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kavinashah
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what are the main risk factors for skin cancer?
- excess sun exposure
- fair skin type - always gets red in sun
- radiotherapy
- arsenic
- phototherapy
- previous UV therapy
- atypical mole syndrome
- xeroderma pigmentosum
- gorlins syndrome: predisposition for BCC
- immunosuppressed eg renal transplant
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what are the 3 BENIGN pigmented lesions?
- melanocytic naevi
- seborrheic keratosis
- dermatofibroma
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what is the epidermis and dermis linked by?
basement membrane
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what is the commonest type of melanocytic naevi?
junctional naevus
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how do you describe junctional naevi?
- FUBAR
- flat
- uniform
- brown
- acquired
- regular
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what is an intradermal naevus?
- raised melanocytic naevus
- dome shaped
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what is it called when a mole starts flat and becomes raised?
compound naevus
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what is atypical mole syndrome?
- > 100 moles
- > 5mm diameter
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what is the risk with atypical mole syndrome and can this be reduced by removing the benign moles?
- risk of melanoma
- NOT reduced by removing the moles
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what % of population is affected by atypical mole syndrome?
2%
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who does seborrheic keratosis affect?
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how would you describe seborrheic keratosis?
- pale to dark brown appearance
- stuck on
- waxy
- 'warty'
- keratin cysts
- face trunk limbs
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can seborrheic keratosis turn malignant?
no
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how do you describe a dermatofibroma?
- firm dermal nodule
- pale to dark brown
- may be dimpled/tethered
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what can dermatofibromas follow?
insect bites
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is dermatofibroma more in f or m?
f
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where do you commonly see dermatofibromas?
lower limbs
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what is lentigo maligna?
- in situ melanoma
- pre malignant
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who is at higher risk of lentigo maligna and where on body?
- face
- elderly
- sun damaged skin
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how would you describe a lentigo maligna?
large irregularly pigmented macule
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what is a lentigo maligna melanoma?
- a melanoma that has developed form a lentigo maligna
- ie not it has breached BM and is malignant
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how do you asses if a mole looks atypical?
- Asymmetry
- Border irregularity/notching
- Colour: variable pigmentation
- Diameter >6mm
- Evolving?
- skin markings lost
- may ulcerate, bleed, itch
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what are the 4 main RF for malignant melanoma?
- fair skin
- intermittent intense sun exposure
- atypical mole syndrome
- family history of MM
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what is the prognosis of amelanotic melanoma? why?
- bad as highly malignant
- as melanoma cells become more dysplastic, and less well differentiated they lose capacity to produce melanin
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what are the 4 prognostic indicators for melanoma?
- breslow thickness
- ulceration
- mitotic index
- sentinel node biopsy if breslow > 1mm
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what is definition of breslow thickness?
measurement (histologically) in mm from granular layer to the deepest level of invasion
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what is Rx of melanoma?
excision +/e SNB (if breslow >1mm)
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what is the commonest human cancer?
basal cell carcinoma
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how would you describe a BCC?
- skin coloured
- papular
- pearly
- telangiectasia
- rolled border
- ulcerated or central umbilication
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where do BCCs commonly dorm?
on danger area of the face
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what does actinic damage consist of and what causes it?
- solar damage - sun
- pigmentary change
- actinic keratoses - rough areas of skin
- pre-malignant to SCC
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where do AK's occur?
- face
- dorsal hand
- bald scalp
-
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what is bowens disease?
SCC in situ
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how would you describe bowens disease?
well circumscribed erythematous scaly plaque
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what is differential for bowens disease?
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what causes bowens disease?
- solar radiotion
- hpv 16
- arsenic
- radiotherapy
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how do you confirm diagnosis of bowens?
histologically - skin biopsy
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what are the features of SCC?
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what is the rate of growth of SCC?
rapid!
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who has an increased risk of SCC?
- fair skin
- sun exposed
- transplant recipients
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what are the 2 main additional risk factor for SCC that doesn't apply to BCC?
- SCC may develop in any chronic wound or scar
- marjolin's ulcer
- HPV (more in immunosupp)
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where in the body does SCC have a higher metastatic potential?
head and neck
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describe the evolution of SCC in terms of dysplasia
- AK: partial dysplasia
- bowen's disease: full dysplasia
- SCC: full dysplasia with invasion (covered with keratin)
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which skin cancers/pre-cancers can be treated with topical therapies?
- actinic keratoses
- bowen's disease
- superficial BCC
- lentigo maligna (cryotherapy)
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what are the 4 main topical therapies?
- 5FU - fluorouracil
- imiquimod
- PDT
- cryotherapy
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