Non-melanoma skin cancers and benign skin tumours

Question 1

What are solar keratoses also known as?

Answer 1

Actinic keratosis

Question 2

What are the features of a solar keratotic lesion?

Answer 2

Dysplasia

Keratosis

Question 3

How common are solar keratoses?

Answer 3

Very common,

1 in 5 over 60yrs

Question 4

What is the risk with solar keratoses?

Answer 4

May progress to SCC. less than 1 in 1000

Question 5

What does a squamous cell carcinoma in situ not cross into?

Answer 5

The dermis

Question 6

What does non-melanoma skin cancer (NMSC) refer to?

Answer 6

SCC

BCC

and some other less common skin cancers

Question 7

Where is the basal layer?

Answer 7

The layer of epidermis adjacent to the border with the dermis

Question 8

What % of NMSCs are basal cell carcinomas?

Answer 8

80%

Question 9

What are the subtypes of BCC’s?

Answer 9

Nodular

Superficial

Morpheic/sclerosing

Pigmented

Question 10

What is a morphoeic BCC also known as?

Answer 10

sclerosing BCC

Question 11

Which is more common: melanoma or NMSC?

Answer 11

NMSC

Question 12

What is the metastatic potential of BCC’s?

Answer 12

Low, but locally invade

Question 13

How fast do BCC’s grow?

Answer 13

Fairly slowly (takes months to years before diagnosed usually)

Question 14

What are the symptoms associated with BCC’s?

Answer 14

They are usually asymptomatic

Question 15

Which parts of the body are BCC’s able to occur on?

Answer 15

Any part (more common on face or trunk)

Question 16

What are the classical signs of a BCC?

Answer 16

Pearly white rolled edges

Telangectasia

Sunken or ulcerated

Question 17

What is a common site for BCCs and SCCs to arise?

Answer 17

Sites of chronic inflammation,

wounds,

scars

Question 18

Which subtype of BCC has the greatest risk of recurrence?

Answer 18

Morphoeic BCC

Question 19

What % of non-melanoma skin cancers are squamous cell carcinomas?

Answer 19

20%

Question 20

Do squamous cell carcinomas metastasize?

Answer 20

Yes, to regional lymph nodes first

Question 21

What is the 5-year survival survival for SCCs?

Answer 21

No mets - 85%

w/mets - 25%

Question 22

Which lesions clinically mimic SCC’s?

Answer 22

keratoacanthoma’s

Question 23

Which genetic syndrome can predispose you to BCCs?

Answer 23

Gorlin’s syndrome

Question 24

What type of viral infection can predispose to SCCs?

Answer 24

Human papillomavirus (HPV)

Question 25

What margin should be used for BCC surgical excision?

Answer 25

≥4mm and as deep as subcutaneous fat

Question 26

What is Mohs’ micrographic surgery?

Answer 26

When during surgery slices of tissues are examined histologically to guide further surgery

Question 27

What are the treatment options for BCC's?

Answer 27

Simple surgical excision Mohs’ micrographic surgery Radiotherapy Imiquimod Photodynamic therapy

Question 28

What is imiquimod?

Answer 28

topical immune-response modulator used in the treatment of low risk BCCs

Question 29

What is Efudix?

Answer 29

5-fluorouracil cream

Question 30

What is diclofenac gel?

Answer 30

diclofenac is an NSAID diclofenac gel is used in actinic keratoses treatment

Question 31

What are the precursors to SCC?

Answer 31

Actinic keratosis Intraepidermal carcinoma (aka SCC in-situ)

Question 32

What layer of cells do SCCs, actinic keratosis and intra-epidermal carcinoma all originate from?

Answer 32

Prickle cell layer

Question 33

What clinical technique is there to aid diagnosis of BCCs?

Answer 33

Gentle stretch the skin and the pearly white rolled edges will be more obvious

Question 34

Are mucosal or cutaneous SCC's more likely to metastasise?

Answer 34

Mucosal SCCs

Question 35

What are the treatment options for SCC's?

Answer 35

Simple surgical excision Mohs’ micrographic surgery Radiotherapy

Question 36

What is the treatment for actinic/solar keratosis?

Answer 36

Cryotherapy Curettage and cautery 5-fluorouracil cream (Efudix) Diclofenac gel (Solaraze) Imiquimod Photodynamic therapy

Question 37

What is Bowen's disease also known as?

Answer 37

SCC in-situ, intraepidermal carcinoma

Question 38

What is the treatment of SCC in-situ?

Answer 38

Same as for actinic/solar keratosis: Cryotherapy Curettage and cautery 5-fluorouracil cream (Efudix) Diclofenac gel (Solaraze) Imiquimod Photodynamic therapy

Question 39

What is a cutaneous horn made of?

Answer 39

Compacted keratin

Question 40

What maybe at the base of a cutaneous horn?

Answer 40

actinic/solar keratosis SCC in-situ SCC

Question 41

What is the management for a cutaneous horn?

Answer 41

Excision