Tumours & benign lesions Flashcards
Give examples of benign lesions
Acrochordons Lipoma Keratoacanthomas Seborrheic keratoses Cherry angiomas
What is Acrochordons? Incidence?
= skin tags
Increase incidence with age
Characteristics of lipomas
Benign, asymptomatic
Keratoacanthomas - Characteristics? Associated with? Advice?
- Rapidly growing resemble SCC. Start round firm reddish or skin coloured papules develop into a dome. Usually later in life and in sun exposed areas.
- Associated with sun, smoking , HPV, genetic factors, trauma and chemical carcinogens
- Pruritus and pain
- Some question over if a self-limiting SCC
- Histological cannot differentiate between SCC
- Advise excision- can disappear
Seborrheic keratoses - What is it? Characteristics? When does it occur? Advice?
- Most common epithelial tumour
- Tend to be hereditary occur over 30
- Multiple well circumscribed yellow to brown raised lesions
- See GP- new growth, change in appearance, unusual colour, irritated or painful
- Abrupt eruption of multiple lesions sign for adenocarcinoma of for e.g. stomach
- Generally no treatment usually only cosmetic reasons
Cherry angiomas - when is it common? Characteristics / S&S?
- Common increase with age.
* Asymptomatic small bright red. If damaged will bleed profusely
Nevus - Mole - What is it? When do they appear?
- Non cancerous – melanocytic tumour
* Appear as children
Nevus - Mole - Person with >50 at greater risk of what?
➤ Developing melanoma
Melanoma - how do they appear?
- Change in size, shape or colour of existing nevus
* Or appear as new or abnormal looking mole
Melanoma - When do you have skin checks?
Monthly
Melanoma - due to what?
Sun and repeat sun burn
Melanoma - Increased risk?
o Close family hx melanoma o Pale skin that does not tan easily o Red or blonde hair o Blue eyes o Freckles o Radiotherapy o Immune compromised eg HIV, IBD o Previous diagnosis o Age o May increase if you have had other cancers eg breast, renal, thyroid o More common in females
Distribution of melanoma in males?
head and neck 22%, trunk 41%, arm 19%, leg 13%
Distribution of melanoma in females?
head and neck 14%, trunk 20%, arm 24%, leg 39%
Different types of melanoma & characteristics
- Superficial spreading: -grows outwards rather than downwards most common form. Usually middle aged.
- Nodular melanoma: grows downwards and quickly- may not have arisen from a previous mole chest or back common areas
- Lentigo maligna melanoma: slow growing, elderly, areas lot of sun exposure and those outdoors a lot
- Acral lentiginous melanoma: palms and soles of feet and under nails. Rare, common type of melanoma in dark skinned people
- Amelanotic melanoma: no colour or little colour- rare
Melanoma - Prognostic variables
The Breslow thickness is the single most important prognostic variable (distance in mm of the further tumour cell from the basal layer of the epidermis).
Melanoma - Ix
o Examination o Skin biopsy and mapping o Imaging: CT scan, MRI, PET scan, bone scan, chest xray o Lymph node biopsy o Blood tests- lactate dehydrogenase o Vitamin D levels
Melanoma - Tx
o Surgical
o If spread to other organs cure is difficult - chemotherapy and or radiotherapy to slow progression
o Other treatments immunotherapy e.g. interferon, IL-2; vaccine therapy- trials ongoing
o Metastasised to brain - proton therapy (restricted Tx in the UK)
Melanoma - ABCDE rules
- Asymmetry – shape of one half does not match the other
- Border – edges ragged, notched or blurred
- Colour – uneven and cambered, brown, black etc
- Diameter – usually larger than 6mm but can be any size
- Evolving – changing in size, shape colour, appearance or growing in an area of normal skin
- Also itch, sore, crusty or bleeding
Basal cell carcinoma - Due to what?
Exposure UV light from sun or sun beds
Basal cell carcinoma - Where does it occur?
- Common on sun exposed areas eg head, neck, ears, but can occur anywhere
- Also occur in areas of scars, burns or ulcers
Basal cell carcinoma - In who is it more common?
- More common in males than females, fair skinned, lot of sun exposure, previous BCC
- Most common in immuno compromised eg organ transplant
What is a rare condition associated with basal cell carcinoma?
Gorlins syndrome
Basal cell carcinoma - S&S?
o Painless o Superficial o Scab that bleeds and does not heal completely o >1cm o If left become rodent ulcers
Basal cell carcinoma - Tx?
o Low risk BCC: NICE recommend Rx primary care ➤ low risk NOT head or neck, less than 1cm diameter with clearly defined margins, not a recurrence, not persistence after excision, not morphoeic, infiltrative or basosquamous in appearance, not located over important anatomical features, surgery closure is not a problem
o Other BCC ➤ surgery or radiotherapy in hospital
o Mohs micrographic surgery (surgeon take slices of the BCC and look at it under the microscope. They want a margin around the BCC clear of cancer but they left the healthy tissue so the wound can heal).
o Low risk: curettage and cautery ➤ cure rate 90%
o Imquimod 5% cream: small superficial lesions 70-100% effective
o Photo Dynamic Therapy: superficial BCC, 85% others lower, limited long term results
o Radiotherapy: incomplete excision
Basal cell carcinoma - Prognosis
o Mortality low rarely metastasise
o Increased risk of SCC and melanoma and other BCC
o Recurrence have a worse cure rate
Squamous cell carcinoma - caused by?
- Sun exposure: hobbies, occupational
* Skin damaged by x rays, scars, burns, persistent chronic wounds
Squamous cell carcinoma - Incidence? Higher in?
• Incidence 10,000 per year
• Incidence higher: o Caucasians o Rising incidence with age o HPV o Ionising radiation exposure o Chronic inflammation o Genetic conditions eg albinism, xeroderma pigmentosum o Pre malignant conditions- eg Bowens, actinic keratoses
Squamous cell carcinoma - What does it present like?
A non healing ulcer
Squamous cell carcinoma - Can it spread?
Yes ➤ other parts of the body
Squamous cell carcinoma - Ix
o Excisional biopsy
o CT scan
o MRI
o Lymph node biopsy
Squamous cell carcinoma - Tx
o Refer to dermatologist o Surgical excision o Curettage and cautery small lesions o histology difficult to interpret o Cryotherapy - histology not always possible o Topical Rx Imiquimod 5%, Fluorouracil, diclofenac o PDT o Radiotherapy
Squamous cell carcinoma - Factors affecting the spread
o Tumour location o Diameter o Depth o Histological differentiation o Previous treatment
Squamous cell carcinoma - Prognosis
o Overall mortality low (<5%); distant mets 5 year survival poor 25-40%
o Up to 95% mets and local recurrence detected within 5 years of first treatment
o 70-90% occurring within first 2 years
Skin protection - skin conditions reduced by?
Risk reduced by avoiding getting burnt, wearing protective clothing, avoiding midday sun, using high SPF products
