medical school mindmap

1. Skin tumour 2
skin tumour
malignant
locally aggressive
only rarely have the
potential to
metastasise(typical
exception is
melanoma)
primary(usually)
squamous
epithelium(commonest
origin)
basal cell carcinoma(BCC)
tumour composed of
small, dark cells
resembling basal cells of
epidermis
cell and nuclei arrange in
parallel - 'palisadin'
local invasion risk of local
destruction
esp near eye and
nose=rodent ulcer
risk factors
UV light(UV-B), radiation,
immune suprresion
age, skin type, geography
treatment
surgical excision
Moh's micrographic
surgery if 'high risk'
cryotheraphy,
electrosurgery,
photodynamic therapy,
radiotherapy) if local destruction
5-FU, imiquimod topical treatment
high risk specialist treatment
squamous cell
carcinoma(SCC)
show differentiation
towards keratin
production
good prognosis overall
mets uncommon
if there is usually to
regional lymph node
if on lip, thick/deep or
large tumours, arising in
non sun damaged skin
a/w chronic ulcers or prior
skin disease poorer prognosis
treatment excision
risk factors
sun exposure(UV light)
radiation
immunosuppresion
edge of old scars, burns,
sinuses, chronic
ulcers=MARJOLIN'S
ULCER
genetic
rare
albinism, xeroderma
pgimentosum(unable to
repair induce DNA
damage
BCC+SCC=non-melanoma
skin cancer(NMSC)
locally invasive but rare
cause of mets or death
epidemiology
strongly linked to age
70% >65 yrs
often multiple sun
exposed sites
BCC exceptionally rare
cause of mets
SCC uncommon cause of
mets/death
melanocytes-much less common malignant melanoma
potentially more
aggreassive
outcome depends on
stage at diagnosis
doesn't always produce pigment can be amelanotic
development and spread
of melanoma
progress through stages
in-situ confine to dermis
invasion into dermis
spread withing
skin-satellites tumour
nodules
mets spread to lymph nodes
mets spread via
blood-liver lung and brain
prognostic factors stage
TNM
depends on Breslow
thickness(thickness of
lesion)
histological classification
of invasive melanoma
superficial spreading
nodular invasive at the outset
acral
palms, soles, nails, rare,
commonest form in black
people
lentigo maligna
melanoma=hutchinson's
melanostic freckle
treatment
primary excision
margin of clearance related to tumour invasion
role of sentinel node biopsy
do not shave
risk factors
fair skin, freckle/ burn,
blur eyes, red hair
chronic sun damage or hx
or early sunburn
previous UV radiation
Subtopic
prevention
avoid sun
sunbed regulation
early detection and
treatment
clinical
suspicion-changing/new
mole beyond young
adulthood
A-asymmetry
B-border irregularity
C-colour variation
D-diameter>0.5 cm
E-expanding(change:itch,
bleed,ulcerates, satellites
skin malignancy related to
UV-B light exposure
light skin, fair/red hair,
pale eyes, freckles
outdoor work, live in equator
SCC related to cumulative exposure
most melanoma related to
intense/intermittent exp.
BCC intermediate
UV-A also importants
secondary
metastasis to skin
dysplastic epidermal
precursor lesion
low risk overall
long interval for
progression to invasive
SCC
treatment
local destruction, topical agents
ACTINIC(SOLAR)
KERATOSIS
epidermis shows dysplasia
ranging from mild to
severe but short of in situ
squamous cell carcinoma
BOWEN'S
DISEASE=IN SITU
SQUAMOUS CELL
CARCINOMA
epidermis with full
thickness/severe dysplasia
equivalent to in situ
squamous carcinoma
pigmented skin lesions
melanocytic lesion
typically pigmented
many non
melanocytic skin
lesions pigmented
seborrhoeic keratosis,
BCC, dermatofibroma
vascular lesion
caution
all lumps. bumps,
pigmented lesions/moles
removed fromskin: send
for pathological analysis
so that melanoma is no
missed
benign melanocytic lesions
freckle(ephelis)
localised area of increased
melanin production
benign lentigo
flat lesion with increase
number of melanocytes in
the basal layer of
epidermis
long term sun exposuresolar lentigo=liver spots
melanocytic
naevus=pigmented
mole
naevus=benign(or
hamartomatous)
proliferation of one or
other skin element
congenital naeviat birth
acquired naeviby teens/twenties
lesions evolve with time
3 common variants reflect
the evolution
junctional
compound
intradermal
- - Mindjet