Skin Cancers Flashcards
What are the general risk factors for skin cancers?
Increasing age, sun bed use, sun exposure/Hx sunburn, family Hx, fair skin, outdoor occupation
Sqamous Cell Carcinoma - more common in men or women?
Men
What are the clinical features of SCC?
- Solitary papule/nodule often eroded in centre, crusty, pus-producing or bleeding
- Usually fleshy lesion
- usually on sun-exposed areas esp. LIPS
- May ulcerate
Differential diagnosis of SCC?
Keratocanthoma
Actinic keratosis
BCC
seborrhoeic wart
How do you diagnose SCC?
Do a skin biopsy - shave/punch/incisional and examined histologically.
If it has spread (unlikely) - do CT/MRI and lymph node biopsy
Management of SCC?
Surgical excision 4mm margin Curettage and cautery Pre-malignant: - cryotherapy - photodynamic therapy - topical imiquinod/5 fluorouracil cream
Which is more likely to spread? BCC or SCC?
SCC
What are the clinical features of BCC?
- “pearly nodule with raised, red edge with telangiectasia and central ulceration”
- Usually nodular
- May be erythematous, non-pigmented
- May be plaque-like
- Sometimes crusts-over
What is a rodent ulcer?
Basal-Cell carcinoma. Typically ulcerated centre and raised edge
Types of BCCs
Nodular
Superficial
Pigmented
Morphoiec
How do you diagnose BCC?
Skin biopsy - punch/shave/incisional. Examined histologically.
Differential diagnosis of BCC?
Nodular: molluscum contagiosum, keratocanthoma
Superficial: Psoriasis, actinic keratosis, SCC
Pigmented: Melanoma
Morphoeic: scar tissue, localised scleroderm
Management of BCC
Surgical excision: 5-4mm margin Curettage, cautery Cryotherapy Moh's micrographic surgery Topical imiquinod/5-fluorouracil cream
What is a melanoma?
Malignant tumour of melanocytes with potential for dermal invasion and metastatic spread
What are the risk factors for melanoma?
- Genetic markers
- Family Hx of dysplastic naevi/melanoma
- Moles (melanocytic naevi) >50, >5mm
- Skin type I & II
- Sunburns in childhood (10yrs)
- UV radiation
- Immunosuppression
Subtypes of melanoma
- Superficial spreading of malignant melanoma
- Nodular melanoma
- Acral melanoma
- Melanoma in situ
Clinical features of melanoma. What is included in the 7 point checklist?
2 points:
- Change in size
- Irregular shape
- Irregular colour
1 point:
- largest diameter >7mm
- Inflammation
- oozing
- change in sensation
> =3 pts is suspicious.
Diagnosis of melanoma
excision biopsy for pathological and histological assessment
Differential for melanoma
- intradermal naevi
- dysplastic naevi
- seborrhoeic wart
- pigmented BCC
Management of melanoma
Surgical excision (wide local excision)
Breslow 1mm - 2 cm margin
If metastatic - chemotherapy
Assess lymph node spread - lymphadenectomy
long term follow up
How do you assess the severity of the melanoma?
Using breslow’s thickness. Used as prognostic indicator. measured vertically in mm from top of granular layer to deepest point of tumour involvement
