Skin cancer BW2 Clare Heal

Question 1

Which of the following is most predictive of

Answer 1

1. All of these are predictive

But Personal hx is most predictive!!!!!! (melanoma)

Question 2

Skin History? What do you need to ask?

Answer 2

Question 3

What is important for examination of skin cancers? or skin in general?

Answer 3

1. Good lighting
2. Undress to underwear
3. Systematic approach - routinely examine all skin, under underwear etc, webbing under toes

Question 4

What is a BCC?

What are the subtypes?

What is the most common in Nrth qld? - BCC (most common) SCC very close - most prevalent in mackay

Question 5

What is this lesion?

What is the management of this lesion?

Answer 5

1. Nodular BCC -

Signs:

1) Arborising blood vessels
2) Shiny pearly edges
3) Dermatoscopy shows arborizing vessels

Question 6

What is your DDX of this BCC?

How would you manage it?

Answer 6

• Excision with 3mm margin, mark 12 oclock on sample
• Send sample for histolopathology
• Review 7/7

Or could do a punch biopsy

• then could re-excise with correct margins.

Question 7

What is this?

What is your DDx?

How would you manage this?

Answer 7

1. Could be anything

Actually a Superficial BCC, could equally be Bowens disease, SCC insitu, psoriasis, Excema, dermatitis

Pain- is common sign skin cancer

Question 8

How do we manage SCC?

BCC?

Pre cancerous AK/IEC?

What are the margins for SCC? BCC?

Answer 8

Question 9

Ulcerated centre, micronodule surrounding area-

The patient was treated innappropriately with Iminquinod! (should only be used for superficial BCC) - But these lesion is nodular BCC- and can get severe eruption reactions:

Need to review patients regularly weekly when prescribing

Answer 9

Question 10

What is your DDX?

What is this lesion?

Answer 10

SCC insitu - Bowens disease!

(but is a pink patch- can do a punch or shave biopsy)

Question 11

What is this?

(Marjolins - non healing ulcer, DDX)

Occur in burns/scars

Answer 11

Marjolins

Question 12

What is this lesion?

Answer 12

Keratoacanthoma

• often in elderly, occur in the shins area
• Can be Curretage, can be treated as SCC (jurys out, similair)
• Central punctum, quick rising,
• Can use cryotherapy, can curretage, can use aldara/efudix

(need 5-10 seconds burning with 3mm margin)

Question 13

How would you describe this lesion?

Answer 13

Question 14

How would manage this Melanoma?

• on Arm -

Melanoma management:

Answer 14

2mm margins initially

Wait for histo- then 1cm or 10mm margins, wait breslows etc

Question 15

What is this lesion?

Answer 15

1. Lentigo melanoma, Melanoma insitu - clincial diagnosis - shave biopsy needed (epidermal component)

most common type:

is superficial spreading melanoma

Acrolentigous- nail subtype

Question 16

What is the most important prognostic indicator for melanomas?

Answer 16

• Breslows thickness!

Want to look at this on the histology report. Most important prognostic factor

Question 17

What are NHMRC guidelines and breslows thickness

• Note always start with punch in situ, because

What is the staging of Melanoma?

Answer 17

Question 18

What investigations are needed for different stages of melanoma

e.g anything stage 3 or 4 need detailed hx, physical, CT chest, pelvis, whole body PET

If symptomatic

LDH, CT, MRI, PET!

Answer 18

Question 19

What do you need to do for all follow up patients with melanoma?

Answer 19

Question 20

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