Non-melanoma skin cancer

Question 1

Which skin tumour is clasically described as pearly, with a rolled edge and telangiectasia?

Answer 1

Basal cell carcinoma

Question 2

Complications of basal cell carcinoma (2)

Answer 2

Very rarely metastasize but can cause local destruction

Question 3

Where do BCCs typically occur?

Answer 3

Mainly the face, but also other sun-exposed areas

Question 4

What questions should be asked in the history to assess risk factors for skin cancer? (8)

Answer 4

Occupation (and sun exposure)?
Typical response to sun (i.e. Fitzpatrick scale)?
Any previous serious episodes of sunburn (with blistering)?
History of sunbed use?
Significant time spent abroad?
Family history of skin tumours?
Personal history of skin problems/tumours?
Any immunosuppressive medication?

Question 5

Treatment options for basal cell carcinoma (5)

Answer 5

Excision with a margin of 4mm
Moh's micrographic surgery
Curettage and cautery (for small superficial lesions)
Cryotherapy for small low risk lesions
Topical Imiquimod or 5'FU

Question 6

Clinical variants of basal cell carcinoma? (4)

Answer 6

Nodular
Superficial
Pigmented
Morphoeic

Question 7

What pattern of sun exposure broadly predisposes to a) BCC b) SCC?

Answer 7

a) intense, intermittent e.g. severe episodes of sunburn

b) chronic sun exposure e.g. an outside occupation like a farmer

Question 8

What is Bowen’s disease?

Answer 8

Squamous cell carcinoma in situ (i.e. confined to the epidermis)

Question 9

Red and scaly patches, typically waxing and waning over time, often seen on scalp and other sun-exposed areas

Answer 9

Actinic keratoses

Question 10

Why are actinic keratoses and Bowen’s disease usually removed?

Answer 10

Precursor lesion to squamous cell carcinoma

Question 11

What is a common variant of Bowen’s disease and where are lesions seen in this condition?

Answer 11

Erythroplasia of Queyrat- on the penis

Question 12

Why is SCC more serious than BCC?

Answer 12

As well as being locally invasive it may metastasize to regional lymph nodes

Question 13

Presentation of SCC?

Answer 13

Variable, but typically presents as a non-healing ulcer with hard edges, which may bleed/itch. Local lymphadenopathy if metastatic

Question 14

Management of SCC? (2)

Answer 14

Complete surgical excision and biopsy
Other treatments (as for BCC) may be appropriate