Skin Cancers Flashcards
Which skin cancer has the nickname rodent ulcer?
BCC
Which skin cancers can metastasise?
SCC and melanoma
Name the 3 common skin cancers
Squamous cell carcinoma (SCC)
Basal cell carcinoma (BCC)
Malignant melanoma
Name the ABCDE criteria for pigmented skin lesions
A = asymmetry
B = irregular border
C = multiple colours
D = diameter >6mm
E = evolution (growing)
BCC risk factors
UV radiation
Ionising radiation
Immunosuppression
Chronic scarring and ulceration
Arsenic
Hereditary factors
SCC risk factors
UV radiation
Ionising radiation
Immunosuppression
Chronic scarring and ulceration
Wart virus
Hereditary factors
Malignant melanoma risk factors
UV radiation
Immunosuppression
Hereditary factors
List 3 hereditary factors causing skin cancer
Germline mutation eg. Familial melanoma
Acquired mutation eg. BRAF^V600E
Epigenetic eg. Arsenic toxicity
Malignant melanoma protective factors
Constitutional pigmentation
Immune system
DNA repair
Accurate control of cell division
Behaviour (avoiding UV rays, covering up, SPF)
SCC protective factors
Constitutional pigmentation
Immune system
DNA repair
Accurate control of cell division
Behaviour (avoiding UV rays, covering up, SPF)
BCC protective factors
Constitutional pigmentation
Immune system
DNA repair
Accurate control of cell division
Behaviour (avoiding UV rays, covering up, SPF)
What is a precursor for SCC?
Actinic keratosis
Bowen’s disease
Describe actinic keratosis
Sun-exposed sites (face, backs of hands, bald scalp)
Rough area of skin/raised, keratosis lesion
Usually multiple
Hard, spiky keratin our surface
Proliferations of cytologically aberrant epidermal keratinocytes
Pruritis, burning or stinging pain, bleeding and crusting
Describe Bowen’s disease
Superficial intraepidermal tumour
Slow radial expansion
Localised erythematous, scaly or crusted plaque
Not usually ulcerated, moist or thickened
Overlying scale or crust
Sun-exposed areas
Describe the carcinogenesis cycle
DNA lesion -> mutation -> gene -> cell phenotype -> clinal expansion -> pre-cancer or carcinoma
What type of UV exposure is a risk factor for SCC?
Flash fry (blistering burns)
What type of UV exposure is a risk factor for BCC?
Intermittent simmer (frequently tanning/burns)
Do SCCs or BCCs present later in life?
SCCs present later
General skin cancer risk factors
Skin type (eg. Red hair, blue eyes, pale,)
Sunburns (especially in childhood)
Outdoor exposure in occupation/hobbies
Living in sunny location
Immunosuppression (eg. Transplant)
Sunbeds/sunbathing
Family history
PMH skin cancer
Genetic disorders (eg. Albinism)
What are the types of albinism?
Type 1 = more severe, no melanin
Type 2 = some melanin
Occular albinism = normal, or slightly paler than normal for their ethnicity, skin and hair
Actinic keratosis risk factors
Older age
Male
Fair skin (easily burns and freckles)
Blonde/red hair and blue eyes
Cumulative UV radiation exposure
Immunosuppression
Prior AKs/other skin cancers
Arsenical keratosis clinical findings and cause
Associated with chronic arsenicism
Yellow keratosis paperless
Areas of constant pressure or repeated trauma
The bar and lateral borders of hands
Sides of fingers, dorsal fingers over joints
Bowen’s disease risk factors
UV exposure
Immunosuppression
Infection with Human Papillomagirus (HOV)
Chronic arsenicism
Describe lentigo maligna
Subtype of melanoma in situ
Seen on chronically sun-exposed areas (eg. Cheeks, nose, neck, scalp, ears)
Lentigo maligna clinical findings
Flat, slowly-enlarging brown freckle-like macule
Irregular shape and differing shades of brown and tan
Usually arising in background of photo damage,
ill-defined borders
Where do BCCs originate?
Derived from non-keratinising cells from basal layer of epidermis
Genetic causes of BCCs?
Gorlin’s syndrome (dental facts, palm pits)
Xeroderma pigmentosum
Describe BCC clinically
Intermittent bleeding
May appear to heal
Pearly, translucency, ulceration, telangiectasia
Rolled edge
Slow-growing
Describe Nodular BCC
Sun-exposed areas
Translucent Paul’s or nodule
Telangiectasia
Rolled border
Describe pigmented BCC
Subtype of nodular BCC
Increased melanisation
Hyperpigmented, translucent Paul’s/nodule
May be eroded
Describe superficial BCC
Commonly on trunk
Erythematous patch
May resemble eczema
Localised, red plaque
Scaly
Usually solitary or few
Slowly enlarge
Describe infiltration BCC
Scar-like (lack of skin creases/indented)
Difficult to define edges of lesion
Shiny
Tenlangiectasia
What cells cause SCC?
suprabasal epidermal keratinocytes
SCC clinical findings
Flesh-coloured or erythematous
Hyperkeratotic, bleeding, oozing, crusting
Papule, nodule or plaque
May be pigmented or ulcerate
May have cutaneous horn
May be verrucous
List 4 melanoma subtypes
Superficial spreading malignant melanoma (SSMM)
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Describe seborrhoeic keratosis
Common benign lesion
Well-demarcated, stuck on appearance
Varied colours
Nodular or macular
Surface normally rough
No increases malignancy risk
Can bleed/ulcerate if traumatised
Should you biopsy melanomas?
No
Describe the Glasgow 7-point checklist for melanoma
Major features = change in size, irregular shape, irregular colour
Minor features = diameter >7mm, inflammation, oozing, change in sensitisation
Dermoscopy melanoma findings
Pigment network = atypical irregular, variable and widened lines that end abruptly at periphery
Brown globules = correlate with pigmented nests of melanocytes in papillary dermis
Black dots = focal collections of melanocytes and clumps of melanin in stratum corneum
Blue-grey veil = represents regression in melanoma
Describe cutaneous lymphoma
Consider in eczema which has not responded to topical steroids
Usually scaly, red rash
Less itchy than eczema
Not as thick as psoriasis
Progressive over decades
Which cells are in the epidermis?
Keratinocytes
Melanocytes
Basal cells
Langerhans cells
What is found in the dermis?
Capillaries
Fibroblasts
Lymphocytes
Macrophages
Mast cells
Granulocytes
What is found in the subcutaneous tissue?
Collagen
Vessels
Elastic fibres
GAGs
Fibronectin
When does an acquired naevus appear?
after birth
When does a congenital naevus appear?
present at birth
What are the 4 clinical types of acquired naevi?
junctional malanocytic neavus
compound melanocytic naevus
intradermal melanocytic naevus
rare naevi (eg. spitz, blue)
What does a junctional naevus look like?
brown/black and flat
usually small
What does a compound naevus look like?
pigmented papules
raised and palpable
What does a dermal/intradermal naevus look like?
fawn or skin-coloured papules (raised)
can be hairy
Describe congenital naevi
solitary
often relatively large
do not go through normal mole ageing process
List the 4 main types of melanoma
lentigo maligna melanoma
superficial spreading malignant melanoma
acral lentiginous malignant melanoma (hands and feet)
nodular malignant melanoma
Features of melanocytic lesions on dermoscopy
pigment network (regular, reticular pattern is good)
blue white veil
peripheral hypo/hyper-pigmentation
vascular structure
dots and globules (globular pattern)
What is a marjolin ulcer?
SCC arising in a chronic site of inflammation, most commonly on an old burn scar or a venous ulcer
presents as new, persistent site of ulceration
Which HPV types can cause HPV-associated SCC?
16 and 18
Describe a keratoacanthoma
BCC or SCC like
nodule with central hard keratin or rolled edge
rapid growth
mimics histologically a SCC
good prognosis
normally excised as difficult to distinguish from SCC clinically
