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Flashcards in Skin cancer Deck (13):
1

Important history

1. History of skin cancer 2. FHx of melanoma, death from skin cancer 3. Past/present occupation 4. Outdoor interests 5. >5 blistering sunburns 6. PMHx Skin conditions Medication Allergies Immunosuppression 7. Current skin lesions of cancer 8. Exposure-> UV, ionising radiation, chemicals, chronic irritation, hyperthermia, tobacco, HPV

2

Types of skin cancer

1. BCC 2. SCC 3. Melanoma 4. Keratocanthoma 5. Benign nevi 6. Malignant melanoma 7. Appendageal Ca 8. Actinic keratoses

3

Features of SCC, risks, metastatic risk

1. Pearly edge 2. Pink, scaly 3. Keratin production 4. Sun damage (cumulative), chronic inflammation, viruses, chronic ulcers, previous Xrays, chemicals, immune suppression, genetic (xeroderma pigmentosum) 1% metastasise: highest risk on the ear, lower lip and scalp

5. Can include: actinic keratosis, Bowens (IEC), infiltrating, exophytic/fungating and keratoncanthoma

4

Treatment of SCC

1. Surgical excision with a 3 to 5 mm margin is the treatment of choice for SCC.

2. Curettage and diathermy may be considered in patients with low-risk lesions.

3. Radiotherapy may be used for a primary tumour when surgery is likely to produce severe scarring or is unsuitable (eg for an elderly or infirm patient). Adjuvant radiotherapy is recommended following excision of a high-risk primary tumour (eg presence of perineural spread on histopathology).

5

Follow up in SCC

1. F/U 6 monthy for 2 years

2. Examination for signs of secondary tumours

6

What is keratocanthoma

1. Well differentiated SCC, resolves after 3 months

2. Treat as SCC

7

Types of BCC

1. Noduloulcerative

Telangiectasia, glistening, transluscent

2. Cystic

3. Morphoiec

Appears as scar, slowly expanding

4. Pigmented

5. Superficial

 

8

Differential for superficial BCC

1. Solar keratosis

2. Bowen's

3. SCC in situ

4. Psoriasis

9

Management of BCC

1. Surgery

Wide excision 3-4 mm or +if aggressive->micronodular, infiltrative, morphoiec, recurrent/large

2. Curettage/cautery

Well demarcated, superficial 

Not for aggressive, recurrent

Skill required

3. Cryotherapy

Well defined on the trunk

For primary

Histological confirmation required prior

4. Radiotherapy

When surgery likely to be very destructive/surgery contraindicated

5. Topical imiquimod

Good histo clearance for superficial

Need biopsy proven

Imiquimod 5% topically, at night 5 times/week for 6 weeks

6. Photodynamic

7. Mohs microscopically controlled

High risk recurrenct, eyelid, centrofacially, when tissue conservation is critical

Allows histo confirmation of clearance before wound closure

10

Management of aktinic keratosis

1. Premalignant->erythematous, scaly

2. Cryotherapy 5-10 seconds

3. If IEC 30 seconds with 3mm margin

4. Imiquimod and efudix (5FU) if histoL confirmed IEC

11

Biopsy options

1. Incisional

2. Excisional

3. Shave

4. Punch

12

Risk factors for malignant melanoma

Specific risk factors for malignant melanoma include:

  • age over 40
  • Australian born
  • family history
  • fair complexion/light hair and eye colour
  • freckles (sign of sun sensitivity)
  • tendency to burn
  • high number of common acquired naevi (>50)
  • large congenital naevi
  • dysplastic naevus syndrome (>5 dysplastic naevi)
  • solar skin damage
  • severe childhood sunburn (2+ episodes)
  • recreational exposure
  • mutations in CDKN2A/CDK4 genes (genetic traits associated with MM)
  • immunosuppression

13

Specific risk factors for BCC/SCC

  • age
  • male
  • sun-sensitive skin
  • burn easily and tan poorly
  • sun-related skin damage (incl. freckles)
  • cumulative long-term exposure (SCC)
  • high recreational exposure, or ‘binging’ (BCC)
  • frequent sun exposure