Summary
Summary Dermatological cancers
- Course
- Institution
Summary, background, clinical featurs, diagnosis and management of dermatological cancers, cancer precursors and of benign lesions which may look like cancer
[Show more]
Seller
Follow
ellie0899
Content preview
BCCFriday, January 12, 2024 1:12 PM
Basal cell carcinoma
• Originate in keratinocytes in the stratum Basale where the cells are dividing
• Locally invasive
• Most common malignant skin tumour
• Very slow growing (develop over months/years)
• Most common over the head and neck (80%)
• Rarely metastasise
• Main risk factor -
○ UV light exposure
○ Many foreign holidays or living abroad
○ History of frequent or serious sun burn
○ Outdoor occupations and/or hobbies
○ Excess use of sun beds
• Specific risk factors for BCC: age (most common in elderly/middle aged)
○ Male sex
○ Age - very common in older people
○ Genetic - albinism, xeroderma pigmentosa, certain mutations
○ Immunosuppression - AIDS and transplant patients
○ Previous skin cancers
○ Fitzpatrick skin types 1 and 2
○ Gorlin's syndrome - aka nevoid basal cell carcinoma syndrome (NBCCS)- increases risk of
deveoping BCCS.
▪ Rare autosomal dominant condtion.
▪ Normally begin to develop BCC in early adulthood or adolescence
▪ Has many other clinical features e.g. Broad nasal root
○ Carcinogens - ionising radiation, arsenic (especially multiple superficial BCC),
hydrocarbons
Presentation:
• Painless lesion with many different morphologies:
○ Nodular - most common (60-80%)
▪ Generally small and skin coloured or pinkish
▪ Dome shaped nodules
▪ Central depression
▪ Most common on the forehead, temples, nose and upper lip (sun exposed areas)
▪ Telangiectasia - surface telangiectasia
□ Especially on the rolled edges
▪ Ulceration - if they develop an ulcerated or necrotic centre, they are called Rodent
ulcers
□ Common if older
□ Can become necrotic
▪ Rolled edges - characteristic pearly rolled edges
▪ Pearlescent appearance or sheen (pearly edges)
○ Superficial - scaly irregular erythematous plaque with clear rolled border. May have
micro erosions. Slightly raised. Most common in younger people. 10%-20% of BCC
○ Basosquamous - more aggressive.
▪ Bit of a combination of BCC and SCC (5%).
▪ Quick growing
▪ Potentially metastatic so needs to be removed
▪ Can bleed and ulcerate
Lesions Page 1
, ▪ Can bleed and ulcerate
▪
○ Morphoeic - rare and normally more invasive (5%).
▪ Poorly demarcated thickened patch of skin
▪ Irregular borders, waxy scar like plaque
○ Pigmented - blue/black very rare (5%).
▪ Difficult to distinguish from melanoma so excised like a melanom
○ Cystic
○ Keratotic
• Bleeding and ulceration is rare and indicates more severe lesion
• Very slow growing lesion
There is a very low metastatic potential but there is a risk of local invasion
Very slow development and increase in size
Management of BCC
• Conservative - watch and wait
Lesions Page 2
, • Conservative - watch and wait
○ Very low risk of local invasion so low metastatic potential
○ Conservative is common in older people because BCCs rarely become malignant
• Wide local excision with biopsy - gold standard investigation/diagnosis and management.
• For tumours/lesions <2cm in size
▪ Larger lesions require Moh's micographic surgery to ensure you have removed the
entire lesion
• Need at least 3-5mm margins
• Need to excise deep enough through the skin to see the hypodermis
▪ Cancerous cells are in the basal layer
▪ Take a small cuff of ft
• Curettage +/- cautery - scraping away the surface, cauterise, scrape etc. Done 3 times.
• Normally only for really superficial low risk lesions becuse there is no sample to
examine to ensure you have clear margins
• Imiquimod is a topical agent which is sometimes used for very superfiial lesions
• Not commonly used
• Cryotherapy - used for superficial lesions
• Using liquid nitrogen to "burn off" the BCC
• MOHs micrographic surgery
• Used in cosmetically sensitive location (e.g. Ears, faces)
• Excise lesion -> send for examination under microscopy -> see if there are clear
margins -> keep excising until there are clear margins
• After you have excised the whole tumour, surgical reconstruction of the region
• Can also be used in very large ill defined lesion where you can't be sure you have
excised it all
• Not done in every centre though
• Radiotherapy - normally just for adjuvant therapy to prevent recurrence, in recurrent BCC or
in high risk patients or areas where surgery isn't appropriate (e.g. Too large to be resected)
Features of a high risk BCC
○ >2cm
○ Around the eyes, nose lips or ears
○ Poorly defined margins
○ Morphoeic, basosquamous or highly infiltrative
○ Patient is immunosuppressed
○ Previous treatment failure
○ Perivascular or perineural invasion
Lesions Page 3
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ellie0899. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.14. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
77254 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now