Skin tumours Flashcards
What are the different types of skin cancers
Non-melanoma: BCC and SCC
Melanoma
list precancerous lesions of SCC
AK
Bowen’s disease
what is the commonest type of skin cancer
BCC
what is AK
Actinic keratosis is a precancerous skin lesion from accumulative photodamage causing partial thickness dysplastic keratinocytes
What is Bowen’s disease
carcinoma in situ / full thickness dysplasia
appearance of AK
scaly, crusty, erythematous
sun exposed areas e.g. H+N, ears
appearance of Bowen’s disease
erythematous
scaly, dry plaque
lower legs of older ladies
list genetic conditions that can predispose to skin cancer
albinism
epidermolysis bullosa
Gorlin’s syndrome
Xeroderma pigmentosum
list iatrogenic factors that can predispose to skin cancer
immunosuppression - steroids, ciclosporin, biologics
phototherapy
radiotherapy
List risk factors for developing skin cancer
increased sun exposure and burning sunbeds, holidays, no suncream... age FH and genetics immunosuppression - drugs naevi Fitzpatrick skin type smoking radiation chronic wound / ulcer chemicals
SCC are usually as a result from intermittent burning episodes, true or false
false, they result from cumulative UV exposure
BCC and melanomas are usually as a result from intermittent burning episodes, true or false
true
risk factors for melanoma
personal/FH number of moles excess sun exposure sunbed use multiple sunburns fair skin
List major criteria for changing moles
change in shape, size and colour
List minor criteria for changing moles
diameter >6mm
bleeding
sensory change
inflammation
Clinical features of malignant melanoma
ABCDE Asymmetry irregular Border multiple Colours Diameter >6mm fast Evolution
what tool can be used to examine skin lesions more closely
dermastocope
causes for changing moles
melanoma
psoriasis
eczema
halo naevus
examples of melanocytic naevi
blue naevus congenital Spitz normal naevi dysplastic halo atypical
advise for a patient with atypical naevi
regular monitoring
sun protection
what are atypical naevi a marker of
patient’s tendency to develop melanoma
does chopping out atypical naevi reduce risk of melanoma
no, there is still the same genetic risk and they could appear in ‘normal’ skin
what are the different subtypes of melanoma
superficial spreading acral / lentiginous lentigo maligna nodular amelanotic
all types of melanoma have radial growth phase (RGP), true or false
false
Nodular melanoma just has VGP
the rest have RGP initially and may develop VGP
Do nodular melanomas have the worst prognosis?
yes because they have VGP from the outset therefore increased risk of metastasis
What is Lentigo maligna
discolouration of the skin which is pre malignant for lentigo maligna melanoma
more likely in sun damaged skin and in the elderly
still in radial growth phase
what is acral lentiginous melanoma
melanoma on the soles or palms or even nails and mucosal surfaces
What is amelanotic melanoma
melanoma without the brown colouration
occurs from dedifferentiation as the cells have become so advanced they have lost their original function of producing colour
only VGP melanomas can metastasise, true or false
true
drugs for advanced melanoma
chemo, radiotherapy
immunotherapy
what is used to determine prognosis in melanoma
Breslow thickness
define breslow thickness
measure of deepest tumour cell from the granular layer of the epidermis in mm
KL is very variable in different body sites which would give a false impression of the Breslow thickness
what is the prognosis if the breslow thickness is:
<1mm
>4mm
<1mm = 95% 5 year survival >4mm = 50% 5 year survival
in acral lentiginous melanoma, what is the name of the sign for melanoma originating from the nail matrix
Hutchinsons sign
what are BCC
slow growing skin lesions
describe the appearance of a typical BCC
raised nodular lesion with a pearly shine, rolled edges and telangiectasia
central ulceration
prognosis of BCC
good prognosis as they rarely metastasise
don’t need immediate excision
however they are locally invasive and if left alone can become destructive and disfiguring
types of BCC
superficial infiltrative - like a tree stump, blur margins nodular cystic multicentric morphoeic
management of BCC
surgical excision
Mohs surgery
what is Mohs surgery
surgical excision of a BCC where tissue conservation is important to attain good cosmetic outcome e.g. nose, ears, eye
tumour is removed in stages and assessed until clear margins are achieved
non-surgical options for superficial BCC
imiquimod / aldara cream
PDT (superficial non life threatening skin cancers)
cryotherapy
management of AK
cryotherapy for solitary lesions
mild AK - solaraze/topical diclofenac
imiquimod or 5-FU / efudix for more severe AK
sun protection
management of Bowens disease
cryotherapy
imiquimod
5FU
PDT
features of SCC
fast growing lesions
potential to metastasise
scaly, painful, bleeding
sun exposed areas - scalp, ears, lips
what should be done in the case of advanced SCC
palpate for regional lymph nodes as there is the potential for metastasis
Who is more at risk of mouth SCC
smokers
what is a keratoacanthoma
fast growing lesions with a central plug of keratin that behave like SCC but regress in size spontaneously
generally they are excised as they resemble SCC and so are treated in the same way
what skin cancer can develop over a chronic wound/ulcer
SCC
what is the most common skin cancer in immunosuppressed individuals post transplant
SCC
More at risk of HPV strains that predispose to SCC development
what are seborrhoeic keratoses / warts
basal cell papillomas
benign lesions with warty appearance
cerebreform under dermatoscope
can be brown, pink, white, yellow
management of seborrhoeic keratoses
nothing
cryotherapy if bothersome
features of lipoma
subcutaneous mobile swelling
what are dermatofibromas
benign proliferation of fibroblasts usually in response to insult e.g. insect bite
features of dermatofibromas
limbs firm lumps pigmentation static asymptomatic itch squeezing can cause dimpling
epidermoid cyst = sebaceous cyst, true or false
true
features of epidermoid cysts
firm well defined
pus discharge
left alone unless problematic - remove
what are acrochordons
skin tags
benign
associated with metabolic syndrome
left alone or undergo cryotherapy
what are haemangiomas
benign overgrowth of blood vessels
what can haemangiomas be mistaken for initially
melanoma
dermatoscope helps to differentiate colour
what is a pyogenic granuloma
overgrowth of vascular and granulation tissue following trauma
bleeds easily
exaggerated healing response
management of pyogenic granuloma
curettage and cautery or excision
histology to exclude rare types of melanoma
risk of intense bleeding
risk of recurrence
describe features of a merkel cell tumour
rare malignancy of merkel cells in the epidermis
viral origin
fast growing and poor prognosis
cutaneous B cell lymphoma
new lump in an older patient
what is Kaposi’s sarcoma
AIDS associated condition
vascular tumour
pigmented BCC
classic BCC with a brown colour
management of neglected, large BCC
radiotherapy
BCC are radiosensitive
types of naevi
junctional
compound
intradermal
what naevus has an increased risk of melanoma
atypical naevi
management of atypical naevi
skin surveillance
management of malignant melanoma
surgical excision with 2mm margins initially
+- SNLB if thicker than 1mm
genetic therapies - BRAF inhibitor
immunotherapy
management of lentigo maligna ?melanoma
biopsy from more concerning looking parts
excision - ?graft if near the eye
imiquimod cream
surveillance if patient is old and frail
acral melanomas tend to be related to genetic conditions rather than sun damage, true or false
true
who is more at risk of amelanotic melanomas
Skin types 1+2
albinism
(not vitiligo, they have lost their melanocytes)
new skin lesion in a man with prostate cancer with rapid growth, worrying?
yes
rapid onset is concerning
Merkel cell tumour
fast growing
viral origin
poor prognosis
when would you prefer not to excise a lesion?
multifocal lesions and poor healing site e.g. lower legs
management of B cell lymphoma
radiotherapy
Which of the following naevi are flat and raised:
junctional
compound
intradermal
junctional - flat
compound - raised
intradermal - raised
