Skin Malignancies Flashcards
List 4 risk factors for skin cancer
- Age and sex; ↑ elderly males
- Previous skin cancer
- Sun damage (photo-ageing, actinic keratoses) + Sunburn
- Skin types 1-3
- Previous cutaneous injury, thermal burn, disease (e.g. cutaneous lupus, sebaceous naevus)
- Immune suppression- inherent or drug induced
history
Explain the Skin Cancer Lesion ABCD Approach
Approach to pigmented lesions, scars
Which Fitzpatrick skin types are at the highest risk for skin cancer and why?
Skin types 1-3; less melanin therefore less melanin protection
What is a basal cell carcinoma?
Common, locally invasive (stays in the basal layer), keratinocyte cancer (NMSC- Non-Melanoma Skin Cancer)
Commonest skin cancer in the UK
List the main characteristics/ presentation of a BCC
- 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
On what locations do BCC tend to appear?
Sun-exposed areas of the head and neck, with the remainder mainly occurring on the trunk or lower limbs
What are telangiectasia?
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
List the 4 sybtype presentations of BCC
What would be seen on examination of a BCC with a dermascope?
Telangiectasia
Bleeding vessels (dark points)
Characteristic shiny translucency under dermatoscope due to SHINY PEARLY EDGES
What subtype BCC is shown below?
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
List 2 ddx for BCC
- SCC
- Trichoepithelioma
Investigations for a BCC
1 Diagnosed clinically, dermatoscope can aide diagnosis
- Confirmed through excision biopsy
Management of BCC?
What is a Squamous Cell Carcinoma?
Malignant tumour of keratinocytes, arising from the epidermal layer of the skin (NMSS)
Second most common form of skin cancer
Why may we be more concerned about SCC than BCC
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
List 2 pre-malignant conditions which may give rise to a SCC
- Bowen’s disease
- Actinic keratoses
List 4 risk factors for SCC
- Cumulative prolonged exposure to UV light (eg. excessive sunbed use)
- Chronic wounds and inflammation
- SCC arising in chronic ulcers and scars (particularly burns scars) → known as a Marjolin’s ulcer
- Immunosupression
- Pre-malignancy conditions, such as Bowen’s disease or actinic keratoses
- Smoking (lip SCC)
List the characteristics/ presentation of SCC
Appearance can be highly variable:
- Can be nodular, indurated, or keratinised with associated ulceration or bleeding
- Growth over weeks to months
- Size is variable (few millimetres to several centimetres)
On which locations do SCC tend to occur?
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)
What would be seen on dermoscopy of SCC
Most commonly:
- white circles or structureless areas
- looped blood vessels,
- a central keratin plug
Investigations for a SCC
- Full history and examination, incl palpation of regional lymph nodes
- Dermoscopy to aid diagnosis
- Biopsy to confirm diagnosis
List 2 ddx for SCC
- Bowens disease
- BCC or Melanoma
Compare the appearance of a BCC vs SCC carcinoma
SCC firm red nodule, tends to crust and is more fleshy
BCC pearly/waxy bump or flat brown lesion. Often tender or painful
Management of a BCC or SCC
- Urgent dermatology opinion
- In primary care - 2week wait refferal
- If in doubt - remove it
- Punch biopsy or wide local excision
- Regular follow ups
What is Bowens disease?
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
What is Melanoma?
Malignant tumour of melanocytes
Commonly arises from melanocytes in the stratum basale of the epidermis, but can also arise from melanocytes at other sites
What are the most common locations for melanoma to present?
Trunk or legs
Why is early identification key in Melanoma
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
Describe the progression and clinical features of Melanoma
Early melanomas are often asymptomatic
Patients usually present having noticed a new naevus or changes in an existing mole
What is the ugly ducking sign?
Describes an atypical nevus that is obviously different from others in an individual:
- colour change and variation
- can be non-pigmented
- regression- scarring
- itchy, tender, bleed, non-healing
What 2 ways can we score melanomas?
- ABCDE
- Glasgow 7-point checklist; looks at major and minor features. A score of 6 and above gets an immediate referral to dermatology
List the 4 various subtypes of Melanoma on dermascopy
Superficial, Nodular, Lentigo, Acral
Management of Melanoma
- Urgent 2 week referral, NOT to be managed within primary care
- Wide local excision +/- lymph node dissection (possible dissection of local lymph nodes)
- Genetic testing
- Imaging for metastasis
- MAB (Monoclonal Antibody Body) therapy:
- Imatinib; aids in seeding of metastatic melanoma
- Dabrafenib
- Regular follow up: Skin, scar and nearby lymph node examination
How is Melanoma diagnosed?
Diagnosis is made through excision biopsy - Histology is GOLD standard
History is still very important, Dermoscopy can aid
List 2 topical treatments for superficial lesions
e.g. Actinic keratoses, Bowens Disease, Superficial BCC
- Solaraze - diclofenac gel
- Actikerall - 5FU +Salicylic acid
Side effect of topical treatment for superficial lesions?
Can cause an erythematous rash
When is Cryotherapy is used in treatment?
For warts, AK, Bowens
Surgery is the gold standard treatment for which types of skin cancer?
SCC and Malignant Melanoma
Must get 2mm margin of clearance
