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Skin neoplams

Malignant melanoma

Definition: malignant tumour of melanocytes. Incidence of about 10 per 100,000 per year and rising at a rate of 7% per year. M:F 1:2

Features

Early
  1. ↑size
  2. asymmetry
  3. colour
  4. irregular margin
  5. new naevus after puberty
Late (missed the boat)
  1. itching
  2. bleeding
  3. satellite lesions
  4. enlarged lymph nodes

Types

  1. Superficial spreading (09% in UK)
  2. Lentigo maligna
  3. Acral lentiginous (commonest form in mongoloids)
  4. Nodular
  5. Amelanotic

Prognosis

Depends on Breslow thickness (stratum granulosum to deepest identifiable melanoma cell). Five year survival:

Treatment

Excision. 1 cm margin for every mm thickness as determined by frozen section.

Basal cell epithelioma

= basal cell carcinoma

Epidemiology

Commonest neoplasm.

Features

  1. sun exposed site
  2. pearly (= translucent = cystic)
  3. rolled edge
  4. telangiectasia
  5. central erosion

Treatment

Excision, curettage, cryotherapy.

Squamous cell carcinoma

Features

  1. sun exposed site/chronic ulcer
  2. hyperkeratotic/granulomatous
  3. crusted, horny
  4. ulcerated
  5. hard, elevated/undermined edge
  6. indurated beyond visible margin

Treatment

Excision.

Solar keratosis

Keratoacanthoma

Features

  1. Rapid growth (4–6/52)
  2. Sharpy defined
  3. Hemispherical
  4. Keratin plug/crater
  5. Disappears in 2–12 months
  6. May scar

Treatment

Excision, curettage, cautery.