Skin cancer Flashcards
(18 cards)
What is basal cell carcinoma?
Slow growing, locally invasive malignant tumour of epidermal keratinocytes
Normally in older pts
Rarely metastasises
Most common malignant skin tumour
What are the causes of BCC?
RFs include
- UV exposure
- Hx frequent/severe sunburn in childhood
- Skin type 1
- inc age
- Male
- Immunosuppression
- PMHx skin ca
- Genetic predisposition
What forms of BCC exist?
Various morphological presentations -Nodular (most common) -Superficial (plaque-like) -Cystic -Morphoeic (sclerosing) -Keratotic -Pigmented Most common over head and neck
How does nodular BCC present?
Small, skin-coloured papule or nodule with surface telangectasia and pearly rolled edge
Lesion may have necrotic/ulcerated centre (rodent ulcer)
What is the management of BCC?
Surgical excision -treatment of choice -allows histological examination of tumour and margins Mohs micrographic surgery -excision of lesion and tissue borders progressively excised until specimens microscopically free of tumour -for high risk, recurrent tumours Radiotherapy -when surgery inappropriate Other -cryotherapy -curettage and cautery -topical photodynamic therapy -topical treatments (e.g. imiquimod cream, for small and low risk lesions)
What are the complications of BCC?
Local tissue invasion and destruction
What is the prognosis of BCC?
Dependent on
- size
- site
- type
- growth pattern/histological subtype
- failure of previous treatment/recurrence
- immunosuppression
What is squamous cell carcinoma?
Locally invasive malignant tumour epidermal keratinocytes or its appendages
Has potential to metastasise
What are the risk factors for SCC?
UV exposure
Pre-malignant skin conditions e.g. actinic keratoses
Chronic inflammation e.g. leg ulcers, wound scars
Immunosuppresion
Genetic predisposition
How does SCC present?
Keratotic (e.g. scaly, crusty), ill-defined nodule which may ulcerate
How is SCC managed?
Surgical treatment -treatment of choice Mohs micrographic surgery -necessary for ill-defined, large, recurrent tumours Radiotherapy -large, non resectable tumours
What is the prognosis for SCC?
Dependent on tumour size, site, histological pattern, depth of invasion, perineural involvement and immunosuppression
What is a malignant melanoma?
Invasive malignant tumour of epidermal melanocytes
Potential to metastasise
What are the risk factors associated with malignant melanoma?
Excessive UV exposure
Skin type 1
Hx multiple moles or atypical moles
FHx/PMHx melanoma
How does malignant melanoma present?
ABCDE symptoms (note A, C and E major suspicious features)
-Asymmetrical shape
-Border irregularity
-Colour irregularity
-Diameter >6mm
-Evolution of lesion (e.g. change in size and/or shape)
Symptoms of bleeding and itching
More common on legs in women and trunk in men
What types of malignant melanoma exist?
Superficial spreading melanoma -common on lower limbs -young to middle aged adults -related to intermittent high-intensity UV exposure Nodular melanoma -common on trunk -young to middle aged adults -related to intermittent high-intensity UV exposure Lentigo maligna melanoma -common on face -elderly -related to long-term cumulative UV exposure Acral lentiginous melanoma -common on palms, soles and nail beds -elderly -no clear relation to UV exposure
How is malignant melanoma managed?
Surgical excision
-definitive treatment
Radiotherapy sometimes useful
Chemotherapy for metastatic disease
What is the prognosis for malignant melanoma?
Recurrence of melanoma based on Breslow thickness -<0.76mm = low risk -0.76-1.5mm = medium risk ->1.5mm = high risk 5 year survival based on TNM classification -Stage 1 (T <2mm thick, N0, M0) = 90% -Stage 2 (T>2mm thick, N0, M0) = 80% -Stage 3 (N>/=1, M0) = 40-50% -Stage 4 (M>/=1) = 20-30%
