Skin Cancer Flashcards
Spread of melanoma
Local spread
- lesion expands horizontally at basal lamina
- dermal invasion of lesion - metastatic potential
Lymphatic
Haematogenous
Risk factors for melanoma
UV radiation - sun exposure and sunburns - naturally light skin - exposure early in life Nevi - benign growths Genetic background - xeroderma pigmentosum - Werner syndrome PMHx of melanoma Immunosuppression
Pathophysiology of melanoma
Malignant tumour that starts in melanocytes (melanin-producing cells)
Often starts as slow-growing superficial tumour
Features of melanoma on examination
A - asymmetry B - border irregularities C - colour variegation (different colours in same region) D - diameter greater than 6 mm E - evolving
Ix for melanoma
Dermoscopy Biopsy USS to check lymph nodes CXR CT/MRI/PET
Mx of melanoma
Wide local excision +/- sentinel lymph node biopsy Surgical resection Lymph node dissection Biological therapies - nivolumab Radiotherapy
Features of basal cell carcinoma on examination
Nodular
- pink, pearly, well demarcated lesion with telangiectatic vessels
- bleeding
Superficial
- erythematous, well-defined, scaly/shiny lesion
- pruritius
Sclerosing
- pale colour with poorly defined borders
Most common over head and neck
Features of squamous cell carcinoma
Overlying scale
Erythematous
Well-defined borders
Mx of non-melanoma carcinoma
Surgical excision Moh's surgery - microscopic margin control Radiation therapy Curettage and electrodessication Cryotherapy Topical 5-FU Imiquimod
Premalignant conditions for non-melanoma
Actinic keratosis
- erythematous and scaly
Bowens disease
Nice major criteria for skin lesion
2 points each
Change in size
Irregular shape
Irregular colour
Nice minor criteria for skin lesion
1 point each Largest diameter 6mm or more Inflammation Oozing/bleeding Change in sensation
Nice criteria for skin lesions
3 points = secondary care skin cancer clinic within 2 weeks
Types of ix for skin lesions
Shave biopsy
Punch biopsy
Excision biopsy - whole lesion removed
Incisional biopsy - part of lesion and part of healthy skin removed
Key points of incisional biopsy
See border
Don’t have to remove whole lesion
