Skin Cancer Quiz: BCC and Melanoma

Dermatology 3 - CAM I

• Course instructor: Professor Jacobus, MSBS, PA-C
• Course offered by: South College
• Course description: Dermatology focus including etiology, epidemiology, clinical features, differential diagnosis, and management of selected skin disorders.

Instructional Objectives

• Students will identify and describe the etiology, epidemiology, clinical features, differential diagnosis, and management of selected skin disorders.

Topics

• Neoplasms
• Bacterial Infections
• Others

Malignant Neoplasms

• Basal Cell Carcinoma (BCC)
• Squamous Cell Carcinoma (SCC)
• Melanoma
• Kaposi Sarcoma

Basal Cell Carcinoma (BCC)

• Most common skin cancer
• Onset typically after age 40, more common in females
• Etiology: primarily caused by ultraviolet light (UVB)
• Occurs most frequently on fair-skinned individuals (types I-III)
• Risk factors include light-colored eyes, red hair, prolonged sun exposure, northern European ancestry, and heavy sun exposure in youth
• Clinical sub-types include superficial, nodular, pigmented, morpheaform
• Histologic sub-types include superficial, nodular, micronodular, infiltrative
• Slow-growing, often asymptomatic, may show bleeding/scab, sensitivity to nerve involvement

Basal Cell Carcinoma (BCC) - Diagnosis and Treatment

• Diagnosis is often clinical, confirmed by biopsy
• Treatment typically includes excision with primary closure, cryosurgery, electrosurgery, Mohs surgery, topical treatments such as 5-fluorouracil ointment and imiquimod (for superficial lesions below neck)

Nodular BCC

• Most frequent subtype (80%)
• Skin-colored, reddish, or translucent (pearly)
• Well-defined, firm, smooth papule or nodule with telangiectasias
• May show erosions, melanin stipples, or ulceration. Rolled border
• Examples provided in images

Pigmented BCC

• Brown, blue, or black
• Hard, firm
• Round or oval, possibly ulcerated
• Differential diagnosis from melanoma is vital

Morpheaform BCC

• 5-10% of total BCC cases
• Smooth, flesh-colored, or light erythematous papules or plaques
• Atrophic, ill-defined borders
• Scar-like appearance

Squamous Cell Carcinoma (SCC)

• More common in individuals over 55 and females
• Risk factors include sun exposure, light-colored skin, poor tanning, outdoor occupations, immunosuppression, chronic inflammation, industrial carcinogens
• Types include solitary or multiple macules, papules, plaques, ulcers; hyperkeratotic or scaling
• Can arise from actinic keratosis (AK)
• Rapid evolution can occur

Squamous Cell Carcinoma (SCC) - Treatment

• Treatment for in situ SCC includes imiquimod or 5-fluorouracil, curettage, and electrodessication
• Management for invasive SCC involves excision or Mohs surgery

Superficial SCC

• Most frequent site is the trunk
• Presentation includes slightly scaly macules, patches, or thin plaques, and light red to pink coloration.
• Telangectasias may be present
• Differential diagnosis may include actinic keratosis (AK)

Melanoma

• Most common malignant skin tumor
• Leading cause of death related to skin disease
• Relatively least common skin cancer
• Lifetime risk of 2% (Caucasians), 0.1-0.5% (non-Caucasians)
• Etiology and pathogenesis remain largely unknown, likely due to ultraviolet (UV) radiation exposure
• Various clinical presentations with considerable variability

Melanoma - Clinical & Histologic Types

• Superficial spreading (70%)
• Nodular (15%)
• Lentigo malignant (5%)
• Acral lentiginous (5-10%)
• Tumor thickness is a key prognostic factor, impacting 10-year survival rates

"ABCDE" Criteria

• Asymmetry
• Border irregularities
• Color variation
• Diameter > 6 mm
• Evolution

Kaposi Sarcoma

• Systemic endothelial cell tumor linked to HSV-8 infection
• Presents in clinical manifestations with purple, brown, or black patches, plaques, or nodules
• Primarily seen in populations with immunodeficiencies, such as HIV/AIDS
• Treatment often involves radiation, chemotherapy, or antivirals and generally responds to treatment

Congenital Nevus

• Nevus (single) or nevi (plural)
• Small congenital nevi can be dome-shaped, especially on the face
• May be mamillated or hypertrichotic
• Benign moles
• Distinction is necessary between benign moles and large or giant congenital nevi, where the risk of developing melanoma is 5-10%
• Yearly monitoring with photographs is advised for larger nevi

Atypical Nevi

• Aka dysplastic nevi
• Benign acquired melanocytic nevi share characteristics of melanoma, including asymmetry, irregular borders, color variegation, and a diameter greater than 5 mm.
• Increased risk of melanoma with 50 or more nevi
• 5% of Caucasian population, comparatively rare in Japanese people, common in familial cases of cutaneous melanoma

Biopsy of Suspicious Lesions

• Never perform superficial shave biopsy on pigmented lesions suspected of being melanoma
• Accurate determination of Breslow depth (tumor thickness) is essential for survival assessment

Biopsy vs. Excision

• Biopsy is initially performed for histologic confirmation before surgical removal
• Benign growth is identified, avoiding unnecessary excision
• Malignant tumor may require different management approach to suspected lesion
• Melanomas necessitate wide margins

Skin Biopsy - Indications and Contraindications

• Indications: rashes, blisters, drug reactions, skin abnormalities, suspected lesions.
• Contraindications: infection, patient on blood thinners

Bacterial Infections

• Abscess
• Folliculitis
• Furuncle/carbuncle
• Cellulitis
• Erysipelas
• Impetigo

Pressure Ulcers (aka Pressure Sores)

• Body weight over bony promontories can cause friction, increased pressure, and injuries.
• Elderly patients, bedridden patients, poor nursing care, lack of sensation, and hypotension are risk factors.
• Staging includes non-blanching erythema (Stage 1), epidermis/dermis loss (Stage II), full-thickness loss (Stage III), and full-thickness loss with exposed tissue/bone (Stage IV).
• Treatment involves repositioning, decreasing pressure, and antibiotics and/or surgery as needed.

Other Disorders

• Burns
• Lipomas
• Epidermal Inclusion Cysts
• Sebaceous Cysts
• Pressure Ulcers
• Vitiligo
• Melasma
• Photosensitivity Reactions
• Syphilis

Topical Treatments -Amount per Dosage

Dermatology Steroids

Steroid Side Effects

Examination Procedures