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Flashcards in Skin Cancer Deck (91)
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1

What classifies skin types

Fitzpatrick

2

What are the 6 skin types

1 - never tans, burns (red hair, blue eyes)
2 - tans but burns
1+2 have increased cancer risk
3 - always tans, sometimes burns (dark hair and eyes)
4 - always tans, rarly burn (olive skin)
5 - sunburn and tan after extreme UV (brown / Asian)
6 - black (never tans or burns)

3

What are the non-melanoma skin cancers and most common

Basal cell = 70%
Squamous cell

4

What are the RF for BCC / SCC

UV light exposure
- SCC = chronic long term
- BCC = sporadic burning
Skin type 1 +2
Age
Male
FH skin cancer
PMH skin cancer
Photo chemotherpay
Chemical carcinogens
X-ray / radiation
HPV
Smoking

5

What are RF for SCC

Chronic inflammation
Marjolins ulcer = excision
Pre-malignant condition
Organ transplant
Immunosuppressoin

6

Where does BCC commonly affect

Head and neck

7

What is prognosis

Slow growing
Locally invasive causing destruction
Don't tend to metastasis
Depends on tumour size, site, growth and histiological subtype
Failure of Rx / recurrent of immunosuppression = poorer prognosis

8

What is the presentation of BCC

Most common
Pearly pink lesion
Flesh coloured lesion
Erythemtous keratotic papule or nodule
Areas of sun exposure
Irregular border
May have central erosion o ulceration
Telangiectasia around
Rolled edge

9

What is BBC and types

Slow growing locally invasive malignant tumour of keratinocytes
Superficial - plaque like
Nodular = most common
Ulcerative - rodent ulcer
Pigmented
Morphoeic = aggressive

10

How do superficial BCC present

Scaly and crusty
Pigmented
Pink to red brown
Erosions / ulceration = less common
Often resembles eczema or psoriasis

11

How do you manage superficial

Can be Rx conervatively
Cyrosurgery
Curettage and cautery

12

What do you do if high risk site or large

Excision
RT
Mohs procedure if high risk or cosmesis

13

What do nodular lesions tend to have

Smooth elevated surface
Telengiectasia's
Arborizing vessel on dermoscopy
Central ulceration

14

How do you Rx

Excision

15

How does ulcerative present

Cycles of crusting and bleeding
May progress from nodular

16

What do you do if suspect BCC

Refer
Dermascope
Biopsy

17

What is gold standard Rx for BCC

Excision with margins

18

What are other options

Mohs = highly specalised
Curettage / cyroterhapy if unfit
RT

19

What can be used if not suitable for surgery / RT or metastatic

Vismodegib
Shrinks tumour and heals lesions

20

What are SE

Hair loss
Weight loss
Taste
Muscle spasms
Nausea

21

Where do SCC arise from

Keratinising squamous cells
Potential to metastasise

22

What are predisposing pre-malignancy conditions / RF

Bowen's - well defined
Marjolins ulcer - chronic inflamation
Acitinic keratitis - crust
HPV
Post transplant on immunosuppressants
Chronic granuloma
Chronic radiant heat - erythema ab igne
Chronic UV
Age
Smoking

23

What are 1st signs of SCC and where does it affect

Induration of skin
Skin coloured papule
Head / ear / neck

24

How does it then go on to present

Plaque like
Keratotic - scaly / crusty
Ulceration
Firm on palpation
Irregular border
Asymmetrical
Hard to define
Tender
Scaly / crusting
Common on sun exposed sites
Grows more rapidly

25

Does SCC metastasis

Yes
3% at Dx have nodal mets

26

How do you Dx

Excision biopsy
Urgent referral if no response to 2 weeks topical Ax

27

How do you Rx SCC if insitu

5FU / imiquimod 2 week course with steroid
Excision
Mohs micrographic surgery may be needed for ill-defined large recurrent tumour

28

How do you Rx if +Ve nodes + what margins

Chemo / RT + block dissection
>4mm margin if low risk
>6mm if high risk

29

What is high risk requiring follow up

Immunosuppressed
>20mm or 2cm
>4mm depth
On ear, nose, lip, perineurial invasion
Poorly differentiated
Recurrent
2 to chronic inflammation

30

What do you follow up for

Local recurrence
Nodal involvement