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
- ↑size
- asymmetry
- colour
- irregular margin
- new naevus after puberty
Late (missed the boat)
- itching
- bleeding
- satellite lesions
- enlarged lymph nodes
Types
- Superficial spreading (09% in UK)
- Lentigo maligna
- Acral lentiginous (commonest form in mongoloids)
- Nodular
- Amelanotic
Prognosis
Depends on Breslow thickness (stratum granulosum to deepest identifiable melanoma cell).
Five year survival:
- <0.75 mm >95%
- 0.75–1.5 mm 93%
- 1.5–3.5 mm 67%
- >3.5 mm 38%
Treatment
Excision. 1 cm margin for every mm thickness as determined by frozen section.
Basal cell epithelioma
= basal cell carcinoma
Epidemiology
Commonest neoplasm.
Features
- sun exposed site
- pearly (= translucent = cystic)
- rolled edge
- telangiectasia
- central erosion
Treatment
Excision, curettage, cryotherapy.
Squamous cell carcinoma
Features
- sun exposed site/chronic ulcer
- hyperkeratotic/granulomatous
- crusted, horny
- ulcerated
- hard, elevated/undermined edge
- indurated beyond visible margin
Treatment
Excision.
Solar keratosis
Keratoacanthoma
Features
- Rapid growth (4–6/52)
- Sharpy defined
- Hemispherical
- Keratin plug/crater
- Disappears in 2–12 months
- May scar
Treatment
Excision, curettage, cautery.