Skin cancer Flashcards
What is the most common skin cancer?
Basal cell carcinoma
List the 3 types of skin cancer
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
List the risk factors of basal cell carcinoma
Increased age Male Sunburn in childhood Skin type 1 UV exposure Genetic predisposition Previous family history of skin cancer
Describe the presentation of basal cell carcinoma
Various morphological types - nodular (most common), sclerosing (plaque), cystic, Morphoeic (sclerosing), keratotic and pigmented
Nodular BCC is a small skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge, the lesion may have a necrotic or ulcerated centre (rodent ulcer)
Most common on head and neck
What is basal cell carcinoma?
A slow growing, locally invasive malignant tumour of the epidermal keratinocytes
How is basal cell carcinoma treated?
Surgical excision - allows histological examination of the tumour and margins
Mohs micrographic surgery - excision of the lesion and borders progressively until specimens are microscopically free of tumour - for high risk, recurrent tumours
Radiotherapy - for when surgery is not appropriate
Cryotherapy, curettage and cautery, topical photodynamic therapy and topical treatment
List some complications of basal cell carcinoma
Local tissue invasion and destruction
Describe the prognosis of BCC
Depends on the tumour size, site, type and growth pattern/histology subtype, failure of previous treatment/recurrence and immunosuppression
What is a squamous cell carcinoma
A locally invasive malignant tumour of the epidermal keratinocytes or its appendages which has the potential to metastasise
What are the risk factors for squamous cell carcinoma
Excessive UV exposure
Pre-malignant skin conditions - actinic keratosis
Chronic inflammation - leg ulcers, wound scars
Immunosuppression
Genetics
How does a squamous cell carcinoma present?
Keratotic (scaly, crusted lesion)
Ill defined nodule which may ulcerate
Describe the management of squamous cell carcinoma
Surgical excision
Mohs micrographic surgery for ill defined and large recurrent tumours
Radiotherapy
Describe the prognosis of squamous cell carcinoma
Depends on tumour size, site, histological pattern, depth of invasion, perineural involvement and immunosuppression
What is malignant melanoma
An invasive malignant tumour of epidermal melanocytes which has the potential to metastasise
List some risk factors of malignant melanoma
Excessive UV exposure
Skin type 1 - always burns, never tans
History of multiple moles/atypical moles
Family history or past medical history of melanoma
Describe how melanomas present
ABCDE symptoms
Asymmetrical shape Border irregularity Colour irregularity Diameter >6mm Evolution of the lesion (change in size/shape) Symptoms - bleeding and itching
More common on the legs of women and trunk in men
List the different types of melanoma
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Describe superficial spreading melanoma
Common on the lower limbs in young and middle aged adults
Related to high intensity intermittent sun exposure
Describe nodular melanoma
Common on the trunk in young and middle aged adults
Related to high intensity intermittent sun exposure
Describe lentigo maligna melanoma
Common on the face, in elderly population, related to long term cumulative UV exposure
Describe acral lentiginous melanoma
Common on the palms, soles and nail bed in elderly population
No clear relationship with UV exposure
Describe the management of melanoma
Surgical excision
Radiotherapy
Chemotherapy for metastatic disease
Describe the prognosis of melanoma
5 year survival rates based on TNM staging
Stage 1 - 90%
Stage 4 -20-30%
What scoring system is used to predict the chance of recurrence of melanoma
Breslow’s thickness
<0.76mm - low risk
0.76-1.5mm - medium risk
>1.5mm - high risk
