Skin Cancers Overview Flashcards
What 8 things would you want to ask about to assess sun exposure (4L’s & 4S’s)
- Lived abroad
- Lots of travel
- Leisure activaties
- Lifetime occupations
- Sunbeds
- Skin type
- Sunscreen use
- Severe sunburns (e.g. blistering)
How does sun exposure relate to type of skin cancer
BCC / melanoma – intense intermittent sun exposure
SCC / precursors – chronic cumulative sun exposure
How would you assess a pigmented lesion
ABCDE approach
Asymmetrical
Borders
Colour
Diameter
Evolution (change over time) & Elevation
How would you assess a non pigmented lesion
What cells are affected in BCC
basal keratinocytes
What are BCCs aka
Rodent ulcer
BCC clinical history
slow growing, “just won’t heal”, asymptomatic
BCC clinical features
•Rolled pearly edge
•Central ulceration
•Telangiectasia
BCC prognosis
Excellent
Is locally invasive
But doesn’t metastasise
BCC appearance (compare the three subtypes)
- Nodular - Raised edge, ulcerated appearance
- Infiltrative - Grows deeper into the skin/ central depression
- Superficial - well defined flat erythema, crust/scale/erosion
BCC management (based on the three types)
- Nodular - surgical excision, ~3mm margin
- Infiltrative - surgical excision or mohs surgery
- Superficial - cryotherapy/ imiquimod cream/ photodynamic therapy
What is Mohs surgery & when is it used
- Excise lesion then check under microscope
- Excise further & repeat process until clear margins seen under microscope
- Used for infiltrative BCCs on e.g. face, where you want to minimise excision area
What cells are affected in SCC
supra-basal keratinocytes
What group of individuals are commonly affected by SCC
immunosuppressed population
SCC clinical history
faster growing, usually changes over 2-3 months, often tender
SCC clinical features
•Depends on how well-differentiated the cells are
•Scaly lumps or ulcerated lumps
SCC prognosis
Not as good as BCC, potential to metastasis (but doesn’t usually)
Describe the two main precursors of SCC
Actinic keratosis (aka solar keratosis)
- partial thickness keratinocyte dysplasia of epidermis,
- often affects older males bald heads
Bowens disease
- full thickness keratinocyte dysplasia of epidermis,
- usually affects older ladies lower legs,
How would an SCC present differently from a precursor
Thicker with ulcerative appearance
Becomes tender
SCC precursors management
cryotherapy/ 5-flurouracil cream/ imiquimod/ photodynamic therapy
SCC management
complete surgical excision (+ biopsy) with a wide margin
What cells are affected by melanoma
Melanocytes
Melanoma clinical history
changing pigmented lesion, itchy / bleeding
Melanoma clinical features
•A – asymmetry
•B – irregular border
•C – variable colour
•D – diameter >6mm
•E – evolution / elevation
Melanoma prognosis
all invasive melanomas have potential to metastasise
Changing moles main criteria
Change in shape, size & colour
Are elevated/lumped melanomas more or less worrying
- Elevated/lumped melanomas are more advanced
- As they grow up they also grow down into the basement membrane where they can metastasise
Lentigo maligna vs Lentigo maligna melanoma vs nodular melanoma
Lentigo maligna
- flat
- only horizontal growth - least worrying
Lentigo maligna melanoma
- wide & nodular that progresses from Lentigo maligna
- horizontal & vertical growth - now invasive
Nodular melanoma
- nodular melanoma +/- bleeding or ulceration
- vertical growth from day 1 - no warning period, most aggressive & worrying
Describe the normal progression of melanoma
1) Grow horizontally (radially), no metastatic potential
2) Then grow vertically, metastatic potential
** Once they grow deep into basement membrane they can metastasis
What is a acral lentiginous malignant melanoma
Arise as pigmented lesions on the palm or sole or under the nail, and usually present late
How is the vertical growth phase of a melanoma measured
Breslow thickness
What is breslow thickness
measures deepest tumour cell from granular layer of epidermis
What determines malignant melanoma prognosis
Breslow thickness (depth of invasion)
Malignant melanoma treatment
