Tumours Flashcards
Benign neoplasms of the skin
Seborrhoeic keratosis Keloid scars
Cysts (pilar & epidermoid) Dermatofibroma
Skin tags (Acrochordons) Capillary haemangioma
Pyogenic granuloma Benign Melanocytic lesions
Benign Melanocytic lesions
Freckle Lentigo
Junctional naevus Compound naevus
Intradermal naevus Other (blue naevus, mongolian blue spot, beckers naevus, halo naevus)
Lentigo
like freckles but due to sun exposure (sun spots)
Melanocytic naevus
A collection of melanocytes –> a mole
The nature depends on the location within the skin and the bodily reaction
If congenital have a very small but real risk of malignancy
Junctional naevus
A form of melanocytic naevus where the collection of melanocytes are in the junction between the dermis and the epidermis
Compound naevus
A raised, benign development of a junctional naevus which arises later in life
Intradermal naevus
A mole/naevus which is the same colour as the surrounding skin – may be noticed as a patch of hairlessness on the scalp
Halo naevus
An autoimmune reaction to a naevus leading to a pale ring around it. the central naevus may become involuted leaving a small grey centre
Beckers naevus
A large hyperpigmented lesion which appears at adolescence in males with some unclear genetic link
Atypical Naevi
Clinical signs – irregular edge and pigmentation, >5mm, inflammed
Histology – Architectural atypia, cytological atypia
Photocarcinogenesis
UV causes DNA damage – the most important cutaneous carcinogen
UV may also alter immune surveillance
Skin types (Fitzpatrick)
I - V. white, pale/freckly, ginger - burn not tan (irish)
II - white, pale, no freckles - tan after burning (cornish)
III - kinda white, dark hair - tan easily (south french)
IV - mediterranean - tan dont burn (spainish)
V - Brown - mixed race or arab VI - black african
History of sun exposure
Where did you grow up? Occupation? (outdoors or not) Hobbies? (outdoors or not) Sun-bed use How many times have you been sun burned?
Pre-malignant neoplasms
Carcinoma in situ – on the way to cancer but not invaded yet
Actinic (solar) keratosis
Can be single or multiple. Dry, rough and scaly lesion
Occur in areas of chronic sun exposure - keratinocyte atypia on histology. Can be treated with 2-3wks of fluorouracil
Bowen’s disease
Squamous cell carcinoma in situ – should be treated as risk of invasive disease
A solitary, well defined erythematous patch on the skin
Treatment of pre-malignant or atypic lesions
Cryotherapy
Topical 5-fluoracil or imiquimod (immune modulator)
Surgical removal
Lentigo maligna
Irregular macula stains on the head or neck - atypical melanocytes in situ – precursor to malignant melanoma
Risk factors for Skin cancers
UV radiation is the biggest – other ionising radiation
Skin type I or II Burns or vaccine scars
Arsenic poisoning Immunosuppression
Basal cell carcinoma (BCC)
Most common type of skin cancer – locally aggressive and destructive but with limited ability to metastase - rolled, pearly edge
Can be nodular, morphoeic or pigmented
Manage with surgical excision, curettage or radiotherapy
Squamous cell carcinoma (SCC)
If differentiated will be keratinised – if not may ulcerate, erode or bleed
90% remission rate but depends on differentiation
Requires urgent excision and possible radiotherapy
Keratoacanthoma
A mildly common, benign neoplasm of the pilosebaceous glands. Domed rapidly growing nodule with a keratinous centre – rarely becomes malignant, may be a marker for Muir-Torre syndrome. Should refer to exclude SCC/BCC
Features of Malignant Melanoma
Major – change in size, shape or colour
Minor – >6mm, inflammed, Oozing/bleeding, itch or altered sensation
ABCDE check list for melanoma
Asymmetry. Border. Colour. Diameter. Evolving
Risk factors for malignant melanoma
Intense, intermittent UV Skin type I or II
Pre-existing melanocytic lesions – greater risk with increasing atypia
FH of melanomas or multiple naevi
Prognostic factors for melanoma
Tumour thickness – Breslow Histology
Stage at start of treatment
Depends on stage - 95% at stage I to 25% at stage III
Management of melanoma
Uregent excision – second excision if margin is not clear
Lymph node sampling and staging decides next steps
Metastasis of melanomas
Lymphatic - regional lymph nodes
Blood - lung, liver, brain
Local - surrounding skin and subcutaneous tissue
Amelanotic melanoma
A rare type of melanoma which does not produce melanin and so is not dark. the resulting delay in detection means it has a poor prognosis and recurrence is high
Cutaneous lymphoma
A monoclonal T cell tumour which initially migrates to the skin forming an itchy psoriasiform rash – subsequently spreads to lymphatics and organs
Kaposi’s sarcoma
A multisystem vascular neoplasm linked to HHV-8 which arises during immunosuppression/ presents as purple papules on the skin and mucosa. these can ulcerate leading to effusion or haemoptysis
Treat with improving immune function, chemotherapy and radiotherapy
Cancers which metastase to skin
Breast Lung
GI (bowel and stomach) Kidney
Bladder Thyroid
Liver
Important genetic skin cancer conditions
Tuberous sclerosis. Neurofibromatosis. Gorlin’s syndrome
Oculo-cutaneous albinism. Xeroderma pigmentosa
Tuberous sclerosis
Mutation in TSC1/2 - autosomal dominant
hamartomas in skin, brain, eye and heart
Clusters of firm, pink/violet papules around the muzzle
(adenoma sebaceum)
Neurofibromatosis
Mutation in NF1 (neurofibrin) - autosomal dominant
Cafe-au-lait macules, neurofibromas, freckling, optic gliomas, lisch nodules, osseus lesions
Gorlin’s syndrome
BCC syndrome - also skeletal anomalieis and odontogenic cysts
Mutations in PTCH tumour suppressor gene
Oculo-cutaneous albinism
Partial or total lack of melanin – no protection from UV
Xeroderma pigmentosa
Defective DNA repair leading to photosensitivity and photodamage from infancy – melanomas by age 8
Strawberry Naevi (capillary haemangioma)
Not present at birth by may develop rapidly in the first month of life. Erythematous, raised and multilobed tumour. grow until 6-9months then regress by 10yrs (95%). 10% of white infants and females, premature babies and babies whose mothers underwent chorionic villous sampling are at greater risk. Treatment if needed is systemic steroids.
Cavernous Haemangioma
A deep capillary haemangioma
Leukoplakia
A premalignant condition more common in smokers with hard, white spots on the mucous memebranes of the mouth, Cannot be ‘rubbed off’ –> transformation to SCC occurs in 1%.
Cherry Haemangioma (Campbell de morgan spots)
Benign skin lesions containing an abnormal proliferation of capillaries. Increasingly common with age and equal gender balance. erythematous, papular lesions (1-3mm in size). Non-blanching and not found in mucous membranes. No treatment needed.
Chondrodermatitis nodularis helicis
Common, benign condition causing a painful nodule on the ear due to pressure. More common in men and with increasing age. Treat by reducing pressure, cryotherapy, steroid injections, collagen injections. Surgery can be used but there is a high recurrence rate.
SSC and psoriasis
SCC is the most significant complication of PUVA with psoralen.
Spider naevi
Benign blanching lesions found on the upper body in 10-15% of people. (more in children). Increased number is associated with liver disease, Pregnancy, COC,
Pyogenic granuloma (eruptive haemangioma)
Relatively common benign lesions associated with trauma, pregnancy and more common in women and young adults. Small spot which rapidly progresses within days into a spherical raised lesion. Usually on the hands, head or upper trunk and oral lesions are common in pregnancy. Pregnancy related lesions will resolve spontaneously but others require excision, cryotherapy etc.
