Head and neck skin cancer Flashcards Preview

Year 3 Human Disease > Head and neck skin cancer > Flashcards

Flashcards in Head and neck skin cancer Deck (32):

describe 7 melanoma subtypes

-superficial spreading (radial growth, can see spread under skin)
-nodular (vertical growth - more serious)
-lentigo maligna (diffuse appearance, varied colour/shape)
-amelanotic (pigmented)
-acral (in extremities. common in non white people)
-mucosal eg mouth


7 point checklist for suspected malignant melanoma

major signs: change in shape/ colour/ size
minor signs: inflammation, crusting/bleeding, sensory change inc itch, diameter >7mm


what is ABCDE of malignant melanomas

evolution (changed shape/ size/ colour or risen)


clinical stages of melanoma in terms of spread and 10 yr prognosis

I: local tumour, 81%
II: involvement of local lymph nodes, 47%
III: disseminated disease, 0%


resection margins for stage I cutaneous melanoma
a. melanoma in situ
b. melanoma 2mm
e. lentigo malignant melanoma
f. acral/ subungal melanoma

resection margins for stage I cutaneous melanoma
a. melanoma in situ: 0.5cm
b. melanoma 2mm: not known
e. lentigo malignant melanoma: usually 0.5-1cm, depends on tumour thickness
f. acral/ subungal melanoma: based on tumour thickness. may have to dislocate joint nr tumour


clarke's level: define and levels

deepest portion of skin invaded by tumour, 5 layers of outermost epidermis under fat
I: preinvasive
II:thinly invasive
III-IV: moderately invasive
V: deeply invasive


are clarkes levels qualitative or quantitative? explain

epidermis thickness varies all over body eg thicker on sole of foot


breslow thickness: define and levels

mm thickness of melanoma, reflects depth of penetration in to skin
0-0.99mm: lower risk
1-3.99mm: intermediate risk
4mm +: higher risk


7 reasons for urgent referral to LSMDT

-new mole after puberty which is changing shape/ colour/ size
-long standing mole changing shape/ colour/ size
-mole with or more colours and lost symmetry
-mole itching/ bleeding
-any new persistent skin lesion esp if growing/ pigmented/ vascular and if diagnosis not clear
-new pigmented damage to nail esp where there is associated damage to nail
-lesion growing under nail


what to include in HISTORY of malignant melanoma 5

-duration of lesion
-change in size
-change in colour
-change in shape
-symptoms eg itching, bleeding


what to include in EXAMINATION of malignant melanoma 4

-description (margins, pigmentation,ulceration)


what is the least deadly skin cancer

basal cell carinoma


describe basal cell carcinoma 4

-slow growing
-locally invasive


pattern of bcc tissue infiltration

3 dimensional contigious pattern


7 clinical appearances of bcc

-morphoeic/ sclerosing: spread out from margins


risk factors of bcc 4

UV sunlight exposure
inc age
gorlins sydrome (multiple keratinous tumours of jaws)


most common cancer in USA/ UK
2nd most common

basal cell carcinoma
2. squamous cell carcinoma


6 factors affecting prognosis of bcc

-tumour size
-tumour site
-tumour type/ definition of margins
-growth pattern
-recurrent tumours
-immunocompromised pts


6 surgical techniques used for bcc

destructive :
-currettage & cautery/ electrodisection
-carbondioxide laser

excisional: primary, recurrent, mohs' micrographic surgery


what is mohs micrographic surgery and stages

maps tumour so no healthy tissue is removed
1. saucer shaped patch of tissue removed
2. removed tissue is cut in to sections, stained and marked on a detailed diagram (Mohs map)
3. roots of cancer identified on undersurface/ edge of map. if residual cancer is found, mohs map used to guide removal
4. when this is repeated so no cancer remains, surgical defect is ready for repair


bcc surgical margins mm margin and % cure
a. well-defined lesions
b. morphoieic lesions

a. 3mm surgical margin 85% cure
--> 4-5mm surgical margin 95% cure

b. morphoeic lesions:
3mm margin 66%
5mm margin 82%
13-15mm margin >95%


7 non surgical techniques for bcc

-topical therapy
-intralesion interferon
-photodynamic therapy
-palliative therapy


causes of squamous cell carcinoma scc 3

1. chronic sun exposure
2. injuries to skin (burns, sores, chemicals eg arsenic, petroleum
3. spontaneous on normal, healthy skin


people more at risk of scc

fair, blue/ green/ grey eye, light hair, spend a lot of time in the sun


6 factors affecting metastatic potential of cutaneous scc

-size (diameter): >2cm more likely to recur locally
-size (depth/ invasion): >4mm depth or extending in to subcutaneous tissue more likely to recur/ metastasize
-histological differentiation/ subtype: more serious if poorly differentiated/ perineural involvment/ lymphatic/ vascular invasion
-host immunosuppression
-previous tx/ tx modality


order of common sites of scc 5

1. sun exposed sites (not lip or ear)
2. lip
3. ear
4. non sun exposed eg perineum, sacrum , sole of foot
5. areas of radiation/ thermal injury/ chronic draining sinuses/ chronic ulcers/ chronic inflammation/ Bowens disease


describe low risk scc 5

-arising at sun exposed sites exluding lip or ear
-tumours up to 20mm diameter
-up to 4mm depth, confined to epidermis
-no evidence of immune dysfunction


surgical margins for cutaneous scc

2cm tumour/ poorly differentiated/ extending subcutaneous/ ear/ lip/ scalp/ eyelids/ nose: 6mm margin/ mohs micrographic surgery/ examine histologically


name and describe 2 pre-malignant conditions

-actinic/ solar keratosis: rough, scaly, slightly raised growths that range in colour brown - red and may be up to 2cm diameter
-actinic cheilitis: actinic keratosis in lips --> dry, cracked, scaly, pale, white. lower lip (more exposed to sun)


treatment of pre malignant conditions 8

-curettage/ electrodesiccation
-excisional surgery
-x ray
-mohs excisional surgery
-laser surgery
-photodynamic therapy
-imiquimod, 5 fluorouracil, topical diclofenac


prognosis of pre malignant conditions and issues

10% progression to scc (more likely in over 70s)
not cost effective to treat all pre malignant lesions


what things about a person increases risk of skin cancer

white 80%
family history
hair and eye colour