Skin cancer

Question 1

Malignant Melanoma: Epidemiology

Answer 1

F>M = 1.5:1
UK incidence = 10 000/yr and 2000 deaths/yr
80% in 20yrs

Question 2

Malignant Melanoma: features of lesion

Answer 2

Asymmetry
  Boarder: irregular
  Colour: non-uniform
  Diameter > 6mm
  Evolving / Elevation

Question 3

Malignant Melanoma: Risk factors

Answer 3

Sunlight: esp. intense exposure in early years.
Fair skinned (Low Fitzpatrick Skin Type)
no. of common moles
+veFH
age
Immunosuppression

Question 4

Malignant Melanoma: Classification

Answer 4

Lentigo Maligna Melanoma Often elderly pts.
Face or scalp
Acral Lentiginous
Asians/blacks
Palms, soles, subungual ( ̄c Hutchinson’s sign)
Nodular Melanoma
All sites
Younger age, new lesion
Invade deeply and metastasis early = poor prog
Amelanotic
Atypical appearance delayed Dx

Question 5

Malignant Melanoma: Staging and Prognosis

Answer 5

Breslow Depth
Thickness of tumour to deepest point of dermal invasion
<1mm = 95-100% 5ys
>4mm = 50% 5ys
Clark’s Staging
Stratifies depth by 5 anatomical levels Stage 1: Epidermis
Stage 5: sc fat

Question 6

Malignant Melanoma: sites of Metastasis

Answer 6

Liver

Eye

Question 7

Malignant Melanoma: Management

Answer 7

Excision + 2O margin excision depending on Bres depth
± lymphadenectomy
± adjuvant chemo (may use isolated limb perfusion)

Question 8

Malignant Melanoma: Poor prognostic indicators

Answer 8

Male sex (more tumours on trunk cf females)
mitoses
Satellite lesions (lymphatic spread)
Ulceration

Question 9

Squamous Cell Carcinoma: Features

Answer 9

Ulcerated lesion ̄c hard, raised everted edges

Sun exposed areas

Question 10

Squamous Cell Carcinoma: Causes

Answer 10

Sun exposure: scalp, face, ears, lower leg
May arise in chronic ulcers: Marjolin’s Ulcer
Xeroderma pigmentosa

Question 11

Squamous Cell Carcinoma: Evolution

Answer 11

Solar/actinic keratosis Bowen’s SCC

Lymph node spread is rare

Question 12

Squamous Cell Carcinoma: Rx

Answer 12

Excision + radiotherapy to affected nodes

Question 13

Actinic Keratoses: features

Answer 13

Irregular, crusty warty lesions.

Pre-malignant (~1%/yr)

Question 14

Actinic Keratoses: Rx

Answer 14

Cautery
  Cryo
  5-FU
  Imiquimod
  Photodynamic phototherapy

Question 15

Keratoacanthoma features.

Answer 15

A well differentiated SCC that arises in a hair follicle. Fast-growing, dome-shaped ̄c a keratin plug.
Usually regress but may be excised

Question 16

Basal Cell Carcinoma features

Answer 16

Commonest cancer
Pearly nodule ̄c rolled telangiectactic edge May ulcerate
Typically on face in sun-exposed area
Above line from tragus angle of mouth

Question 17

Basal Cell Carcinoma features - Behaviour

Answer 17

Low-grade malignancy very rarely metastasise

Locally invasive

Question 18

Basal Cell Carcinoma features -Rx

Answer 18

Excision
Mohs: complete circumferential margin assessment using frozen section histology
Cryo/radio may be used.