Basal and Squamous Cell Carcinoma

Bernard Ho looks at these common and important types of skin cancers.

 

Lecture by

Video Duration: 5 minutes

  • Squamous Cell Carcinoma
    Created by Alison Thornton
    General
    Epidemiology

    SCC is the 2nd most common form of skin cancer after BCC

    It affects males more than females, and the elderly

    Common in patients who have had an organ transplant or long term immunosuppression

    Is aggressive and can metastasise!

    Pathology

    Malignant proliferation or keratinocytes

    Top three causes

    1. Chronic UV exposure

    2. Carcinogen exposure: Tar, Soot, Arsenic, Smoking and HPV 16,18

    3. DNA repair defect: Xeroderma Pigmentosum

    Clinical Features
    Symptoms

    Patients present with a rapidly growing lesion commonly on face, arms, hands

    Patient may be asymptomatic

    RED flag signs to look out for:

    - recent unexplained weight loss

    - night sweats

    - fever

    Signs

    Lesion:

    Hyperkeratotic

    Crusting

    Ulceration

    Not healing

    Recurrent bleeding

    Investigations
    Cultures

    None

    Bloods

    FBC - anaemia

    LFTs - Liver metastasis

    Imaging

    CT/ MRI to see if any metastasis

    Scopic/Biopsy

    Biopsy and Histology

    Functional

    None

    Treatment
    Conservative

    Education on sun exposure

    Medical

    Topical Fluorouracil 5% cream

    Radiotherapy

    Surgical

    Surgical excision - margin of 4mm around tumour

    Good prognosis

  • Basal Cell Carcinoma
    Created by Alison Thornton
    General
    Epidemiology

    BCC is the most common form of skin cancer

    It affects males > females, and the elderly population

    Pathology

    Malignant proliferation of basal cells of the epidermis, which grows slowly, commonly on the nose

    Top three causes

    1. UV exposure, Skin type 1/2

    2. Resin, Tar, Arsenic

    3. Congenital: Gorlins

    Clinical Features
    Symptoms

    Patient present commonly with a slow progressive lesion on the face, scalp, ears, trunk.

    Apart from the lesion, patient may be asymptomatic.

    RED flag signs to look out for:

    - recent unexplained weight loss

    - night sweats

    - fever

    Signs

    O/E of lesion:

    - umbilicate centre

    - telangiectasia

    - shiny pearly nodule

    Investigations
    Cultures

    None

    Bloods

    None

    Imaging

    CT/MRI if bony involvement or potential for nerve invading

    Scopic/Biopsy

    Biopsy and histology

    Functional

    None

    Treatment
    Conservative

    None

    Medical

    Topical: Imiquimod 5% cream - affective for superficial tumours.

    Topical: Fluorouracil 5% cream - used for multiple superficial on trunk and limbs.

    Surgical

    Surgical excision - margin of 4mm around tumour.

    Moh's microscopic surgery - cure rate of nearly 100%.