Derm - Malignancies Flashcards

1
Q

Describe the typical appearance of a BCC.

A

Most common over head + neck:

  • skin-coloured nodule with pearly rolled edge + surface telangiectasia
  • +/- necrotic/ulcerated centre
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2
Q

Suggest risk factors for dev. of BCCs

A
  1. UV exposure and Hx of frequent/severe sunburn in childhood
  2. skin type I
  3. increased age
  4. male
  5. immunosuppression
  6. PMHx of skin cancer
  7. genetic predisposition e.g. xeroderma pigmentosum, albinism, basal cell naevus/Gorlin’s synd.
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3
Q

A 70yo man presents to derm 2ww clinic and is diagnosed with a BCC on his cheek.

What are the management options?

A

Surgery acceptable to pt:

  1. surgical excision (Tx of choice) with 4mm margins
  2. Mohs micrographic surgery: if high risk
Surgery not-acceptable:
3. RT: if high risk, high success rate but poorer cosmetic outcome and risk of complications
4. cyrotherapy or curretage + cautery
5. topical IMIQUIMOD for 6/52 
    topical FLUOROURACIL for 3-6/52
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4
Q

Describe the typical appearance of SCC.

A

Usually on sun-exposed areas:

  • keratotic (e.g. scaly, crusty)
  • ill-defined nodule
  • may ulcerate
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5
Q

Describe 2 pre-malignant skin conditions that can lead to SCC.

A
  1. ACTINIC KERATOSIS
    - pink, red brown or skin-coloured crusty or scaly lesions on sun exposed areas
  2. BOWEN’S DISEASE (SCC in situ)
    - slow-growing, erythematous, scaly irregular pink/brown patch
    - dermoscopy: irregular clusters of coiled BVs (glomerular)
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6
Q

Suggest RFs for dev of SCCs

A
  1. excessive UV exposure
  2. immunosuppresion
  3. smoking
  4. chronic inflammation e.g. leg ulcers (Marjolin’s ulcer), wound scars
  5. genetic predisposition e.g. xeroderma pigmentosum, oculocutaneous albinism
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7
Q

A 50yo man presents to derm 2ww clinic and is diagnosed with an SCC on his cheek.

What are the management options?

A
  1. surgical excision
  2. Mohs microcraphic surgery: if tumour in sensitive location, >2cm diameter or any recurrent tumours
  3. RT: if large non-resectable tumours
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8
Q

A 60yo woman presents with a scaly irregular pink patch on her leg, present for 6/12. On dermoscopy, clusters of coiled blood vessels are seen.

What are the Tx options?

A
  1. topical FLUOURACIL (Efudex) for 3-4/52 (then topical fucidin to clear up side effects)
  2. cyrotherapy
2nd line (if recurrence or no response):
3. surgical excision or Mohs micrographic surgery
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9
Q

An 76yo man presents with 3x4cm red crusty lesion on his scalp. He is diagnosed with actinic keratosis.

What are the Tx options?

A
  1. crytotherapy OR
  2. topical IMIQUIMOD
    topical FLUOROURACIL
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10
Q

Suggest risk factors for malignant melanoma.

A
  1. excessive UV exposure inc. sunbed use
  2. skin type 1
  3. > 100 common naevi or >2 atypical naevi
  4. FHx or previous Hx of melanoma
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11
Q

Where are melanomas most commonly located?

A
  • trunk in men

- legs in women

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12
Q

A 35yo woman presents with a rapidly growing pigmented lesion on her leg.

How would you investigate?

A
  1. dermoscopy
  2. full-thickness excisional biopsy

Staging (do not offer if stage IA or IB with Breslow thickness <1mm):

  1. sentinel LN biopsy
  2. CT chest/abdo/pelvis +/- CT brain (if suspected stage 4)
  3. FBC + LDH (prognosis)
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13
Q

What is Breslow staging?

A

Thickness of melanoma, predicts recurrence rate:

  • <0.76mm: low risk
  • 0.76-1.5mm: medium risk
  • > 1.5mm: high risk
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14
Q

What are the management options for melanoma?

A
  1. surgical excision: WLE with clinical margins at least
    - 0.5 cm in stage 0
    - 1 cm in stage I
    - 2cm in stage 2
  2. lymphadenectomy, LN dissection or RT sometimes used in higher stage disease
  3. chemotherapy for metastatic disease
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