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 risk factors of Basal Cell Carcinoma?
- 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 a Basal Cell Carcinoma 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
What is the management for a Basal Cell Carcinoma?
- 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 complications of Basal Cell Carcinoma?
- Local tissue invasion and destruction
- Depends on tumour size, site, type, growth pattern/histological subtype, failure of previous treatment/recurrence, and immunosuppression
What are risk factors for Squamous cell carcinoma?
- Excessive UV exposure
- Pre-malignant skin conditions (e.g. actinic keratoses)
- Chronic inflammation (e.g. leg ulcers, wound scars)
- Immunosuppression
- Genetic predisposition
What is a squamous cell carcinoma?
Locally invasive malignant tumour of the epidermal keratinocytes or its appendages, which has the potential to metastasise
How does a Squamous cell carcinoma present?
Keratotic (e.g. scaly, crusty), ill-defined nodule which may ulcerate
What is the management of Squamous Cell Carcinoma?
- 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 for Squamous Cell carcinomas?
- Depends on tumour size, site, histological pattern, depth of invasion, perineural involvement, and immunosuppression
What is a malignant melanoma?
An invasive malignant tumour of the epidermal melanocytes, which has the potential to metastasise
What are risk factors of Malignant Melanoma?
- UV exposure
- Skin type I (always burns, never tans)
- History of > 100 moles or atypical neavus
- Syndrome moles
- Family history in first degree relative or previous history of melanoma
What is the presentation of Malignant Melanoma?
The ‘ABCDE Symptoms’ rule (*major suspicious features):
- 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 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; around 70% of all melanomas are superficial spreading melanomas
- 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
What is the management of Malignant Melanoma?
- Depends on the staging of melanoma (currently used system in the UK - 2009 American Joint Committee of Cancer Staging System (AJCC)).
- Stages I-IV are based on primary tumour Breslow thickness, lymph node involvement and evidence of metastases. Stage I is the earliest and stage IV is the most advanced
- In general, surgical excision is the definitive treatment (often a second surgery, wide local excision is needed after the initial excision biopsy).
- Radiotherapy may sometimes be useful. Chemotherapy is used for metastatic disease.
What is the prognosis of Malignant Melanoma?
- Prognosis depends on the stage of melanoma and Breslow thickness.
- In general, 90% of people diagnosed with melanoma in England and Wales survived 10 years or more.
What is this?
Superficial spreading melanoma
What is this?
Nodular Melanoma
What is this?
Lentigo maligna melanoma
What is this?
Acral lentiginous melanoma (in situ)
