Tumours/Cancers Flashcards
background
skin cancer = commonest UK cancer
BCC, SCC, AK, IEC, KA, Paget’s….
increasing incidence
low mortality, high morbidity (impairment, cosmesis)
basal layer (d/e junction): BCC prickle cell layer (spinosum): SCC/precursors
RFs
UV exposure age fair skin (TI/TII) genetics (Gorlins, XP) chronic inflammation (burns, ulcers, DLE) immunosuppression HPV (SCC)
BCC - BG
commonest (80%); M>F
slow growing, aSx, low mets risk, local invasion
sun-sites, exposure linked, also PMH and genetics, age and skin type
BCC - types
superficial: trunk/face, similar to eczema/psoriasis; plaque, scale, telangiectasia; Bx needed
nodular (commonest): sun sites, defined, classical features
pigmented: very similar to melanoma
morphoiec: scar tissue (hypopigmented), poor definiton, Moh’s surgery
‘rodent ulcer’ erodes skin, mm, bone, meninges
BCC - features
circ’d/defined, rolled shiny/pearly border, slightly irregular
telangiectasia, crusting/bleeding/ulceration
raised
BCC - recurrence RFs
size/increasing site: eyes, lips, nose, ears poorly defined morphoeic aggressive: perineural/perivascular invasion previous treatment failure/recurrence
BCC - Rx
Mohs if high risk (e.g. morphoeic)
better cosmesis usually means worse recurrence
simple excision: 3-5mm; 5yr
BCC - prognosis
complications: local tissue invasion/destruction
prognosis: depends on site, size, type, growth, histology, recurrence/Rx failure, immunosuppression
SCC - BG
20% of skin cancers; increasing incidence metastatic potential (LN) 5ys 75-90% (mets = 25%)
SCC - RF
UV, age, skin
inflammation, radiation, immunosuppression
smoking
precursors
mets: site (ear/lip), size >2cm, thick/deep, non-sun or chronic inflammation site, poor diff, immunosupp, mucosal, perineural invasion
SCC - features
everted edge, scaling/crusting often keratinised/plugged firm skin-coloured nodule, can be soft and fleshy eroded surface can be a non-healing wound
pain, oozing, bleeding
fast growing
SCC - Rx
simple excision: 3-10mm; 95%; wider if large/thick/site/diff
MMS: rare (large/recurrent/blurry)
CC: small diff primary
SCC - prognosis
recurrence: 95% detected with 5y (f/u important)
prognosis: size, site, histology, depth, perineural involvement, immunosuppression
keratoacanthoma
indistinguishable from SCC but symmetry, epidermis over central crater and in base.
isolated domed nodule, usually face
central keratin plug, peripheral telangiectasia
rapid growth, plateau, then regression
Rx: self-resolving but often excised (?SCC)
actinic keratosis
multiple small rough patches/macules, sun sites
erythema, scaling, irregular pigmentation
feel > see; DScope = ‘strawberry’
aSx but can be sore/itchy
skin around: telangiectasia, UV damage, erythema
AK - Rx
discrete: CC/cryo
multple: 5FU/imiq or PDT
cryo: small/discrete/thick; cheap/easy; 95-100%
5FU(effudix)/imiquimod: diffuse multiple; inflammatory (erythema, sore, erosion); 4-6/52 BD
C&C: good if small, scarring risk; good cosmesis, high CR; not for legs
PDT: large/multi/widespread/poor-healing areas (not scalp - painful); 12m recurrence 0-28%
diclofenac (solarize): mild AK
IEC/Bowen’s
often legs of elderly women (also head and neck)
singular erythematous scaly defined patch/plaque
slow-growing aSx
IEC/Bowen’s - Rx
punch biopsy
5FU/imiqimod cryo C&C excision PDT: often preferred
Other NMSC
Merkel cell carcinoma
microcystic adnexal Ca
lymphoma
benign lesions
dermatofibroma: firm nodulel arms/legs; insect bites
neurofibroma:
cysts:
haemangioma:
pyoderma granuloma: rapid, bleeding, red lump
viral wart:
seborrhoeic keratosis
warty, keratin plugs, ‘stuck on’, pigmented
