Skin tumours

Question 1

What are some risk factors for squamous cell carcinoma?

Answer 1

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

Question 2

Describe the appearances of squamous cell carcinoma

Answer 2

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

Question 3

What are the origins of squamous cell carcinoma?

Answer 3

De novo Actinic/solar keratosis Bowen’s disease Chronic inflammation - leg ulcers

Question 4

What is Bowen’s disease?

Answer 4

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.

Question 4

When is a squamous cell carcinoma malignant?

Answer 4

>2cm

Question 5

How is SCC managed?

Answer 5

2 week wait referral to secondary care Surgical excision Moh micrographic surgery Radiotherapy

Question 6

What are the origins of basal cell carcinoma?

Answer 6

De novo No pre-malignant state

Question 7

Describe the growth of basal cell carcinomas

Answer 7

Slow growth (2-3mm/y) Rarely metastasise

Question 8

Describe the appearance of BCC

Answer 8

Pearly edge Bloody crust Skin lesions never fully heal, and bleed or scab

Question 9

What are the risk factors for basal cell carcinoma?

Answer 9

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

Question 10

Outline management of BCC in primary care

Answer 10

Efudix (5-FU) cream: induces inflammation of skin to destroy sun-damaged areas. 2 week wait referral to secondary care

Question 11

How is BCC treated in secondary care?

Answer 11

Surgerical excision Mohs micrographic surgery Cryotherapy Radiotherapy

Question 13

What conditions are treated with Efudix cream?

Answer 13

Actinic (solar) keratosis Bowen’ disease Superficial basal cell carcinoma

Question 14

What is basal cell nevus syndrome?

Answer 14

Rare autosomal dominant condition characterised by: 1. multiple early onset basal cell carcinomas 2. Other tumours Due to abnormal PTCH 1 tumour suppressor gene.

Question 15

What is keratoacanthoma?

Answer 15

A skin lesion of the hair follicle that erupts in sun-damaged skin. Treated as SCC, surgically removed.

Question 16

What aspect of a history would suggest a potential pre-cancerous or cancerous skin lesion?

Answer 16

New onset single skin lesion

Question 17

What part of the history would help differentiate SCC and BCC?

Answer 17

Duration. BCC initially occur several months ago, whilst SSC is significantly more recent (weeks)

Question 18

List 4 variants of basal cell carcinoma

Answer 18

Nodules Superficial Morphoeic (sclerosing) Basisquamous

Question 19

Why are atypical BCC important to identify?

Answer 19

Generally tend to be more aggressive and have higher risk of complications

Question 20

Which type of BCC is commoner in >55?

Answer 20

Noduler BCC

Question 21

What type of BCC is commoner in 40-50yr?

Answer 21

Superficial BCC

Question 22

Compare nodular and superficial BCC

Answer 22

Nodular: rolled edge, pearly border, 1-2cm, telangiectasia Superficial: thin rolled edge, slightly scaly, telangiectasia

Question 23

Describe a morphoeic BCC

Answer 23

Depressed, atrophic skin lesion. Often has a scar-like plaque. May infiltrate cutaneous nerves

Question 24

What is a basisquamous carcinoma?

Answer 24

BCC with features of a SCC. Has an infiltrative growth pattern

Question 27

Where are BCC located most commonly?

Answer 27

Head and neck

Question 28

What are the complications of BCC?

Answer 28

Local tissue invasion and destruction

Question 29

Differentiate Solar keratosis and Bowen’s disease

Answer 29

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

Question 30

Why is the 2 week wait important regarding SSC?

Answer 30

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)

Question 31

What is the commonest cause of a rapidly growing cyst?

Answer 31

Active infection