ulcerating OR 1-2mm non ulcerating
2a - 1-2mm ulcerating OR 2-4mm non ulcerating
2b - 2-4mm ulcerating OR >4mm non ulcerating
2c - >4mm ulcerating
3 - Lymph Node Involvement
4 - Metastatic melanoma
What investigations are carried out for malignant melanomas?
Full thickness excision biopsy with 2mm margins
+/- SLNB with blue dye
What are some poor prognostic indicators for malignant melanoma?
High Breslow thickness
Ulcerated
Node involvement
Location of head, neck, back of arms
What is the breslow thickness?
Depth from epidermal granular layer to the base of the tumour at thickest point
What is first line management for malignant melanomas?
Wide Local Excision with margins dependant on Breslow thickness
Describe how BCC grow
Slow growing
Locally Invading
Very rarely metastasis
What cells do BCC’s arise from?
epidermal tumours arising from hair follicles
What areas are predominantly affected by BCC?
areas of UV radiation - head and neck but not ear
How do BCC’s appear?
Pearly and translucent nodule
Telangiectasia
Indurated/ rolled edge
Ulcerated centre
How do SCC’s appear?
nodules on head and neck ulcerated lesion hard raised edges bleeding rapidly growing
How are SCC’s investigated?
excision biopsy first
then MRI/CT to assess spread
FNA can be done to assess enlarged lymph nodes
How are BCC’s and SCC’s managed?
Surgical excision - gold standard Mohs micrographic surgery Cryotherapy Topical imiquimod and flourouracil Radiotherapy Active surveillance
What is Mohs micrographic surgery?
Individual layers of cancer tissue are removed and examined under a microscope one at a time until all cancer tissue has been removed
What chemotherapy agents are used for BCC’s?
topical imiquimod or fluorouracil
What are the risk factors for SCC?
Immunosuppression (renal transplant patients) Smoking Solar keratosis Bowens disease Long-standing leg ulcers (Marjolijn's)
What are the complications of surgery for SCC and BCC?
Scarring and contractures can distort the face
Facial numbness
