Dermatology - Skin Cancers for Medical Students
Summary
TLDRIn this educational video, Jade, a medical student, discusses common skin cancers: basal cell carcinomas (BCC), squamous cell carcinomas (SCC), and malignant melanomas. She explains the characteristics, risk factors, and appearances of these tumors, using dermatological terms to describe them. Jade also covers various treatment options, including surgical excision, cryotherapy, photodynamic therapy, and radiotherapy, emphasizing the importance of early detection and management for better prognosis.
Takeaways
- 🌞 Basal cell carcinomas (BCC) are slow-growing, invasive malignant tumors of epidermal keratinocytes, often caused by UV exposure.
- 🌚 BCCs can present as nodular, superficial, cystic, morphic, carrot otic, or pigmented, with nodular being the most common.
- 🏥 Treatment for BCC includes cryotherapy, topical treatments, surgical excision, and Mohs micrographic surgery.
- 📈 Squamous cell carcinomas (SCC) are fast-growing, invasive tumors that can metastasize, sharing similar risk factors with BCC.
- 🔍 Suspicious SCC lesions should be surgically excised and examined histologically to confirm diagnosis.
- 🏥 Management of SCC involves surgical excision, possibly plastic surgery referral, radiotherapy, and chemotherapy for metastatic disease.
- 🖤 Malignant melanomas are invasive malignant tumors of melanocytes, with superficial spreading being the most common type.
- 🔎 Key features of suspicious melanomas include asymmetry, border irregularity, color irregularity, diameter over 7mm, and evolution of the lesion.
- 🩺 Suspicious melanoma lesions require excision biopsy for diagnosis, with imaging and sentinel node biopsy considered for metastasis.
- 🏥 Malignant melanomas are treated with wide local excision, possibly involving regional lymph node removal, and radiotherapy or chemotherapy if surgery is inappropriate.
- ⚠️ Early detection and treatment are crucial for all skin cancers to prevent metastasis and improve prognosis.
Q & A
What is a basal cell carcinoma (BCC)?
-A basal cell carcinoma is a slow-growing invasive malignant tumor of epidermal keratinocytes. It originates from the cells that produce keratin, which forms the protective barrier of the skin.
What are the different types of BCC mentioned in the script?
-The script mentions several types of BCC: nodular, superficial, cystic, morphic, carrot otic, and pigmented. The most common type is nodular.
What are the risk factors for developing basal cell carcinomas?
-Risk factors for developing BCC include UV exposure, history of frequent or severe sunburn in childhood, skin type 1, increasing age, male gender, immunosuppression, family history of skin cancers, and personal history of skin cancer.
How would you describe the appearance of a nodular BCC?
-A nodular BCC is described as a round pearly pink papule or nodule with notable telangiectasia, a well-defined border, central depression, and rolled edges. It may also appear dry and flaky.
What is the difference between a papule and a nodule in dermatological terms?
-In dermatology, a papule is a small, solid elevation less than 0.5 centimeters in diameter, while a nodule is a larger solid elevation greater than 0.5 centimeters in diameter.
What is telangiectasia and how does it relate to BCC?
-Telangiectasia refers to dilated red blood vessels visible on the skin. In BCC, telangiectasia can be observed as dilated red blood vessels on the skin lesion.
How is a basal cell carcinoma typically managed?
-Basal cell carcinomas are typically managed by surgical excision with histology, which includes a margin of normal skin around the tumor. Other options include cryotherapy, topical photodynamic therapy, and topical treatments like Emiquon Maude cream.
What is a squamous cell carcinoma (SCC)?
-A squamous cell carcinoma is a fast-growing invasive malignant tumor of epidermal keratinocytes that can metastasize. It is associated with risk factors similar to BCC, such as excess UV exposure and immunosuppression.
What are the signs that distinguish a malignant melanoma from other skin conditions?
-Malignant melanomas are distinguished by the presence of an asymmetrical, irregularly bordered, colored irregularly pigmented lesion with a diameter of over seven millimeters. Symptoms such as bleeding or itching can also raise suspicion.
How is a malignant melanoma diagnosed and treated?
-A malignant melanoma is diagnosed through excision biopsy for histological confirmation. It is treated with wide local excision, possibly including the removal of regional lymph nodes based on clinical findings and sentinel node biopsy results. Radiotherapy and chemotherapy may also be necessary in certain cases.
What does the 'ABCD' rule refer to in the context of melanoma detection?
-The 'ABCD' rule is a mnemonic used to identify suspicious moles or pigmented lesions that may indicate melanoma. It stands for Asymmetry, Border irregularity, Color irregularity, and Diameter over 6 millimeters.
Outlines
🌞 Basal Cell Carcinomas Explained
Jade, a medical student, discusses basal cell carcinomas (BCC), a slow-growing malignant tumor originating from epidermal keratinocytes. She explains the role of keratinocytes in skin protection and the differentiation process from stem cells in the stratum basale to the stratum corneum. Jade outlines various types of BCC, including nodular, superficial, and pigmented, with nodular being the most common. Risk factors such as UV exposure, skin type, age, gender, immunosuppression, and family history are highlighted. She describes a BCC lesion's appearance, noting its round, pearly pink, papule or nodule form with telangiectasia. Jade also discusses treatment options like cryotherapy, topical treatments, surgical excision, and Mohs micrographic surgery. She emphasizes BCC's good prognosis due to low metastasis rates but mentions the risks of treatment failure and recurrence.
🔍 Squamous Cell Carcinomas and Malignant Melanomas
The script continues with a discussion on squamous cell carcinomas (SCC), which are fast-growing and can metastasize. Jade mentions risk factors similar to BCC and the significance of a history of precancerous conditions like Bowen's disease and actinic keratosis. She describes an SCC lesion, noting its large, asymmetrical, well-defined nodule with ulceration and telangiectasia. Jade stresses the importance of surgical excision for diagnosis and the potential need for further investigations like sentinel node biopsy and imaging due to metastasis risks. Management strategies include surgical excision, Mohs micrographic surgery, radiotherapy, and chemotherapy. The final part of the paragraph covers malignant melanomas, explaining their origin from melanocytes and the different types such as superficial spreading, nodular, and acral lentiginous. Jade guides on how to describe a melanoma lesion, focusing on asymmetry, border, color, and diameter (ABCDE rule). She advises excision biopsy for diagnosis and discusses treatments like wide local excision, lymph node removal, radiotherapy, and chemotherapy for metastatic disease.
🏥 Treatment and Management of Skin Cancers
In the final paragraph, Jade summarizes the treatment approaches for skin cancers. She mentions wide local excision as a common treatment for malignant melanomas and the potential need for regional lymph node removal based on clinical findings and sentinel node biopsy results. Jade also discusses the use of radiotherapy when surgery is not suitable and chemotherapy for metastatic disease. The paragraph concludes with a thank you note to the viewers for watching the video.
Mindmap
Keywords
💡Basal Cell Carcinoma (BCC)
💡Keratinocytes
💡Telangectasia
💡Squamous Cell Carcinoma (SCC)
💡Malignant Melanoma
💡Melanocytes
💡Asymmetry
💡Border Irregularity
💡Color Irregularity
💡Diameter
💡Excision Biopsy
Highlights
Jade introduces the topic of the video: basal cell carcinomas, squamous cell carcinomas, and malignant melanomas.
Definition of basal cell carcinoma as a slow-growing invasive malignant tumor of epidermal keratinocytes.
Explanation of keratinocytes' role in producing keratin for skin protection.
Description of the types of basal cell carcinomas: nodular, superficial, cystic, morphic, carrot otic, and pigmented.
Risk factors for developing basal cell carcinomas include UV exposure, skin type, age, gender, immunosuppression, and family history.
Visual description of a basal cell carcinoma lesion, including its characteristics.
Differentiation between papule and nodule based on diameter.
Management options for basal cell carcinomas such as cryotherapy, topical treatments, surgical excision, and radiotherapy.
Importance of surgical excision with a margin of normal skin to prevent recurrence.
Description of squamous cell carcinoma as a fast-growing invasive tumor that can metastasize.
Risk factors for squamous cell carcinomas, including genetic predisposition and history of precancerous conditions.
Visual description of a squamous cell carcinoma lesion, noting its asymmetry and ulceration.
Investigations for squamous cell carcinomas, such as surgical excision with histology and potential further imaging.
Management of squamous cell carcinomas through surgical excision, Mohs micrographic surgery, and other treatments.
Introduction to malignant melanomas, which are invasive malignant tumors of melanocytes.
Different types of malignant melanomas and their common presentations.
Visual description of a malignant melanoma lesion, focusing on asymmetry, border irregularity, and color variation.
Importance of examining the evolution of a lesion and symptoms like bleeding or itching in diagnosing melanoma.
Diagnostic process for melanomas, including excision biopsy and sentinel node biopsy.
Treatment options for malignant melanomas, such as wide local excision, lymph node removal, and radiotherapy.
Transcripts
hi everyone my name is Jade and I'm a
medical student in Leicester in this
video we will be talking about basal
cell carcinomas squamous cell carcinomas
and malignant melanomas we will be
revising dermatology terminology as we
go along to
[Music]
let's start by talking about basal cell
carcinomas a basal cell carcinoma is a
slow growing invasive malignant tumor of
epidermal keratinocytes remember the
keratinocytes are the cells that produce
keratin the substance which makes the
skin a protective barrier keratin helps
keep moisture in and microbes out a
group of actively dividing stem cells
differentiate to form keratinocytes in
the deepest layer of the epidermis that
is the stratum basale II or the basal
cell layer and the keratinocytes move
towards the skin surface as they
continue to differentiate and mature
further the outermost layer of the
epidermis the stratum corneum is
essentially a layer of dead
keratinocytes and keratin there are
several types of BCC nodular superficial
cystic morphic carrot otic and pigmented
the most common type of BCC however is
nodular risk factors for developing BCC
include UV exposure for example Sun bed
use or occupational exposure history of
frequent or severe sunburn in childhood
skin type 1 which refers to skin that
never tans and always burns increasing
age male gender immunosuppression for
example if there's a past medical
history of HIV family history of skin
cancers and finally a personal history
of skin cancer here's a picture of a BCC
how would you describe this lesion pause
the video now and try to think of some
dermatological terms to describe the
appearance of the lesion I would say
that this is a round pearly pink papule
or nodule with notable telangiectasia
and a well-defined border there is an
area of central depression and rolled
edges the lesion also appears dry and
flaky if possible I'd like to comment on
the diameter of the lesion and its site
but in this case we don't have this in
formation this lesion is likely a
nodular BCC you might be wondering why I
said papule or nodule simply because I
don't know the diameter of the lesion if
the lesion is less than 0.5 centimeters
in diameter then it can be described as
a papule if it is more than 0.5
centimeters in diameter it must be one
of these two as we can see from the
image that the lesion is raised if it
was not raised we may use terms like
macule or patch another important point
to note is that the term telangiectasia
refers to dilated red blood vessels that
we can see on this skin lesion BCC's
commonly appear on the head and neck
which have the Sun exposed areas when
patients present with bcc's firstly of
course they'll mention the slowly
growing lesion but they may also mention
spontaneous bleeding or ulceration how a
basal cell carcinoma is managed one
option is cryotherapy which involves
freezing the lesion with liquid nitrogen
and allowing it to crust over and fall
off another option is topical
photodynamic therapy we can also
consider topical treatment including
Emiquon Maude cream if the lesion is
small or low-risk the most common
management however is surgical excision
and histology which should include a
three to five millimeter margin of
normal skin around the tumor to prevent
recurrence if the arrow too big sized is
very large consider a plastics referral
Mohs micrographic surgery can be done if
the lesion is high-risk for example if
it's around the eyes nose or lips if
it's infiltrative or recurrent finally
you may consider radiotherapy if surgery
is considered inappropriate
bcc's are associated with a good
prognosis as they rarely metastasize but
there is a risk of treatment failure or
recurrence of BCC as well as
immunosuppression and damage to local
tissues now let's move on to squamous
cell carcinoma a squamous cell carcinoma
is a fast-growing invasive
lignan tumor of epidermal keratinocytes
which can metastasize risk factors are
the same for BCC for example excess UV
exposure immunosuppression genetic
predisposition but also if there's a
history of bowen disease and actinic
keratosis bowen disease is a
precancerous in situ sec that can evolve
to become sec here's a picture of an sec
pause this video now and see if you can
have a go at describing this lesion
using dermatological terms
I would say that this is a large
asymmetrical well-defined nodule on the
right anterior aspect of the patient
scalp it has an irregular border with
rolled edges keratosis and
telangiectasia there is a large area of
central ulceration there are no signs of
infection and surrounding skin seems
normal
I would also comment on the diameter if
I was able to when there is a high
suspicion for sec based on clinical
features and presentation the most
important investigation to perform is
surgical excision with histology this
will confirm the diagnosis if the SCC is
classified as high risk based on biopsy
results then you may also need to
perform further investigations due to
the risk of metastasis for example a
sentinel node biopsy and imaging like
ultrasound scan x-ray CT or MRI this
condition is managed by surgical
excision usually and if the lesion is
very large consider referral for a
plastic surgeons opinion most
micrographic surgery can be performed if
the sec is high-risk or recurrent
radiotherapy if the lesion is large or
non receptacle and finally chemotherapy
for metastatic disease
the final skin cancer we will cover is
malignant melanomas a malignant melanoma
is an invasive malignant tumor of the
epidermal melanocytes melanocytes are
the cells in the basal layer of the
epidermis that produced the pigment
melanin which is important to absorb UV
light and prevent skin burning remember
that non cancerous growth of melanocytes
results in moles also called benign
melanocytic nevus and freckles there are
a few different types of malignant
melanomas the most common type is
superficial spreading which is commonly
seen on the arms legs back and chest and
seen in young people the second most
calm
type is not yella which is associated
with an erythematous nodule that bleeds
easily Lent aegyo malignus less common
and is typically seen in older people
who have a history of sun exposure a
cruel Antigonus is another rare form
which is seen usually in the
afro-caribbean or South Asian population
it presents as a darkening or
pigmentation of the nails palms or soles
of feet patients may present with a
lesion like the one in the picture pause
the video now and try to describe the
lesion you see I would say that this is
an oval-shaped pigmented macule or patch
with an irregular but well-defined
border it is asymmetrical and there is
color irregularity I would also comment
on diameter and sight if I knew that
information why did I say macula or
patch simply because I do not know the
diameter of the lesion although I would
expect it to be macula patches are much
larger flat areas of altered color or
texture in your history you'd want to
ask about the evolution of the lesion
that is how the lesion has changed over
time and how quickly and symptoms such
as bleeding or itching these two
features would make you highly
suspicious of malignant melanoma as
opposed to benign skin conditions like
actinic keratosis on examination you
would want to look for asymmetry border
irregularity color irregularity and
diameter of the lesion remember this as
a b c d it's important to look for these
four features in any pigmented lesion
two or more colors within the lesion and
a diameter of over seven millimeters
should increase your suspicion of
melanoma also palpate regional lymph
nodes for lymph adenopathy as malignant
melanomas have the potential to
metastasize suspicious lesions should
undergo excision biopsy for confirmation
of the diagnosis on histology the lesion
is surgically removed with a small
clinical margin for pathological
examination
and to prevent recurrence depending on
the results of the biopsy you may
consider forms of imaging to look for
metastasis as well as sentinel node
biopsy malignant melanomas are treated
with wide local excision usually it may
also be necessary to remove the regional
lymph nodes depending on clinical
examination findings as well as the
results of the sentinel node biopsy
radiotherapy may be necessary if surgery
is deemed inappropriate and chemotherapy
if metastatic disease thanks for
watching
5.0 / 5 (0 votes)