Skin Cancers Flashcards
What is a basal cell carcinoma?
A slow-growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older individuals
Only rarely
metastasises
Most common malignant skin tumour
What are some risk factors for BCC?
UV exposure, history of frequent or severe sunburn in childhood, skin type I (always burns, never tans),
increasing age, male sex, immunosuppression, previous history of skin cancer, genetic predisposition
How does BCC present?
Various morphological types including nodular (most common),
superficial (plaque-like), cystic, morphoeic (sclerosing), keratotic
and pigmented
Nodular basal cell carcinoma 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 over the head and neck
How do you manage BCC?
Surgical excision - treatment of choice as it allows histological examination of the tumour and margins
Mohs micrographic surgery (i.e. excision of the lesion and tissue borders are progressively excised until specimens are
microscopically free of tumour) - for high risk, recurrent tumours
Radiotherapy - when surgery is not appropriate
Other e.g. cryotherapy, curettage and cautery, topical
photodynamic therapy, and topical treatment (e.g. imiquimod cream) - for small and low-risk lesions
What are some complications and the prognosis of BCC?
Local tissue invasion and destruction
- Rarely metastasises
Prognosis:
- Depends on tumour size, site, type, growth pattern/histological 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 some risk factors for SCC?
Excessive UV exposure, pre-malignant skin
conditions (e.g. actinic keratoses), chronic inflammation (e.g. leg ulcers, wound scars), immunosuppression and genetic predisposition
How do does SCC present?
Keratotic (e.g. scaly, crusty), ill-defined nodule which may ulcerate
How do you manage SCC?
Surgical excision - treatment of choice
Mohs micrographic surgery – may be necessary for ill-defined large, recurrent tumours
Radiotherapy - for large, non-resectable tumours
What is the prognosis in SCC?
Depends on tumour size, site, histological pattern, depth
of invasion, perineural involvement, and immunosuppression
What is malignant melanoma?
An invasive malignant tumour of the epidermal melanocytes,
which has the potential to metastasise
What are the risk factors for malignant melanoma?
Excessive UV exposure, skin type I (always burns, never tans), history of multiple moles or atypical moles, and
family history or previous history of melanoma
What is the mnemonic to remember risk factors for malignant melanoma?
MMRISK:
M – moles, atypical looking >5 total
M – moles, common > 50 total
R – red hair
I – inability to tan (Fitzpatrick type 1 skin)
S – sunburn, especially severe in childhood
K – kin risk/FHx
What is the mnemonic to remember the presentation of malignant melanoma?
ABCDE Symptoms rule:
- Asymmetrical shape*
- Border irregularity
- Colour irregularity*
- Diameter > 6mm
- Evolution of lesion (e.g. change in size and/or shape)*
- Symptoms (e.g. bleeding, itching)
More common on the legs in women and trunk in men
What are the types of malignant melanoma?
Superficial spreading melanoma:
- Common on the lower limbs,
in young and middle-aged adults; related to intermittent high-intensity UV exposure
Nodular melanoma:
- Common on the trunk, in young and middle-aged adults; related to intermittent high-intensity UV exposure
Lentigo maligna melanoma:
- Common on the face, in elderly
population; related to long-term cumulative UV exposure
Acral lentiginous melanoma:
- Common on the palms, soles and nail beds, in elderly population; no clear relation with UV exposure
