Skin Cancer Diagnosis PDF

# Skin Cancer The most important are BCC, SCC, MELANOMA. The most common type of skin cancer is basal cell carcinoma. ## Common Key Words - Painless lesion - Hx of sun exposure (come from Australia, Summer, outdoor job...) - Increase in size for months. ## In Case of BCC * Nodular lesion w...

# Skin Cancer The most important are BCC, SCC, MELANOMA. The most common type of skin cancer is basal cell carcinoma. ## Common Key Words - Painless lesion - Hx of sun exposure (come from Australia, Summer, outdoor job...) - Increase in size for months. ## In Case of BCC * Nodular lesion with central ulceration * Non tender, firm, pearly telangiectatic papules * Most lesions appear on the face or other sun-exposed areas * Diagnosis: Excisional biopsy, shave biopsy or punch biopsy. * Treatment: * If on the trunk or extremities: surgical excision with 3-5 mm margins * lesions on the face: Surgical excision (Mohs Micrographic Surgery) A 48-year-old woman comes to the physician because of a small swelling on her neck. She has worked outdoors her entire life. This swelling has been present for the past 6 months and is slowly enlarging. On examination, there is a small nodular lesion with central ulceration that is firm, nontender, pearly, and indurated. Which of the following is the most likely diagnosis? ## In Case of SCC Common in patients with * History of transplant * on chronic immunosuppressive therapy * Ionizing radiation * Burn injuries * Nodular lesion with intermittent bleeding and itching. * The lesions often become keratinized (with a thickened, rough surface) * Lesions can ulcerate with crusting and bleeding * Perineural invasion is a feature of SCC -> numbness, paresthesia and itching. Confirm with shave biopsy, which may show keratin pearls and full-thickness atypical keratinocytes with invasion into the dermis. ## Treatment Surgical excision or Mohs surgery (very thin slices are excised and examined with a microscope via frozen section, ideally used for cosmetically sensitive areas such as face and distal extremities). Lesions with high metastatic potential may need radiation or chemotherapy. A 65-year-old man comes to the office due to a nonhealing ulcer on the left upper extremity. For the last 2 months, he has had an enlarging ulcerated lesion, with intermittent bleeding and itching. He does not recall any injury prior to the onset of symptoms. He has good appetite and reports no weight loss. There is no fever, dyspnea, or cough. He does not use tobacco, alcohol, or illicit drugs. Vital signs are normal. Physical examination of the lesion *is shown in the image below*. The remainder of the examination is unremarkable. Which of the following is the most likely diagnosis? ## In Case of Malignant Melanoma: * ABCDE criteria * A= Asymmetry * B= Border (irregular border with indistinct margins) * C= Color (variegated pigmentation within the same lesion) * D= Diameter > 6 mm * E= Evolving ( a lesion that changes in size, shape, or color over time) * If the patient has multiple nevi, a lesion that is significantly different from patient's other moles also warrants increased suspicion ("Ugly duckling" sign) * Dx: Skin biopsy * Tx: Wide local excision * Excision should be performed with surgical margins determined by the Breslow depth. * Prognosis: Tumor thickness, as determined from the Breslow thickness, is the most important prognostic factor. A 63-year-old man comes to the physician for the evaluation of a skin lesion on his chest. He first noticed the lesion 2 months ago and thinks that it has increased in size since then. The lesion is not painful or pruritic. He otherwise feels well. He has type 2 diabetes mellitus, hypercholesterolemia, and glaucoma. The patient has