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Flashcards in Dermatological lesions Deck (15):

Risk factors for malignancy

skin type
sun bed use
cigarettes smoking - squamous cell carcinoma
being on immunosuppression
FH of skin cancer


Risk factors for basal cell carcinoma

chronic UV light exposure
skin type one and two
gorlins syndrome
previous squamous cell carcinoma


risk factors for squamous cell carcinoma

chronic UV light exposure
skin type one and two
chronic ulcers
xeroderma pigmentosum


Squamous cell carcinoma

malignant tumour arising from keratinocytes of epidermis
can invade locally and potential to metastasise


presentation of squamous cell carcinoma

often indurated nodular lesion which have usually crusted or hyperkeratotic surfaces
lesions are ulcerated and rarely verrucous forms which can be mistaken for viral warts
often painful and grow rapidly - few weeks to couple of months


common sites for squamous cell carcinoma

face, scalp, back of hands


referral of squamous cell carcinoma

2 week wait if skin lesion raises suspicion of squamous cell carcinoma


management of squamous cell carcinoma

surgical excision
Mohns micrographic surgery - if tumour ill defined, large or recurrent
curettage and cautery considered for low risk
chemotherapy if metastatic
radiotherapy considered where surgical excision challenging or difficult to perform
adjuvant radiotherapy if high risk of local reoccurrence or involved margins


refer to MDT/ poor prognosis if:

SCC arising on ear or lip
tumours >2cm - twice as likely to metastasis
tumour depth >4mm
tumour extension beyond dermis/lower dermis or through subcutaneous fat
perineurial invasion
poorly differentiated
desmoplastic subtype

high risk features: immunosuppression, site and diameter = poorer prognosis


Advice on UV protection

wear a hat in sun
never burn
sun cream
spend time in shade between 11am -3pm


Basal cell carcinoma

slow growing locally invasive malignant tumour of epidermal keratinocytes usually in older individuals
rarely metastasises
most common type of skin cancer


types of BCC

small papules or nodules with rolled edge
frequently central depression which may become ulcerated
nodules are pearly and may have dilated telangiectatic blood vessels on their surface
head and neck

erythematous patch on skin, often trunk
may be mistaken for eczema not usually pruritic and slowly enlarge
firm 'whipcord' edge may be present

pigmented lesion:
can lead to confusion with nave, melanoma

morphemic or clerking type
superficial atrophic scar
loss of normal skin markings and edge usually indistinct
can lead to incomplete excision of these infiltrative BCCs


management of BCC

surgical excision - Mohns (excision of lesion and tissue borders progressively excised until specimens are microscopically free of tumour
excision and grafting
curettage and cautery, cryotherapy, photodynamic therapy, topical treatment (imiquimod) for small low risk lesions
phototherapy for large superficial lesions
radiotherapy - if surgery not appropriate


high risk BCCs

lesions involving eyelid margins, ear and lip
perineurial invasion on histology
recurrent lesion


referral for BCCs

routine referral
unless delay may have significant impact