Skin Lesions (Malignant and Pre-Malignant)

Question 1

Malignant Melanoma Epidemiology

Answer 1

5F:M, incidence in Uk 10,000/yr and 2,000 deaths/yr

Question 2

Malignant Melanoma Features

Answer 2

Asymmetry 
Board: irregular 
Colour: non-uniform
Diameter: >6mm
Evolving/Elevation

Question 3

Malignant Melanoma Risk Factors

Answer 3

Sunlight - esp. intense exposure in early yrs 
Fair skinned (Low Fitzpatrich skin type)
Increased no. of moles 
FHx 
Increased age
Immunosuppression

Question 4

5 classification of Malignant Melanoma

Answer 4

Superficial spreading (80%)
Lentigo maligna melanoma 
Acral lentiginous 
Nodular melanoma 
Amelanotic

Question 5

Superficial spreading overview

Answer 5

Irregular borders, colour variation
Commonest in caucasians
Grow slowly, metastasise late = better prognosis

Question 6

Lenitgo maligna melanoma overview

Answer 6

Often elderly pts

Face or scalp

Question 7

Acral lentiginous overview

Answer 7

Asians/blacks

Palms, soles, subungal (w/ Hutchinson’s sign)

Question 8

Nodular melanoma overview

Answer 8

All sites
Younger age, new lesion
Invade deeply and metastasis early = poor prognosis

Question 9

Amelanotic overview

Answer 9

Atypical appearance -> delayed Dx

Question 10

Breslow depth

Answer 10

For measuring staging and prognosis
thickness of tumour to deepest point of dermal invasion
<1mm = 95-100% 5yrs
>4mm = 50% 5yrs

Question 11

Clark’s staging

Answer 11

Staging based on depth by 5 anatomical levels
stage 1: epidermis
stage 5: sc fat

Question 12

Malignant Melanoma common metastasis sites

Answer 12

Liver

Eye

Question 13

Malignant Melanoma Mx

Answer 13

excision and 2ary margin excision depending on Breslow depth
+/- lymphadenopathy
+/- adjuvant chemo (may use isolated limb perfusion)

Question 14

Poor prognostic indicators in malignant melanoma

Answer 14

M (more tumours on trunk than F)
Increased mitoses
Satellite lesions (lymphatic spread)
Ulceration

Question 15

Squamous cell carcinoma appearance

Answer 15

Ulcerated lesion w/ hard, raised everted edges

Sun exposed areas

Question 16

SCC Causes

Answer 16

Sun exposure: scalp, face, ears, lower leg
May arise in chronic ulcers: Marjolin’s ulcer
Xeroderma pigmentosa

Question 17

Evolution to SCC

Answer 17

solar/actinic keratosis -> Bowen’s ->SCC

Lymph nodes spread is rare

Question 18

SCC Rx

Answer 18

Excision + radiotherapy to affected moles

Question 19

Actinic Keratoses appearance

Answer 19

Irregular, crusty warty lesions

pre-malignant (~1%/yr)

Question 20

Actinic Keratoses Rx

Answer 20

Cautery 
Cryo 
5-FU 
Imiquimod 
Photodynamic phototherapy

Question 21

Bowen’s disease appearance

Answer 21

Red/brown scaly plaques

SCC in situ

Question 22

Bowen’s disease Rx

Answer 22

Cautery 
Cryo 
5-FU 
Imiquimod 
Photodynamic phototherapy

Question 23

Keratoacanthoma overview

Answer 23

Well-differentiated SCC that arises in a hair follicle
Fast-gorwing, dome-shaped w/ a keratin plug
Usually regress but may be excised

Question 24

Basal Cell Carcinoma appearance

Answer 24

Commonest cancer
Pearly nodule w/ rolled telangiectactic edge
May ulcerate
Typically on face in sun-exposured area (above line from tragus -> angle of mouth)

Question 25

BCC behaviour

Answer 25

Low-grade malignancy -> v rarely metastasise

Locally invade

Question 26

BCC Rx

Answer 26

Excision - Mohs: complete circumferential margin assessment using frozen section histology
Cryo/radio may be used