Skin Cancers

Question 1

What are the general risk factors for skin cancers?

Answer 1

Increasing age, sun bed use, sun exposure/Hx sunburn, family Hx, fair skin, outdoor occupation

Question 2

Sqamous Cell Carcinoma - more common in men or women?

Answer 2

Men

Question 3

What are the clinical features of SCC?

Answer 3

• Solitary papule/nodule often eroded in centre, crusty, pus-producing or bleeding
• Usually fleshy lesion
• usually on sun-exposed areas esp. LIPS
• May ulcerate

Question 4

Differential diagnosis of SCC?

Answer 4

Keratocanthoma
Actinic keratosis
BCC
seborrhoeic wart

Question 5

How do you diagnose SCC?

Answer 5

Do a skin biopsy - shave/punch/incisional and examined histologically.
If it has spread (unlikely) - do CT/MRI and lymph node biopsy

Question 6

Management of SCC?

Answer 6

Surgical excision 4mm margin
Curettage and cautery
Pre-malignant: 
- cryotherapy
- photodynamic therapy
- topical imiquinod/5 fluorouracil cream

Question 7

Which is more likely to spread? BCC or SCC?

Answer 7

SCC

Question 8

What are the clinical features of BCC?

Answer 8

• “pearly nodule with raised, red edge with telangiectasia and central ulceration”
• Usually nodular
• May be erythematous, non-pigmented
• May be plaque-like
• Sometimes crusts-over

Question 9

What is a rodent ulcer?

Answer 9

Basal-Cell carcinoma. Typically ulcerated centre and raised edge

Question 10

Types of BCCs

Answer 10

Nodular
Superficial
Pigmented
Morphoiec

Question 11

How do you diagnose BCC?

Answer 11

Skin biopsy - punch/shave/incisional. Examined histologically.

Question 12

Differential diagnosis of BCC?

Answer 12

Nodular: molluscum contagiosum, keratocanthoma
Superficial: Psoriasis, actinic keratosis, SCC
Pigmented: Melanoma
Morphoeic: scar tissue, localised scleroderm

Question 13

Management of BCC

Answer 13

Surgical excision: 5-4mm margin
Curettage, cautery
Cryotherapy
Moh's micrographic surgery
Topical imiquinod/5-fluorouracil cream

Question 14

What is a melanoma?

Answer 14

Malignant tumour of melanocytes with potential for dermal invasion and metastatic spread

Question 15

What are the risk factors for melanoma?

Answer 15

• Genetic markers
• Family Hx of dysplastic naevi/melanoma
• Moles (melanocytic naevi) >50, >5mm
• Skin type I & II
• Sunburns in childhood (10yrs)
• UV radiation
• Immunosuppression

Question 16

Subtypes of melanoma

Answer 16

• Superficial spreading of malignant melanoma
• Nodular melanoma
• Acral melanoma
• Melanoma in situ

Question 17

Clinical features of melanoma. What is included in the 7 point checklist?

Answer 17

2 points:

• Change in size
• Irregular shape
• Irregular colour

1 point:

• largest diameter >7mm
• Inflammation
• oozing
• change in sensation

> =3 pts is suspicious.

Question 18

Diagnosis of melanoma

Answer 18

excision biopsy for pathological and histological assessment

Question 19

Differential for melanoma

Answer 19

• intradermal naevi
• dysplastic naevi
• seborrhoeic wart
• pigmented BCC

Question 20

Management of melanoma

Answer 20

Surgical excision (wide local excision)
Breslow 1mm - 2 cm margin
If metastatic - chemotherapy
Assess lymph node spread - lymphadenectomy

long term follow up

Question 21

How do you assess the severity of the melanoma?

Answer 21

Using breslow’s thickness. Used as prognostic indicator. measured vertically in mm from top of granular layer to deepest point of tumour involvement