Skin tumours Flashcards
What is the commonest sin cancer?
BCC
What is actinic keratoses?
Pre-malignant crumbly yellow-white scaly crust on sun-exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes
What can actinic keratoses progress to?
SCC
What might the following be?
- Actinic keratosis
- Bowen’s Disease
- Psoriasis
- BCC
- Seborrhoeic keratosis
What measures would you take to prevent someone developing actinic keratosis?
Education
- Sunhats
- Suncream
- Monitor skin
What options are available for managing actinic keratosis?
No treatment, or:
- Emollient
- Diclofenac gel
- Fluorouracil
- Imiquimod
- Crytherapy
- Photodynamic therapy
- Surgical excision + curettage
What is bowen’s disease?
Intraepidermal SCC/SCC in situ - superficial well-defined slowly enlarging red scaly plaque with a flat edge. It is a full thickness dysplasia/carcinoma in situ
What is the cause of Bowen’s disease?
- UV exposure
- Radiation
- Immunosuppression
- Arsenic
- HPV infection
How would you manage someone with Bowen’s Disease?
- Cryotherapy
- Topical flourouracil
- Imiquimod
- Photodynamic therapy
- Curettage
- Excision
What is the following?
Seborrhoeic keratosis
What is basal cell carcinoma?
Slow-growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older individuals
What are risk factors for BCC?
- UV exposure
- History of frequent/severe sunburn in childhood
- Skin type I - (always burns, never tans)
- Increasing age
- Male sex
- Immunosuppression
- Previous history of skin cancer
- Genetic predisposition
How does BCC present?
Various morphological types:
- Nodular - small, skin-coloured papule or nodule with surface telangiectasia, a pearly rolled edge - may have necrotic/ulcerated centre
- Superficial (plaque-like)
- Cystic
- Mephoeic (sclerosing)
- Keratotic and pigmented
What could the following be?
BCC
What options are available for treating BCC?
- Remove the lesion - mohs micrographic excision, cryotherapy, photodynamic, Curettage and cautery
- Radiotherapy
- Low risk - Topical treatment (imiquimod)
What are complications of BCC?
Local tissue invasion and destruction
What is squamous cell carcinoma?
Locally invasive malignant tumour of the epidermal keratinocytes or its appendages, which has the potential to metastasise
What are causes of SCC?
- UV exposure
- Pre-malignant skin conditions - actinic keratoses
- Chronic inflammation - leg ulcers, wound scars
- Immunosuppresion
- Genetic predisposition
How does SCC present?
Keratotic, ill defined nodule which eventually ulcerates
How would you manage someone with SCC?
- Surgical excision - Mohs micrographic surgery
- Radiotherapy - large, non-resectable tumours
What is malignant melanoma?
Invasive malignant tumour of the epidermal melanocytes, which has the potential to metastasise
What are risk factors for the development of malignant melanoma?
- Excessive UV exposure
- Skin type I (always burns, never tans)
- History of multiple moles or atypical moles
- Family history
- Previous history of melanoma
What are signs of malignant melanoma?
ABCDEF
- Asymmetry in outline of the lesion
- Border irregularity or blurring
- Colour variation
- Diameter > 6mm
- Evolution/Enlargement
- Funny looking mole
Also new or changing lesion
What are types of malignant melanoma?
- Superficial malignant melanoma
- Nodular melanoma
- Lentigo maligna melanoma
- Acral lentiginous melanoma
What are features of superficial spreading melanoma?
- Common on lower limbs
- Young/middle aged adults
- Related to intermittent high-intensity UV exposure
What are features of nodular melanoma?
- Common on the trunk
- Affects on young and middle aged
- Related to intermittent high-intensity UV exposure
What are features of lentigo maligna melanoma?
- Common on the face
- Affects Elderly
- Related to long-term cumulative UV exposure
What are features of acral lentiginous melanoma?
- Common on the palms, soles and nail beds
- Affects elderly more commonly
- No clear relation with UV exposure
What is the most common type of melanoma?
Superficial spreading melanoma70%
How would you manage someone with malignant melanoma?
- Surgical excision
- Radiotherapy
- Chemotherapy
What margin is used for excision of malignant melanoma?
- Any unusual lesion - 2mm margin of normal skin + cuff of subcut fat
- If malignant melanoma - 3mm
What is breslow thickness?
Thickness of tumour - gives an idea of risk of recurrence
What does a breslow thickness of <0.76mm indicate in terms of risk of recurrence?
Low risk
What does a breslow thickness of 0.76-1.5mm indicate in terms of risk of recurrence?
Medium risk
What does a breslow thickness of >1.5mm indicate in terms of risk of recurrence?
High risk
What is classed as stage I malignant melanoma?
- T < 2mm
- N0
- M0
What is classed as stage II malignant melanoma?
- T>2mm
- N0
- M0
What is classed as stage III malignant melanoma?
- T>2mm
- N >/= 1
- M0
What is classed as stage IV malignant melanoma?
- T>2mm
- N>/=1
- M1
What might be your differential diagnosis for someone who is presenting with features of malignant melanoma?
- Benign melanocytic lesions
- Non-melanocytic pigmented lesion e.g. seborrhoeic keratosis
What might the following be?
Acral lentiginous melanoma
What might the following be?
Superficial spreading melanoma
What might the following be?
Lentigo maligna melanoma
What might the following be?
Nodular melanoma
What is the best diagnostic test for melanoma?
Fill thickness excisional biopsy - can properly estimate thickness
What is the gold standard for management of malignant melanoma?
Complete excision
What would prompt lymph node bipopsy in malignant melanoma?
Tumour thickness > 1 mm
Where are SCCs most commonly found?
Most commonly face - typically lower lip
What is the classic presentation of SCC?
- Painless
- Non-healing, bleeding ulcer
How would you investigate a suspected SCC?
- Punch biopsy
- Wedge biopsy
- Excision biopsy
