Skin cancer Flashcards
Nodular BCC
- commonly on face
- small, shiny
- skin-coloured or pinkish
- pearly, rolled edge
- may have central ulcer/necrotic region (so edges appear rolled)
- open sore = rodent ulcer
- telangectasia
- often bleed spontaneously then heal over/grow back
- continually get bigger
Superficial BCC
- often multiple
- upper trunk and shoulders/anywhere
- pink/red scaly irregular plaques
- grow slowly over months-years
- bleed or ulcerate easily
Morphoeic/sclerosing BCC
- usually mid-facial sites
- skin-coloured, waxy, scar like
- prone to recur after treatment
- may infiltrate cutaneous nerves
Pigmented BCC
- brown, blue, greyish
- nodular or superficial
- may resemble melanoma
Management of BCC
- surgical excision with 4mm margins (and send to lab for histological/margin analysis)
- Mohs micrographic surgery for high risk/recurrent (e.g. morphoeic/sclerosing BCC)
- radiotherapy if surgery not appropriate
For small/low risk lesions:
- cryotherapy
- curettage and cautery
- topical photodynamic therapy
- topical Mx e.g. imiquimod (Aldara)
What is Mohs micrographic surgery?
excision of the lesion where tissue borders progressively excised until specimens are microscopically free of tumour
When to refer BCC
- routine referral to derm for all BCCs
- 2WW only if delay would be problematic e.g. due to size/site of lesion
Who should radiotherapy be avoided in and why?
<60s as causes long-term breakdown of skin
What are precursors to SCC?
Bowen’s disease (SCC in situ) and actinic keratoses
Bowen’s disease
- SCC in situ
- precursor to SCC
- bright red scaly patch
- well-demarcated
Management of actinic keratoses and Bowen’s disease
- Imiquimod (Aldara), diclofenac gel, Efudix, etc.
- cryotherapy
- curettage and cautery
- photodynamic therapy
Management of SCC
- surgical excision
- Mohs if indicated (ill-defined, large, recurrent)
- radiotherapy for large, non-resectable tumours
SCC description
- irregular, keratotic (e.g. scaly, crusty), ill-defined nodule
- or firm erythematous plaque
- often ulcerates
When to refer SSC?
2WW for all SCC
Suspicious features of pigmented lesions
ABCDE (* = MAJOR suspicious feature) *Asymmetrical shape Border irregularity *Colour irregularity (3+) Diameter >6mm *Evolution of lesion (change) Symptoms e.g. bleeding, itching
When to do 2WW for ?melanoma
- looks like melanoma on dermoscopy
- consider if particular concerns
- or 3+ points on Glasgow checklist:
Major features (2 points each)
- change in size
- irregular shape
- irregular colour
Minor features (1 point each)
- diameter >7mm
- inflammation
- oozing
- change in sensation
Where do superficial spreading melanomas commonly occur?
lower limbs
Where do nodular melanomas commonly occur?
trunk
Where do lentigo melanomas commonly occur?
face
Where do acral melanomas commonly occur?
palms, soles, nailbeds
Management of malignant melanoma
Surgical excision in 2 stages: 1. Excise with 2mm margin, analyse and stage the tissue 2. WLE with margin dependant on stage: 0.5cm stage 0 1cm stage 1 2cm stage 2
- plus sentinal lymph node biopsy is Breslow thickness 1mm+
- radiotherapy may be useful
- chemotherapy for metastasis
Risk of recurrence of malignant melanoma based on Breslow thickness
<0.76mm low risk
0.76-1mm medium risk
>1mm high risk
Standard follow up for melanoma
5 years:
- every 3 months for 3 years
- every 6 months for 2 years
