Dermatological malignancies Flashcards
(19 cards)
Main types of skin cancer: (3)
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
Basal cell carcinoma: Overview
- Most common form of skin cancer.
- Commonly occur on sun exposed sites apart from the ear.
- Sub types include nodular, morphoeic, superficial and pigmented.
- Typically slow growing with low metastatic potential.
- Standard surgical excision, topical chemotherapy and radiotherapy are all successful.
- As a minimum a diagnostic punch biopsy should be taken if treatment other than standard surgical excision is planned.
Squamous cell carcinoma: Overview
- Again related to sun exposure.
- May arise in pre - existing solar keratoses.
- May metastasize if left.
- Immunosupression (e.g. following transplant), increases risk.
- Wide local excision is the treatment of choice and where a diagnostic excision biopsy has demonstrated SCC, repeat surgery to gain adequate margins may be required.
Malignant melanoma
The main diagnostic features (major criteria):
- Change in size
- Change in shape
- Change in colour
Secondary features (minor criteria)
- Diameter >6mm
- Inflammation
- Oozing or bleeding
- Altered sensation
Basal cell carcinoma: Definition
Basal cell carcinoma (BCC) is one of the three main types of skin cancer. Lesions are also known as rodent ulcers and are characterised by slow-growth and local invasion. Metastases are extremely rare. BCC is the most common type of cancer in the Western world.
Basal cell carcinoma: Features
- Many types of BCC are described.
- The most common type is nodular BCC, which is described here
- sun-exposed sites, especially the head and neck account for the majority of lesions
- initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’
Basal cell carcinoma: Referral
Generally, if a BCC is suspected, a routine referral should be made
Basal cell carcinoma: Management (5)
- surgical removal
- curettage
- cryotherapy
- topical cream: imiquimod, fluorouracil
- radiotherapy
Squamous cell carcinoma: Definition
Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.
Squamous cell carcinoma: Risk factors
- Excessive exposure to sunlight / psoralen UVA therapy
- Actinic keratoses and Bowen’s disease
- Immunosuppression e.g. following renal transplant, HIV
smoking - Long-standing leg ulcers (Marjolin’s ulcer)
- Genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
Squamous cell carcinoma: Treatment
Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm. Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.
BASAL vs. SQUAMOUS cell carcinoma
Basal and squamous cell skin cancers are the most common types of skin cancer. They start in the top layer of skin (the epidermis), and are often related to sun exposure.
BASAL cell carcinoma start in the basal cell layer, which is the lower part of the epidermis.
SQAUMOUS start in the flat cells in the upper (outer) part of the epidermis.
Actinic (solar) keratosis (AK)
Actinic keratosis (AK) is a pre-cancerous skin condition caused by too much exposure to the sun.
AKs tend to grow slowly and usually do not cause any symptoms (although some might be itchy or sore). They sometimes go away on their own, but they may come back.
A small percentage of AKs may turn into squamous cell skin cancers.
Squamous cell carcinoma in situ (Bowen disease)
Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. “In situ” means that the cells of these cancers are still only in the epidermis (the upper layer of the skin) and have not invaded into deeper layers.
Melanoma
These cancers develop from melanocytes, the pigment-making cells found in the epidermis.
Melanomas are much less common than basal and squamous cell cancers, but they are more likely to grow and spread if left untreated.
LESS common types of skin cancer
- Merkel cell carcinoma
- Kaposi sarcoma
- Cutaneous (skin) lymphoma
- Skin adnexal tumors (tumors that start in hair follicles or skin glands)
- Various types of sarcomas
BENIGN skin tumours
Most skin tumors are benign (not cancerous) and rarely if ever turn into cancers. There are many kinds of benign skin tumors, including:
- Most types of moles
- Seborrheic keratoses: tan, brown, or black raised spots with a waxy texture or occasionally a slightly rough and crumbly surface when they are on the legs (also known as stucco keratosis)
- Hemangiomas: benign blood vessel growths, often called strawberry spots
- Lipomas: soft tumors made up of fat cells
- Warts: rough-surfaced growths caused by some types of human papillomavirus (HPV)
Malignant Melanoma: Overview
There are four main subtypes of melanoma. Nodular melanoma is the most aggressive whilst the other forms spread more slowly.
- Superficial spreading
- Nodular
- Lentigo maligna
- Acral lentiginous
Malignant melanoma: Treatment
Suspicious lesions should undergo excision biopsy. The lesion should be removed in completely as incision biopsy can make subsequent histopathological assessment difficult.
Once the diagnosis is confirmed the pathology report should be reviewed to determine whether further re-excision of margins is required
Margins of excision - Related to Breslow thickness (lesion size)
