Dermatology - Skin Cancers for Medical Students

Summary

In 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

00:00

🌞 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.

05:01

🔍 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.

10:03

🏥 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.

Keywords

💡Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma (BCC) is a slow-growing, invasive malignant tumor that originates from epidermal keratinocytes. Keratinocytes are cells that produce keratin, a substance that forms a protective barrier on the skin. BCC is the most common type of skin cancer and is characterized by its slow growth and low tendency to metastasize. In the script, BCC is described with various subtypes such as nodular, superficial, and pigmented, with nodular being the most common. The description of a BCC lesion includes terms like 'round pearly pink papule' and 'notable telangiectasia,' illustrating its appearance.

💡Keratinocytes

Keratinocytes are the predominant cells in the epidermis, the outermost layer of the skin. They produce keratin, which helps in maintaining the skin's protective barrier function. In the video, keratinocytes are mentioned as the cells that differentiate from actively dividing stem cells in the stratum basale to form the protective layer of the skin. They are integral to understanding the development of BCCs, as these cancers arise from these cells.

💡Telangectasia

Telangectasia refers to the dilation of small blood vessels, which can be visible on the skin as red, thread-like lines. In the context of the video, telangiectasia is used to describe the appearance of a BCC lesion, where the dilated blood vessels are noticeable, contributing to the 'notable telangiectasia' mentioned in the description of the lesion.

💡Squamous Cell Carcinoma (SCC)

Squamous Cell Carcinoma (SCC) is a type of skin cancer that arises from squamous cells, which are flat, scale-like cells found in many body tissues, including the skin. Unlike BCCs, SCCs can metastasize, making them more aggressive. The video script describes SCC as a 'fast-growing invasive malignant tumor' and discusses its risk factors, which are similar to those of BCC, such as excessive UV exposure and immunosuppression.

💡Malignant Melanoma

Malignant Melanoma is a type of skin cancer that develops from melanocytes, the cells that produce melanin, the pigment responsible for skin color. It is the most dangerous form of skin cancer due to its potential to metastasize quickly. The video script discusses different types of malignant melanomas, such as superficial spreading and nodular, and emphasizes the importance of examining for asymmetry, border irregularity, color irregularity, and diameter (the ABCD rule) when suspecting melanoma.

💡Melanocytes

Melanocytes are the cells in the basal layer of the epidermis that produce melanin, the pigment that determines skin color and protects against UV radiation. In the video, melanocytes are the origin of malignant melanomas, and their function in producing melanin is crucial for understanding the development of pigmented lesions like moles and melanomas.

💡Asymmetry

Asymmetry, in the context of dermatological examinations, refers to a lack of balance or equal distribution of features on either side of a lesion. The video script mentions asymmetry as a key feature to look for in suspect melanomas, as benign moles are typically symmetrical, while malignant ones are not.

💡Border Irregularity

Border irregularity is a term used to describe the uneven, notched, or scalloped edges of a skin lesion. In the video, border irregularity is highlighted as a characteristic of suspicious pigmented lesions, which is a departure from the smooth, even borders often seen in benign conditions.

💡Color Irregularity

Color irregularity indicates a patchy or varied color distribution within a skin lesion. The video script points out that color irregularity, where a lesion contains two or more colors, is a warning sign for potential malignant melanoma and should be examined closely.

💡Diameter

Diameter, in dermatology, refers to the size of a skin lesion, typically measured in millimeters. The video script emphasizes that a diameter of over six millimeters increases suspicion of melanoma, which is why it is a critical factor in the ABCD rule for melanoma detection.

💡Excision Biopsy

Excision biopsy is a surgical procedure to remove a suspicious lesion entirely for pathological examination. In the video, excision biopsy is mentioned as a method to confirm the diagnosis of skin cancers like BCC, SCC, and malignant melanoma. It allows for the examination of the entire lesion to determine if cancer cells are present and to assess the margins for potential cancer cells remaining.

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