surgery - PLASTICS skin cancer Flashcards
(35 cards)
what is BCC?
slow-growing and locally-invasive skin cancer that arises from the pluripotent cells of the stratum basale layer of the epidermis.
most common, least likely to metastasise
RF for BCC?
long term UV exposure leading to genetic mutations eg p53 tumour suppressor 9q22
OUVA therapy for psoriasis
Fitzpatrick type 1
immunosuppression
Xeroderma Pigmentosa or Gorlin syndrome
features of CC?
on sun-exposed areas of the head and neck
small slow growing
raised pearly edges
evident telangiectasia
may cause pain, bleeding and ulceration
subtypes of BCC?
ix for BCC?
excision biopsy
dermatoscope examination - arborising vessels, spoke wheel like structures, areas of ulceration
non-surgical mx of BCC?
surgical mx of BCC?
excision biopsy with 3-5mm margin
if close to vital anatomic structure, have indistinct margins or recurrent = mohs’ surgery
what is low and high risk BCC?
Low-risk BCCs are small, well-circumscribed lesions superficial type lesions that do not meet any of the high-risk criteria
High-risk BCCs include those occurring in the young (<25yrs) or immunocompromised patients, recurrent lesions, lesions on the nose, lips, ears, or around the eyes, lesions with poorly defined margins, and all non-nodular subtypes of BCC
what is mohs’ surgery?
prevention of BCC?
reduce their exposure to UV light and avoid sunbeds (primary prevention)
frequent use of SPF50 sunscreen and wearing of protective clothing (secondary prevention).
what is SCC?
malignant tumour of keratinocytes, arising from the epidermal layer of the skin
how do SCC arise?
cumulative prolonged exposure to ultraviolet (UV) radiation
commonly found on head, neck, arms, legs
premalignant condito for SCC?
bowens disease
actinic keratoses
keratin horns
leukoplakia
mets in SCC?
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.
RF for SCC?
features of SCC?
nodular, indurated, or keratinised
assoc ulceration + bleeding
grows over weeks to months
located on sun-exposed sights
what is Bowen’s disease?
ix for SCC?
A full history and examination should be performed, including palpation of regional lymph node basins.
dermatoscopy - white circles or structureless areas, looped blood vessels, and a central keratin plug
excision biopsy
imaging +/- FNA
advantages and disadvantages of excision biopsy?
Excisional biopsy – the whole lesion is excised, together with a margin of normal tissue
Advantages = excises adequate sample for histological analysis, removing all abnormal tissue; disadvantages = often requires more time and results in a larger scar
advantages and disadvantages of incisional biopsy?
ncisional biopsy – only a portion of the lesion is removed, via a relatively smaller skin incision
Advantages = quicker procedure, less invasive than excisional biopsy; disadvantages = lesion will still require further treatment if warranted
advantages and disadvantages of punch biopsy?
Punch biopsy – a small deep hole is punched out of the lesion, with a small cylindrical sample of tissue removed
Advantages = quicker procedure, obtains a full-thickness sample, good cosmetic outcome; disadvantages = incorrect area of sample may be sampled, lesion will still require further treatment if warranted
surgical mx of SCC?
excision biopsy with peripheral margins
low risk ≥ 4mm
high risk ≥ 6mm
very high risk ≥ 10mm
non-surgical mx of SCC?
Primary radiotherapy if surgery not feasible
Immune Checkpoint Inhibitors can be used in locally advanced SCC
chemo if all else not tolerated
what is melanoma?
malignant tumour of melanocytes, the melanin-producing cells of the body. It commonly arises from melanocytes in the stratum basale of the epidermis but can also arise from melanocytes at other sites.
