Skin Caners : MELANOMA/ BCC/ SCC
Given clinical history of lump over arm. Exicision Biopsy do
BCC with depth of invasion,deep margin involvement
Q. Describe lesion ? 10 mm Pearly papule with a central ulcer w
on base and rolled in/ Inverted edges with surrounding telangiecta
Q. Why the surrounding skin is red? presence of dilated subepi
( telangiectasia) ? Inflammation
Q. Most propable diagnosis? BCC
Q. D/D? Actinic keratosis, Seborreic keratosis, SCC, Verruca vulg
Q. How does it spread?
,Q. Biopsy shows BCC .What findings to see in Report ? Depth
Margins, palisading ,ulceration
Q. Natural hx of BCC? Indolent with slow progression, locall
limited potential to metastasise(never metastasize), origin fr
sebaceous-apocrine germ , trichoblast.
Q. How would you manage deep margin involvement? R
Q. Treatment : BCC ?
1. Surgical
-Curettage and Electrodissecation: - (scraping away the tum
bleeding with cautery)
-Excision with primary closure, flaps, grafts, and secondary
excision margin 4 mm around the tumour
-Cryotherapy (with liquid nitrogen), but can't obtain tissue bi
-Mohs micrographic surgery
2. Radiotherapy 3. Topical photodynamic therapy PDT - δ-a
acid( 20% ). 5. Topical fluorouracil (5%) imiquimod (5%)
Q. How to prevent recurrence of deep margin involveme
operation? . If recurrent, go for moh’s micrographic surgery
Q. Skin graft placed for pt and subsequently had graft f
Wound infection
Q. Common organism? S. aureus.
Q. Wound c/s grew MRSA? Methicillin -resistant Staphylo
Q. How to manage this pt with MRSA wound infection ?
Outpatient , Abx : ORAL-
oral as clindamycin,amoxicillin plus tetracyclin or tmp/smx,li
Hospitalized patient
Vancomycin Dose to target trough level 7-14days
Linezolid 600 mg BD PO / IV 7-14
Daptomycin 4 mg/kg OD 7-14
Telavancin 10 mg/kg OD 7-14
Clindamycin 600 mg IV / 300 mg PO 3times daily
,cavities, retina and gastrointestinal mucosa.
Q. How is diff from SCC ? Melanoma needs intermittent su
nonmelanoma needs continuous!
. (1) MM arise from lower most layers of epidermis,while SC
superficial layers. (2) MM develops in younger people than
develops anywhere in body, MM develops in particularly sun
(4) Appearance : SCC appears as red bump, scaly patch or
while MM appears as asymmetrical mole with irregular bord
multicoloured. ( 5) Incidence: SCC-16%, MM-4% , (6) MM s
body parts ( mets) , while SCC rarely metastasise. (7) TREA
needs mostly surgical excision while MM needs surgery ,CT
, Ulceration Histologi
Dermal mitotic rate(mitoses per square mm) Neurotro
Peripheral and deep margin status (positive/negative)
Anatomic level of invasion (Clark level)*
classification
Microsatellitosis Tumour in
Vertical
Q. 1mm MM, margins & < 1 MM during procedure, what
next?. Take wider excision !
Q. Lesion excised Breslow thickness 1.5mm, margins 0
Melanoma insitu: 0.5cm,Less than 1mm : 1 cm, 1-4 mm: 1-2
mm : 2cm margin
Q. how to do this intraoperatively? frozen section
Q. Gene responsible for familial MM? CDKN2A and CDK
Q. Poor prognostic factors? Male, old age...ulceration, sit
head n neck
Q.What skin condition is associated with melanoma? X
pigmentosum : autosomal recessive genetic disorder of DN
the ability to repair damage caused by ultraviolet (UV) light
Albinism :congenital disorder characterized by the complete
of pigment in the skin, hair and eyes due to absence or defe
- giant congenital pigmented naevus
- Fitz patric skin type 1
- Dysplastic neavus , multiple nevi
Given clinical history of lump over arm. Exicision Biopsy do
BCC with depth of invasion,deep margin involvement
Q. Describe lesion ? 10 mm Pearly papule with a central ulcer w
on base and rolled in/ Inverted edges with surrounding telangiecta
Q. Why the surrounding skin is red? presence of dilated subepi
( telangiectasia) ? Inflammation
Q. Most propable diagnosis? BCC
Q. D/D? Actinic keratosis, Seborreic keratosis, SCC, Verruca vulg
Q. How does it spread?
,Q. Biopsy shows BCC .What findings to see in Report ? Depth
Margins, palisading ,ulceration
Q. Natural hx of BCC? Indolent with slow progression, locall
limited potential to metastasise(never metastasize), origin fr
sebaceous-apocrine germ , trichoblast.
Q. How would you manage deep margin involvement? R
Q. Treatment : BCC ?
1. Surgical
-Curettage and Electrodissecation: - (scraping away the tum
bleeding with cautery)
-Excision with primary closure, flaps, grafts, and secondary
excision margin 4 mm around the tumour
-Cryotherapy (with liquid nitrogen), but can't obtain tissue bi
-Mohs micrographic surgery
2. Radiotherapy 3. Topical photodynamic therapy PDT - δ-a
acid( 20% ). 5. Topical fluorouracil (5%) imiquimod (5%)
Q. How to prevent recurrence of deep margin involveme
operation? . If recurrent, go for moh’s micrographic surgery
Q. Skin graft placed for pt and subsequently had graft f
Wound infection
Q. Common organism? S. aureus.
Q. Wound c/s grew MRSA? Methicillin -resistant Staphylo
Q. How to manage this pt with MRSA wound infection ?
Outpatient , Abx : ORAL-
oral as clindamycin,amoxicillin plus tetracyclin or tmp/smx,li
Hospitalized patient
Vancomycin Dose to target trough level 7-14days
Linezolid 600 mg BD PO / IV 7-14
Daptomycin 4 mg/kg OD 7-14
Telavancin 10 mg/kg OD 7-14
Clindamycin 600 mg IV / 300 mg PO 3times daily
,cavities, retina and gastrointestinal mucosa.
Q. How is diff from SCC ? Melanoma needs intermittent su
nonmelanoma needs continuous!
. (1) MM arise from lower most layers of epidermis,while SC
superficial layers. (2) MM develops in younger people than
develops anywhere in body, MM develops in particularly sun
(4) Appearance : SCC appears as red bump, scaly patch or
while MM appears as asymmetrical mole with irregular bord
multicoloured. ( 5) Incidence: SCC-16%, MM-4% , (6) MM s
body parts ( mets) , while SCC rarely metastasise. (7) TREA
needs mostly surgical excision while MM needs surgery ,CT
, Ulceration Histologi
Dermal mitotic rate(mitoses per square mm) Neurotro
Peripheral and deep margin status (positive/negative)
Anatomic level of invasion (Clark level)*
classification
Microsatellitosis Tumour in
Vertical
Q. 1mm MM, margins & < 1 MM during procedure, what
next?. Take wider excision !
Q. Lesion excised Breslow thickness 1.5mm, margins 0
Melanoma insitu: 0.5cm,Less than 1mm : 1 cm, 1-4 mm: 1-2
mm : 2cm margin
Q. how to do this intraoperatively? frozen section
Q. Gene responsible for familial MM? CDKN2A and CDK
Q. Poor prognostic factors? Male, old age...ulceration, sit
head n neck
Q.What skin condition is associated with melanoma? X
pigmentosum : autosomal recessive genetic disorder of DN
the ability to repair damage caused by ultraviolet (UV) light
Albinism :congenital disorder characterized by the complete
of pigment in the skin, hair and eyes due to absence or defe
- giant congenital pigmented naevus
- Fitz patric skin type 1
- Dysplastic neavus , multiple nevi
