Skin tumors Flashcards by Deema Baks

What is the 2nd most common skin cancer?

SQUAMOUS CELL CARCINOMA (epithelioma)

in old men
occurs in pre-existing lesion (venous ulcer or burn)
grossly proliferative/ulcerative/red plaque like

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What are the predisposing factors for SSC?

prolonged exposure to UVR or tar
previous irradiation
long standing irradiation (marjolin ulcer)
PREMALIGNANT LESIONS

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What are the premalignant lesions that predispose to SSC?

senile keratosis
Bowen’s disease
Paget’s disease
leukoplakia
chronic scars

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What is the clinical picture of a SSC?

ulcero-proliferative lesion
raised & everted edge, fixed indurated base, necrotic floor with bloody discharge
induration extends beyond the margin
regional lymph nodes are hard, nodular, initially mobile eventually fixed

histo -> malignant epithelial cells with central Keratin pearls surrounded by prickle cells

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What other variants of SSC are present?

MARJOLIN’S ULCER -> no lymph node involvement

VERRUCOUS CARCINOMA -> no lymph node involvement

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What is the TNM staging of for skin cancer (other than melanoma)?

T0: no tumor 
T1: <2cm
T2: 2-5cm
T3: >5cm
T4: spread to cartilage, muscle or bone

N0: no nodes
N1: regional nodes ++

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What is Broder’s classification of SSC?

I -> Well differentiated 75% or more Keratin pearls
II -> moderately differentiated 50-75% keratin pearls
III -> poorly differentiated 25 - 50% keratin pearls
IV -> <25% keratin pearls

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What investigations should be done for suspected SSC?

edge biopsy

- take a whole lymph node

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How should SSC be treated?

radiotherapy (BRACHYTHERAPY) -> doesnt effect nearby structures
wide excision with safety margin -> skin graft or flap
amputation 1 joint above
block dissection of regional lymph nodes
if LN + -> chemotherapy (methotrexate, vincristine, bleomycin)
cryo probe or topical fluorouracil or electrodessication -> field therapy

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What is the treatment of a Verrucous carcinoma?

wide excision

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What makes the prognosis of SCC worst?

tumor size >2cm
ill defined borders
associated immunosuppression
poorly differentiated
perineural involvement
invasion

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What is the commonest skin tumor?

BASAL CELL CARCINOMA
- more common in whites, males, & middle aged or elderly
- high exposure to UV light
- only locally malignant -> erodes deeply into local tissues including cartilages & bone causing extensive local destruction
RODENT ULCER

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What is the most common site for occurrence of a rodent ulcer?

face above the line drawn between angle of mouth & ear lobule
TEAR CANCER

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What are the types of of BCC?

NODULOCYSTIC & NODULOULCERATIVE (commonest)
nodular
ulcerative
pigmented BCC (mimics melanoma)
field fire or forest fire BCC

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What is forest fire BCC?

wide area involvement with central scabbing & peripheral active proliferating edge

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What are the clinical features of a BCC?

nontender, dry, slowly growing, non mobile ulcer with RAISED & BEADED edge
central scab
beading area is active proliferating cells
DIRECT SPREAD ONLY (no LN involvement)

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What is considered a high risk BCC lesion?

> 2cm
near eye/nose/ear
ill-defined margin
recurrent tumors
immunosuppressed

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How should a BCC be treated?

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radiosensitive
radiotherapy if its FAR from eyes
no radiotherapy if it erodes bones
wide excision with skin graft or flap
laser surgery, cryosurgery
local 5FU ointment

What are the indications for surgery in BCC?

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rodent ulcer eroding cartilage or bone
close to the eye
recurrent
radio-resistant
small lesion

A hemartomata of melanocytes due to excessive stimulation is called?

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NAEVI

- presents during birth of later on

What are the types of NAEVI?

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hairy mole
lentigo (flat black spot replace basal epidermis)
intradermal naevus (cluster of dermal melanocytes in face)
junctional naevus (immature unstable & PREMALIGNANT)
compound naevus (intradermal + junctional) potentially malignant

What is a malignant tumor arising from the epidermal melanocytes? MOST AGGRESSIVE MALIGNANT TUMOR

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MELANOMA

+ dopa test

What are the risk factors for developing a malignant melanoma?

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exposure to UV light
Albinism & Xeroderma pigmentosa
Junctional Naevus
Large congenital naevi (larger than 20cm)
family history
immunosuppression or post renal transplant or NHL

How do we know a benign naevi is turning malignant?

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MAJOR SIGNS -> change in size (more than 6mm), shape, & color

inflammation, crusting, bleeding, itching
nodularity, ulceration, halo around mole
satellite lesions
doppler positive pigmented lesions (>0.9mm thick have blood supply)

What is the most common site in females for development of melanoma?

leg

What is the most common site in males for development of melanoma?

front or back of trunk

What classification is based on the thickness of the tumor in melanoma?

``` BRESLOW'S CLASSIFICATION I -> less than 0.75mm II -> between 0.76 to 1.5mm III -> 1.51 to 4mm IV -> more than 4mm ```

What classification of melanoma is based on the depth of invasion?

``` CLARK'S LEVELS level 1 -> epidermis level 2 -> papillary dermis level 3 -> fill papillary dermis completely level 4 -> reticular dermis level 5 -> subcutaneous tissue ```

what is the common site for an extra cutaneous melanoma?

ocular

What is the most common clinical type of a melanoma?

SUPERFICIAL SPREADING 64% - in middle age - more radial growth - from pre existing naevus - better prognosis

What type of melanoma occurs in a younger age group of men on their trunk or head & neck, and has more vertical growth?

NODULAR MELANOMA 12-25% - more aggressive - poor prognosis

which melanoma is the least malignant, is common in old age & face, is slow growing, variegated, brown macule/lentigo?

LENTIGO MALIGNA MELANOMA (Hutchinson's melanotic freckle) 7-15% - in elderly women - common in face neck & hands

What type of melanoma occurs in palms, soles & subungual region (under nail)?

ACRAL LINTIGINOUS MELANOMA 5% - least common - poor prognosis - more vertical growth phase - mimics fungal infection/pyogenic granuloma

What is the WORST type of melanoma that is S100 & HMB45 +ve?

AMELANOTIC MELANOMA - tumor cells loose their capacity to synthesize melanin - pinkish FLESHY growth of rapidly progressive tumour - mimics soft tissue sarcoma

Which melanoma has high affinity for perineural invasion?

DESMOPLASTIC MELANOMA | - common in head & neck with higher recurrence rate

What are the clinical features of melanoma?

- can start from pre-existing naevus (JUNCTIONAL) or as de novo in normal skin - no induration - pigmentation with irregular surface margin - rapid growth - ulceration, bleeding, itching, change in color

How does the spread of melanoma occur?

- spreads to regional lymphatics - in-transit nodules or satellite nodules (retrograde spread to lymphatics) - blood to lungs, liver, brain, skin, or bones (BLACK SECONDARIES)

What is the TNM staging for melanoma?

T0: no tumor N0: no nodes T: in situ N1a: 1 node micrometastasis T1a: <1mm no ulceration N1b: 1 node macrometastasis T1b: <1mm with ulceration N2a: 2 or 3 nodes micrometastasis T2a: 1-2mm no ulceration N2b: 2 or 3 nodes macrometastasis T2b: 1-2mm with ulceration N2c: satellite of in transit lesions T3a: 2-4mm no ulcerations N3: 4 or more nodes; nodes with satellite or in transits T3b: 2-4mm with ulcerations T4a: >4mm no ulcerations M0: no blood spread T4b: >4mm with ulcerations M1a: skin, subcutaneous tissue, distant node M1b: lung spread M1c: other viscera or distant spread & increase in LDH

what are the 5 most important features of melanoma?

- asymmetry - border irregularity - color variation - diameter >6mm - elevation

what are the tumor markers for melanoma?

- MELAN-A - S100 - HMB45 - LDH

What investigations should be done for melanoma?

- excision biopsy of primary - lymph node excision - US & chest X-ray to see metastasis - CT scan of head chest abdomen pelvis - urine for MELANURIA -> advanced disease - sentinel lymph node biopsy

What is the treatment for primary melanoma?

- wide excision with clearance margin 2cm - in fingers & toes -> disarticulation - if area is wide -> amputate 1 joint above - in anal canal -> abdominoperineal resection - in eye -> enucleation of eye - immunotherapy using tumour antibodies BCG, levamisole in advamced melanomas - radiotherapy on beneficial in secondaries in brain & bones

When should chemotherapy be used in case of melanoma?

- secondaries in liver, lungs, or bone | - after surgery IV (melphalan & carboplatin)

Skin tumors Flashcards

(43 cards)