I Have Something Growing On My Ear

Question 1

Questions to ask a patient with a skin lesion

Answer 1

Has it changed in colour?
Has it changed in shape?
Sunbed use 
Skin type (burn or tan)
FH of skin cancer 
Cigarette smoking (specific for SCC)
Immunosuppression

Question 2

Risk factors for keratinocyte cancer

Answer 2

Chronic UV exposure
Fitzpatrick skin type 1&2
Chemicals 
Immunosuppression
Smoking
Chronic ulcers (SCC)

Gorlin’s Syndrome (BCC)
Xeroderma Pigmentosum (SCC)

Question 3

What is Gorlin’s syndrome?

Answer 3

Genetic condition. Mutation of TSG PTCH 1. Results in development of multiple early onset BCCs

Question 4

What is Xeroderma Pigmentosum?

Answer 4

Autosomal recessive. Defect in DNA repair. Results in extreme sun sensitivity and a predilection for skin cancer

Question 5

Pathophysiology of SCC

Answer 5

Apototic resistance from functional loss of TSG TP53
UV radiation causes DNA damage through creation of pyrimidine dimers, resulting in mutation of TP53
Subsequent UV exposure - keratinocytes undergo clonal expansion, acquiring further genetic defects

Mutations of BCL2 and RAS contribute
EGFR and COX also play a role

Question 6

Progression to SCC

Answer 6

Actinic keratosis(multiple lesions, often head and neck, not indurated, undulated, or painful)

Bowen’s disease (single plaque, often legs; not indurated, undulated, or painful)

SCC (nodule, ulcer, painful)

Question 7

Clinical features of SCC indicating poorer prognosis

Answer 7

Tumours >2cm (2x more likely to metastasise
Lesions on lip or ear
Immunosuppression

Question 8

Histological features of SCC indicating poor prognosis

Answer 8

Invasion >4mm (dermis)
Perineural invasion
Nuclear atypia (poorly differentiated Cells)

Question 9

Advice

Answer 9

Wear UVA UBV protection SPF 30+ star rating of 3 or 4
Never burn
Wear a hat
Spend time in the shade between 11-3
Apply sun cream 30 minutes before going in the sun
Reapply every 2 hours
Wear close weave clothing

Question 10

Typical clinical features of BCC

Answer 10

Telangiectasia

Pearly translucent nodule

Question 11

Appropriate management for Bowen’s disease

Answer 11

Cryotherapy

Question 12

Management of actinic keratosis

Answer 12

5% 5-Fluoracil (Efudix) cream