Skin Cancer

Question 1

Describe the general clinical features of an skin SCC?

Answer 1

Non-pigmented

Tender on palpation

Rapid growth (over weeks or months)

Skin is freely movable over underlying skull

+/- Hyperkeratotic nodule, bleeding, ulceration

Question 2

What is more common SCC or BCC skin lesions?

Answer 2

BCC

Question 3

Where are SCC typically found?

Answer 3

Sun exposed sights

Question 4

What are the group of disorder that result from keratinocyte dysplasia?

Answer 4

Actinic keratosis

SCC in situ (Bowen’s disease)

SCC

Question 5

What is the time course of SCC development?

Answer 5

Weeks to months

Question 6

How are SCC managed?

Answer 6

Surgery with borders of 5-10mm

Adjunct radiotherapy if required

Radiotherapy alone can be used if surgery is contraindicated

Question 7

Describe the clinical features of a BCC?

Answer 7

Pearly nodules with telangectasia

Often centrally ulcerated

Indolent growth

In areas of high sun exposure

Question 8

What are the histopathological features of BCC?

Answer 8

Pallisading

Basaloid cells with a pushing boarder invading into stroma

Question 9

What type of BCC can mimic melanoma?

Answer 9

Nodular BCC

Question 10

How do BCC spread?

Answer 10

Locally

Rarely metastasize

Question 11

How are BCC Mx?

Answer 11

Surgical excision - particular nodular or infiltrative

Serial curettage

Topical imiquimod

Photodynamic therapy

Question 12

At what rate to actinic keratosis overgo malignant transformation to SCCs?

Answer 12

1:1000 per year

Question 13

What must you be way of when examining actinic keratosis?

Answer 13

Hyperkeratotic, tender nodules that might be transformation in SCC

Question 14

How are actinic keratosis managed?

Answer 14

Cyrotherapy

Topical agent eg 5FU, imiquinod

Surgical excision

Question 15

What are the clinical features of Bowen’s disease?

Answer 15

Scaly erythematous plaques with some surface erosions

May be itchy, painful and bleed

Question 16

How is Bowen disease Mx?

Answer 16

Topical therapies - eg 5FU, imiquimod

Surgical excision

Question 17

What is imiquimod?

Answer 17

Local immune stimulator used to treat superficial viral infections and tumours

Question 18

Where is Bowen disease classically found?

Answer 18

Legs - shins

Question 19

How can you divide naevi?

Answer 19

Congenital

Acquired

Question 20

What are you worried about with congenital naevi?

Answer 20

Malignant transformation - larger ones more likely

Cosmetic

Question 21

What are the characteristics of a benign junctional naevus?

Answer 21

Occurs of the epidermal side of the DEJ

Macular - Slightly raised

<1cm

Uniform colour

Question 22

What are the characteristics of a compound benign naevus?

Answer 22

Cell in the both the epidermis and dermis

<1cm diameter

Papules or Nodules

Even colour and smooth border

Question 23

What are the characteristics of a benign intradermal naevus?

Answer 23

All intradermal

Paler colour

Papular or nodule

Small, later onset

Smooth surface

Question 24

What are lentigines?

Answer 24

Papules of increased pigmentation due to increased melanocytes

On sun exposured sites

Static with time

Question 25

What are seborrheic keratosis? What do they look like?

Answer 25

Benign lesions of elderly people due to keratinocyte proliferation Warty, macular appearance Can be pigmented and increase in size

Question 26

What are the clinical features of dysplastic naevi?

Answer 26

Larger \>5mm lesions Smudged border More than 2 colours Atypical pigment on dermatoscope Generally still symmetrical

Question 27

When should dysplastic naevi be removed?

Answer 27

If they are suspicious for transformation to melanoma Not prophylactically