Skin tumours Flashcards
(29 cards)
Risk factors for BCC
Intermittent/childhood sun exposure
Fair skin
Ionising radiation
Arsenic
Genetic susceptibility - Gorlin’s, xeroderma pigmentosum
Risk factors for SCC
Sun exposure
HPV, immunosuppression (more than BCC)
Chronic inflammation, ulceration
Arsenic, industrial carcinogens (e.g. tar)
Ionising radiation
Tobacco smoking
Spectrum of epidermal dysplasia > SCC
Partial thickness: Solar keratosis
Full thickness: Bowen’s
Invasive to dermis: SCC
Appearance of solar keratosis
‘Sandpaper-like’ leions
Ill-defined, on erythematous background
Field changes on sun exposed areas (multifocal)
Appearance of Bowen’s disease
Well-demarcated erythematous lesion
Often lower limbs
Asymptomatic (c.f. inflammation), slowly enlarging
Unresponsive to topical steroids, antifungals
Management of Bowen’s disease
Surgery
Cryotherapy (not on lower limbs)
5-FU topical (Efudix)
Topical imiquimod (Aldara)
Risk of progression of Bowens
3-5% to SCC
Met rate of SCC
3-4% dep on grade, thickness, site
higherthan bcc
Appearance of SCC
Polypoid/raise lesion
Keratotic, ulcerated centre
Rapidly enlarging (6w - 3mo)
Appearance of keratoacanthoma
Very rapid growth (<6w) in late middle age
Spontaneous resolution leaving depressed scar
Keratotic plug - well-differentiated SCC
Presentation of BCC
Ulcer with rolled edges (rodent ulcer)
Telangiectasia
Translucent, pearly white
Features of BCC
10% risk of other skin cancer
Locally destructivebut mets rare
80% in head and neck (Esp scalp, temples)
Management of BCC
Surgical excision
Radiotherapy
Cryotherapy, imiquimod if superficial
Variants of BCC
Ulcerative
Nodular
Superficial (not raised)
Pigmented (consider melanoma!)
Morphoeic (superficial changes don’t match deep, waxy, scar-like, indistinct border, mid-face)
Types of acquired melanocytic naevi
Junctional: at epidermal-dermal j(x), not raised
Compound: Raised naevus due to dermal involvement (‘wobble factor’), pigmented from epidermal involvement
Intradermal: Raised, non-pigmented
Halo: White rim around naevus
Blue: Dark blue/black
Spitz: In children, can be pink
Assessment of changing naevus
Asymmetry
Border
Colour - darker worse, multiple worse irrespectiv of colour
Diameter (esp if >5mm)
Evolution - sensation, surface, surrounding skin
Risk factors for melanoma
FHx (esp if >3 FDR)
PMHx of melanoma or blistering sunburn or other skin cancer
Multiple naevi (>100)
Atypical naevi
Red hair, blue eyes, fair skin
Immunosuppression
What is Hutchinson’s sign
Extension of pigmented lesion into nail fold - signified subungual melanoma
Classification of melanoma
Superficial spreading (shallow and wide. most common)
Nodular (raised and deep)
Acral lentiginous (most common in dark skin, in areas w/o hair follicles)
Lentigo maligna (more common in older patients c.f. other melanomas, sun-damaged skin e.g. skin)
Prognostic signs for melanoma
Breslow thickness: From granular layer to deepest part of lesion, determines excision margin
Regression: White intermixed with pigmented, poor prognosis? indicates spread
Mitotic rate
Ulceration
Nodal status
Average prognosis for melanoma
5-year survival >95% if Breslow <1, <50% if >3
Management of melanoma
Surgical excision with narrow margins - confirm Dx
Repeat excision dep on tumour thickness
Dermaoscopy only if benign! If ?malignany always refer for excision biopsy
Presentation of dermatofibroma
Button-like dermal lesion
Possible reaction to insect bite
May be itchy
On limbs
Do not spontaneously resolve
Dimple sign - displaces when squeezed
Presentation of pyogenic granuloma
Solitary haemangioma following trauma, bleeds easily
In adults - histology for ?SCC/?amelanotic melanoma
Excise and ablate base
