Skin tumours Flashcards
What are some risk factors for squamous cell carcinoma?
UV sunlight Pre-cancerous skin conditions Fair skin, red hair, blue eyes Increasing age Male Pipe smoker Chronic inflammation: e.g. gingivitis, lichen planus, ulcers, chronic osteomyelitis + sinus, lichen sclerosis Immunosuppressed
Describe the appearances of squamous cell carcinoma
A small nodule enlarges and the centre becomes necrotic and sloughs, developing into an ulcer. The tumour therefore usually presents as an ulcerated lesion with hard, raised edges. Slow growth = yellow plugs Fast growth = fleshy
What are the origins of squamous cell carcinoma?
De novo Actinic/solar keratosis Bowen’s disease Chronic inflammation - leg ulcers
What is Bowen’s disease?
In situ squamous cell carcinoma of the skin. Appears as well-defined pink scaly (keratin) patches. Caused by UV radiation. 3% will progress to invasive squamous cell carcinoma.
When is a squamous cell carcinoma malignant?
>2cm
How is SCC managed?
2 week wait referral to secondary care Surgical excision Moh micrographic surgery Radiotherapy
What are the origins of basal cell carcinoma?
De novo No pre-malignant state
Describe the growth of basal cell carcinomas
Slow growth (2-3mm/y) Rarely metastasise
Describe the appearance of BCC
Pearly edge Bloody crust Skin lesions never fully heal, and bleed or scab
What are the risk factors for basal cell carcinoma?
Sun exposure/Frequent or severe sun burn Increasing age Light skin Male Smoking and immunosuppression PMH of cancer Rare genetic disorders: Basal cell nevus syndrome
Outline management of BCC in primary care
Efudix (5-FU) cream: induces inflammation of skin to destroy sun-damaged areas. 2 week wait referral to secondary care
How is BCC treated in secondary care?
Surgerical excision Mohs micrographic surgery Cryotherapy Radiotherapy
What conditions are treated with Efudix cream?
Actinic (solar) keratosis Bowen’ disease Superficial basal cell carcinoma
What is basal cell nevus syndrome?
Rare autosomal dominant condition characterised by: 1. multiple early onset basal cell carcinomas 2. Other tumours Due to abnormal PTCH 1 tumour suppressor gene.
What is keratoacanthoma?
A skin lesion of the hair follicle that erupts in sun-damaged skin. Treated as SCC, surgically removed.
What aspect of a history would suggest a potential pre-cancerous or cancerous skin lesion?
New onset single skin lesion
What part of the history would help differentiate SCC and BCC?
Duration. BCC initially occur several months ago, whilst SSC is significantly more recent (weeks)
List 4 variants of basal cell carcinoma
Nodules Superficial Morphoeic (sclerosing) Basisquamous
Why are atypical BCC important to identify?
Generally tend to be more aggressive and have higher risk of complications
Which type of BCC is commoner in >55?
Noduler BCC
What type of BCC is commoner in 40-50yr?
Superficial BCC
Compare nodular and superficial BCC
Nodular: rolled edge, pearly border, 1-2cm, telangiectasia Superficial: thin rolled edge, slightly scaly, telangiectasia
Describe a morphoeic BCC
Depressed, atrophic skin lesion. Often has a scar-like plaque. May infiltrate cutaneous nerves
What is a basisquamous carcinoma?
BCC with features of a SCC. Has an infiltrative growth pattern
Where are BCC located most commonly?
Head and neck
What are the complications of BCC?
Local tissue invasion and destruction
Differentiate Solar keratosis and Bowen’s disease
Bowen disease is: Less crusty (more scaly) Occurs in the back and limbs (Solar keratosis: face, scalp, neck, ears) More demarcated Larger than solar keratosis
Why is the 2 week wait important regarding SSC?
Early presentations of SSC are indistinguishable from other differentials. 2 weeks is usually enough time for treatments to affect the lesion if it is due to other causes (e.g. Fungal)
What is the commonest cause of a rapidly growing cyst?
Active infection
