December 2, 2015 - Malignant Skin Lesions Flashcards Preview

COURSE 2 > December 2, 2015 - Malignant Skin Lesions > Flashcards

Flashcards in December 2, 2015 - Malignant Skin Lesions Deck (13):

Risk Factors for Skin Cancer

Skin type

UV light exposure




Environmental toxins

Ionizing radiation


Clinical Pearls of Skin Malignancies

More common with advancing age

Lesions often single (but not always)

Lesions usually asymmetrical

Inflammation may or may not be present

Premalignant lesions may or may not be present

Growth rate is variable, BUT generally has evolved over months gradually


Any lesion satisfying the above, and for which a non-malignant diagnosis is not immediately evident, YOU MUST BIOPSY


Cutaneous Neoplasms and Cell of Origin

Squamous cell carcinoma - keratinocytes of the spinous layer

LC Histiocytosis - Langerhans cells

Bascal cell carcinoma - Basal keratinocytes

Melanoma - Melanocytes


Basal Cell Carcinoma (BCC)

Most common malignancy in humans

Related to UV light exposure

Does not metastasize... Direct spread


Central ulcer is often present


Basal Cell Carcinoma - Key Features

Rolled edge


Central ulcer is common


Sun-exposed areas


Squamous Cell Carcinoma (SCC)

Come from the precancerous lesion: actinic keratosis

Low risk of metastasis (about 5% over 2 years), except on the lips or ears or in the context of immunosuppression or in areas of scarring.

If they metastasize, the outcome is terrible.



Actinic Keratosis

Can develop into SCC



Bowen's Disease: SCC in Situ

Restricted to the epidermis



Cancer arising from melanocytes.

Early detection is an important goal in cutaneous melanoma management.

Tumour depth is the most important prognostic factor for cutaneous melanoma.

Melanoma that has spread often has a very poor prognosis.


Growth of Melanoma

First starts in a radial growth phase where the lesion gets bigger and grows outwards.

Next comes the vertical growth phase where it expands deep into the tissue. This is BAD. Ideally, you want to catch and excise the menaloma before this point.

If it has less than 1mm depth, there is a 95% chance of survival. If however, it is deepr than 4mm, there is less than a 20% chance of survival.


Hutchinson's Sign

The leeching of pigment onto skin around the nail. This is highly suggestive of melanoma.


Melanoma Prognosis

5-year survivals


Stage I is less than 1mm thickness and has >95% chance of survival

Stage II has >2mm thickness and has about a 70% chance of survival

Stage III has nodal involvement, but no metastasis and is about 45% chance of survival

Stage IV has distant metastasis and has less than a 10% chance of survival


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