Skin Cancers Overview Flashcards

1
Q

What 8 things would you want to ask about to assess sun exposure (4L’s & 4S’s)

A
  • Lived abroad
  • Lots of travel
  • Leisure activaties
  • Lifetime occupations
  • Sunbeds
  • Skin type
  • Sunscreen use
  • Severe sunburns (e.g. blistering)
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2
Q

How does sun exposure relate to type of skin cancer

A

BCC / melanoma – intense intermittent sun exposure
SCC / precursors – chronic cumulative sun exposure

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3
Q

How would you assess a pigmented lesion

A

ABCDE approach

Asymmetrical
Borders
Colour
Diameter
Evolution (change over time) & Elevation

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4
Q

How would you assess a non pigmented lesion

A
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5
Q

What cells are affected in BCC

A

basal keratinocytes

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6
Q

What are BCCs aka

A

Rodent ulcer

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7
Q

BCC clinical history

A

slow growing, “just won’t heal”, asymptomatic

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8
Q

BCC clinical features

A

•Rolled pearly edge
•Central ulceration
•Telangiectasia

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9
Q

BCC prognosis

A

Excellent
Is locally invasive
But doesn’t metastasise

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10
Q

BCC appearance (compare the three subtypes)

A
  • Nodular - Raised edge, ulcerated appearance
  • Infiltrative - Grows deeper into the skin/ central depression
  • Superficial - well defined flat erythema, crust/scale/erosion
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11
Q

BCC management (based on the three types)

A
  • Nodular - surgical excision, ~3mm margin
  • Infiltrative - surgical excision or mohs surgery
  • Superficial - cryotherapy/ imiquimod cream/ photodynamic therapy
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12
Q

What is Mohs surgery & when is it used

A
  • 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
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13
Q

What cells are affected in SCC

A

supra-basal keratinocytes

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14
Q

What group of individuals are commonly affected by SCC

A

immunosuppressed population

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15
Q

SCC clinical history

A

faster growing, usually changes over 2-3 months, often tender

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16
Q

SCC clinical features

A

•Depends on how well-differentiated the cells are
•Scaly lumps or ulcerated lumps

17
Q

SCC prognosis

A

Not as good as BCC, potential to metastasis (but doesn’t usually)

18
Q

Describe the two main precursors of SCC

A

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,

19
Q

How would an SCC present differently from a precursor

A

Thicker with ulcerative appearance
Becomes tender

20
Q

SCC precursors management

A

cryotherapy/ 5-flurouracil cream/ imiquimod/ photodynamic therapy

21
Q

SCC management

A

complete surgical excision (+ biopsy) with a wide margin

22
Q

What cells are affected by melanoma

A

Melanocytes

23
Q

Melanoma clinical history

A

changing pigmented lesion, itchy / bleeding

24
Q

Melanoma clinical features

A

•A – asymmetry
•B – irregular border
•C – variable colour
•D – diameter >6mm
•E – evolution / elevation

25
Melanoma prognosis
all invasive melanomas have potential to metastasise
26
Changing moles main criteria
Change in shape, size & colour
27
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
28
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
29
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
30
What is a acral lentiginous malignant melanoma
Arise as pigmented lesions on the palm or sole or under the nail, and usually present late
31
How is the vertical growth phase of a melanoma measured
Breslow thickness
32
What is breslow thickness
measures deepest tumour cell from granular layer of epidermis
33
What determines malignant melanoma prognosis
Breslow thickness (depth of invasion)
34
Malignant melanoma treatment