Skin Cancer

Question 1

Melanoma - what is the immediate and subsequent management?

Answer 1

Immediate: urgent excisional Bx w 2mm margin
(consider partial Bx [shave or incisional] only in difficult sites eg. nose, ear, acral, nail)

Subsequent: wide local excision (margins based on Breslow thickness) +/- sentinel lymph node biopsy +/- systemic therapy

Question 2

Melanoma - name 10 risk factors

Answer 2

Male
Increasing age
PHx melanoma or NMSC / keratinocyte cancer
Multiple (>5) atypical naevi
Multiple common naevi (>100 or >11 on arm)
FHx melanoma
Fair skin that burns easily
High levels of sun exposure / skin damage
Blistering sunburn in youth
Immune suppression

Question 3

Melanoma acronym (inc. nodular melanoma)

Answer 3

A - Asymmetry (colour, shape, pattern)
B - Border irregularity
C - Colour variation
D - Diameter >6mm
E - Evolving over time (size, shape, surface, colour, Sx eg. itch, bleeding)

For nodular melanoma
E - Elevated (small, round, raised lump that is black, brown, pink or red)
F - Firm to touch
G - Growing progressively for >1m

Question 4

Melanoma - wide local excision margins based on Breslow thickness (vertical depth) of:
- Melanoma in situ
- <1mm dermal infiltration
- 1-2mm dermal infiltration
- 2-4mm dermal infiltration
- >4mm dermal infiltration

Answer 4

• Melanoma in situ: 5-10mm
• <1mm dermal infiltration: 1cm
• 1-2mm dermal infiltration: 1-2cm
• 2-4mm dermal infiltration: 1-2cm
• > 4mm dermal infiltration: 2cm

Question 5

Name 5 melanoma dermoscopy features

Answer 5

Asymmetric pigmentation
Blue-white veil
Multiple brown dots
Pseudopods
Radial streaming

Question 6

What are basal cell carcinoma key features?

Answer 6

Most common and least dangerous skin Ca
Slow growing, rarely metastasises
Non-tender

Question 7

Basal cell carcinoma - name the 3 sub-types

Answer 7

Nodular = pearly raised edge w surface telangiectasia +/- central ulceration

Superficial = erythematous scaly patch (DDx Bowen’s disease, psoriasis, eczema, tinea)

Morphoeic = scar-like w poorly defined margin

Question 8

What are squamous cell carcinoma key features?

Answer 8

Second most common skin Ca
Grows over months, may metastasise
Tender
Pre-cursor = solar/actinic keratoses

Question 9

Squamous cell carcinoma - name the ‘3’ sub-types

Answer 9

Classic = irregular nodule or erythematous plaque, frequently ulcerates

Bowen’s disease (SCC in situ) = slowly expanding irregular scaly plaque, usually red but sometimes pigmented (DDx superficial BCC, psoriasis, eczema, tinea)

+/- Keratocanthomas = rapidly growing lesion, usually with a smooth outer dome and central kertain core. BENIGN but clinically indistinguishable from SCC -> require excision

Question 10

Name 3 treatment options for SUPERFICIAL basal cell carcinoma

Answer 10

Cryotherapy (low-risk sites)

Curettage and cautery (trunk and proximal limbs)

Topical Imiquimod 5% cream nightly on 5 consecutive days for 6 weeks

DO NOT excise as first-line option

Question 11

Name 4 treatment options for Bowen’s disease / SCC in situ

Answer 11

Cryotherapy
Curettage and cautery
SURGICAL EXCISION

Topical Fluorourcil 5% cream daily or BD for 2-4 weeks