Dermatological lesions Flashcards
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 chemicals immunosuppression gorlins syndrome previous squamous cell carcinoma
risk factors for squamous cell carcinoma
chronic UV light exposure skin type one and two chemicals immunosuppression smoking 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 immunosuppression
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
nodular:
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
superficial:
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
immunosuppression
referral for BCCs
routine referral
unless delay may have significant impact
