Skin cancers Flashcards
What are the risk factors for melanoma? Who is high risk?
Fhx FDR, fair complexion (tendency to burn, freckles, light hair/eyes), marked sun exposure - sunburn as a child, history of NMSC, >20 solar keratoses, immunodeficiency. High risk: prev melanoma, >5 atypical naevi.
What are the risk factors for nonmelanoma skin cancer? Who is high risk?
Age >40, fair complexion (tendency to burn, freckles, light eye/hair), Fhx, male, multiple solar keratoses, high UV exposure, severe sunburn. High risk: immunosuppressed, arsenic exposure, prev NMSC.
What is the management of melanoma - biopsy, referral, followup.
Initial excision 2mm margin, deep to subcut fat within 2 weeks. Definitive wide local excision done depending on thickness (in situ = 5-10mm to if >4mm, 2cm margin). If >1mm or high risk, refer for consideration of lymph node biopsy. Risk mets to nodes, lung, liver, brain. Annual skin checks for 10 years.
What are 4 types of melanoma
Superficial spreading (common), lentigo maligna (in situ) in sun damage/old pt, nodular melanoma (EFG) -aggressive, can be amelanotic; acral lentiginous melanoma - palms/soles in dark skin.
What are the usual features of a BCC? What makes a high risk BCC and how are they managed?
Slow growing, pink/skin or pigment, may bleed, often face (eyelid, temple) or trunk. High risk: >2cm, face/neck/hands/feet, immunosuppression, recurrent. High risk needs surgery. Excision w 2-3mm low risk, 5mm for high risk. (Alt: radiotherapy, Moh’s surgery). Annual skin checks after.
What are the management options for low risk superficial BCCs? What are 2 other types of BCC?
Double freeze-thaw cryotherapy, imiquimod (aldara), photodynamic therapy, electrodessication and curretage. Nodular (pearly papule), morphoeic (scar like, aggressive).
What are the features of invasive SCC? What are concerning features?
Variable appearance, often tender, often grow rapidly. Raised scale OR ulcer OR firm skin, non healing. Scalp/ear/lip 5% metastasise, poor prognosis if in setting of a wound.
What is the management of an SCC?
Surgical excision w 3-5mm margin, if high risk - specialist can excise or do radiation. Curretage/cautery if small. 3-6mo skin checks for 2 years then every 6-12mo after.
What are bowens disease and keratoacanthomas? How are they managed?
SCC in situ - slow demarcated red scaly plaque, in sun exposed area. 3-8% risk invasion, biopsy helpful, need to treat. Can cryo, curretage, aldara or efudix OR radio/phototherapy. Excise if going into hair. KA - variant of SCC, rapid volcano in sun area, excise w 3-5mm margin.
