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Clinical Methods > Skin Malignancies > Flashcards

Skin Malignancies Flashcards

1
Q

List 4 risk factors for skin cancer

A
  1. Age and sex; ↑ elderly males
  2. Previous skin cancer
  3. Sun damage (photo-ageing, actinic keratoses) + Sunburn
  4. Skin types 1-3
  5. Previous cutaneous injury, thermal burn, disease (e.g. cutaneous lupus, sebaceous naevus)
  6. Immune suppression- inherent or drug induced
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2
Q

history

A
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3
Q

Explain the Skin Cancer Lesion ABCD Approach

A

Approach to pigmented lesions, scars

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4
Q

Which Fitzpatrick skin types are at the highest risk for skin cancer and why?

A

Skin types 1-3; less melanin therefore less melanin protection

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5
Q

What is a basal cell carcinoma?

A

Common, locally invasive (stays in the basal layer), keratinocyte cancer (NMSC- Non-Melanoma Skin Cancer)

Commonest skin cancer in the UK

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6
Q

List the main characteristics/ presentation of a BCC

A
  • Small slow-growing lesions
  • Raised pearly edges
  • Characteristic telangiectasia
  • Varies in colour and size

Rarely cause symptoms but if left to grow, can cause pain, bleeding, ulceration, or subsequent local invasion into surrounding tissues

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7
Q

On what locations do BCC tend to appear?

A

Sun-exposed areas of the head and neck, with the remainder mainly occurring on the trunk or lower limbs

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8
Q

What are telangiectasia?

A

Widened venules cause threadlike red lines or patterns on the skin → telangiectases

They form gradually and often in clusters

Sometimes known as “spider veins” because of their fine and weblike appearance

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9
Q

List the 4 sybtype presentations of BCC

A
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10
Q

What would be seen on examination of a BCC with a dermascope?

A

Telangiectasia

Bleeding vessels (dark points)

Characteristic shiny translucency under dermatoscope due to SHINY PEARLY EDGES

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11
Q

What subtype BCC is shown below?

A

LHS: pink and slightly scaly area, can see nodular patch in the superior region, shiny compared to the rest of the area.

RHS: can see ovoid nests and white blotches, can also see the telangiectasia

Therefore → superficial BCC

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12
Q

List 2 ddx for BCC

A
  1. SCC
  2. Trichoepithelioma
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13
Q

Investigations for a BCC

A

1 Diagnosed clinically, dermatoscope can aide diagnosis

  1. Confirmed through excision biopsy
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14
Q

Management of BCC?

A
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15
Q

What is a Squamous Cell Carcinoma?

A

Malignant tumour of keratinocytes, arising from the epidermal layer of the skin (NMSS)

Second most common form of skin cancer

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16
Q

Why may we be more concerned about SCC than BCC

A

Whilst uncommon, SCC has the potential to metastasise via the lymphatic system to regional lymph nodes and any organ

Most commonly lungs, liver, brain, bones and skin

17
Q

List 2 pre-malignant conditions which may give rise to a SCC

A
  1. Bowen’s disease
  2. Actinic keratoses
18
Q

List 4 risk factors for SCC

A
  1. Cumulative prolonged exposure to UV light (eg. excessive sunbed use)
  2. Chronic wounds and inflammation
  3. SCC arising in chronic ulcers and scars (particularly burns scars) → known as a Marjolin’s ulcer
  4. Immunosupression
  5. Pre-malignancy conditions, such as Bowen’s disease or actinic keratoses
  6. Smoking (lip SCC)
19
Q

List the characteristics/ presentation of SCC

A

Appearance can be highly variable:

  1. Can be nodular, indurated, or keratinised with associated ulceration or bleeding
  2. Growth over weeks to months
  3. Size is variable (few millimetres to several centimetres)
20
Q

On which locations do SCC tend to occur?

A

On sun-exposed sites:

  • Hands, forearms, lower limbs
  • The “H zone” of the face (pinnae, pre-auricular, medial and lateral acanthi, eyelids, nose and lips)
21
Q

What would be seen on dermoscopy of SCC

A

Most commonly:

  • white circles or structureless areas
  • looped blood vessels,
  • a central keratin plug
22
Q

Investigations for a SCC

A
  1. Full history and examination, incl palpation of regional lymph nodes
  2. Dermoscopy to aid diagnosis
  3. Biopsy to confirm diagnosis
23
Q

List 2 ddx for SCC

A
  1. Bowens disease
  2. BCC or Melanoma
24
Q

Compare the appearance of a BCC vs SCC carcinoma

A

SCC firm red nodule, tends to crust and is more fleshy

BCC pearly/waxy bump or flat brown lesion. Often tender or painful

25
Q

Management of a BCC or SCC

A
  1. Urgent dermatology opinion
  2. In primary care - 2week wait refferal
  3. If in doubt - remove it
  4. Punch biopsy or wide local excision
  5. Regular follow ups
26
Q

What is Bowens disease?

A

Growth of cancerous cells confined to the outer layer of the skin (also termed SCC in-situ)

Pre-cancerous condition, can progress into SCC. Usually develop as a result of chronic UV radiation exposure

Presents as a slow-growing, small, red, and scaly lesion

27
Q

What is Melanoma?

A

Malignant tumour of melanocytes

Commonly arises from melanocytes in the stratum basale of the epidermis, but can also arise from melanocytes at other sites

28
Q

What are the most common locations for melanoma to present?

A

Trunk or legs

29
Q

Why is early identification key in Melanoma

A

They metastasise early (relative to other tumour types), partly due to their vertical growth (as opposed to radially)

Can spread to nearly every tissue and organ in the body

30
Q

Describe the progression and clinical features of Melanoma

A

Early melanomas are often asymptomatic

Patients usually present having noticed a new naevus or changes in an existing mole

31
Q

What is the ugly ducking sign?

A

Describes an atypical nevus that is obviously different from others in an individual:

  1. colour change and variation
  2. can be non-pigmented
  3. regression- scarring
  4. itchy, tender, bleed, non-healing
32
Q

What 2 ways can we score melanomas?

A
  1. ABCDE
  2. Glasgow 7-point checklist; looks at major and minor features. A score of 6 and above gets an immediate referral to dermatology
33
Q

List the 4 various subtypes of Melanoma on dermascopy

A

Superficial, Nodular, Lentigo, Acral

34
Q

Management of Melanoma

A
  1. Urgent 2 week referral, NOT to be managed within primary care
  2. Wide local excision +/- lymph node dissection (possible dissection of local lymph nodes)
  3. Genetic testing
  4. Imaging for metastasis
  5. MAB (Monoclonal Antibody Body) therapy:
  • Imatinib; aids in seeding of metastatic melanoma
  • Dabrafenib
  1. Regular follow up: Skin, scar and nearby lymph node examination
35
Q

How is Melanoma diagnosed?

A

Diagnosis is made through excision biopsy - Histology is GOLD standard

History is still very important, Dermoscopy can aid

36
Q

List 2 topical treatments for superficial lesions

e.g. Actinic keratoses, Bowens Disease, Superficial BCC

A
  1. Solaraze - diclofenac gel
  2. Actikerall - 5FU +Salicylic acid
37
Q

Side effect of topical treatment for superficial lesions?

A

Can cause an erythematous rash

38
Q

When is Cryotherapy is used in treatment?

A

For warts, AK, Bowens

39
Q

Surgery is the gold standard treatment for which types of skin cancer?

A

SCC and Malignant Melanoma

Must get 2mm margin of clearance

Clinical Methods (21 decks)

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