Malignant cutaneous tumours

Basal cell carcinoma (rodent ulcer)

Overview:

• Most common malignant skin tumour
• Most relate to excessive sun exposure
• Common in later life on exposed sites – although are rare on the ear
• They can present as a slow-growing papule or nodule which may go on to ulcerate
• Telangiectasia over the tumour or a skin-coloured jelly-like ‘pearly edge’ may be seen
• A flat, diffuse superficial form exists (‘morphoeic’)
• The lesion will grow slowly and erode structures if untreated
• Almost never metastasizes

Treatment:

• Usually surgical excision
• Radiotherapy can be useful for large superficial forms
• Curettage is occasionally used in older patients, although not for central facial lesions as they often recur
• Very superficial lesions may be treated with Cryotherapy
• Follow-up is advised

Squamous cell carcinoma

Overview:

• Is a somewhat more aggressive skin tumour which can metastasise
• Most relate to sun exposure and they arise in pre-existing solar keratoses or Bowen’s disease
• They can also arise as a result of chronic inflammation, such as in lupus vulgaris
• Rarely, multiple tumours may arise owing to arsenic ingestion in early life
• Multiple tumours also occur in people who have had prolonged periods of immunosuppression
• They present clinically as fairly rapidly growing nodules which often ulcerate
• Examination of regional lymph nodes is essential
• They are most common on sun-exposed sites in later life
• One should have a high index of suspicion for ulcerated lesions on the lower lip or ear

Treatment:

• Excision or radiotherapy

Malignant melanoma

Overview:

• Is the most serious form of skin cancer as metastasis can occur early and it causes a number of deaths, even in young people
• Risk factors include:
• Childhood sun exposure
• Sun burning
• Atypical mole syndrome
• Giant congenital melanocytic naevi
• Positive family history of malignant melanoma
• Is more common in later life but many young adults are also affected
• It should always be suspected in rapidly growing or bleeding pigmented lesions
• A halo of erythema or the appearance of satellite lesions should also alert the examiner

4 clinical types exist:

• Lentigo maligna melanoma:
• Is where a patch of lentigo maligna develops a papule or nodule, signalling invasive tumour
• Superficial spreading malignant melanoma:
• Is a large, flat, irregularly pigmented lesion which grows laterally before vertical invasion develops
• Nodular malignant melanoma:
• Is the most aggressive type
• It presents as rapidly growing pigmented nodules which bleed or ulcerate
• Acral lentiginous malignant melanoma:
• Arise as pigmented lesions on the palm, sole or under the nail
• Usually present late

Treatment:

• Urgent wide local excision of the lesion
• Metastatic disease is best managed by an oncologist and can involve surgery to lymph nodes, radiotherapy, immunotherapy and chemotherapy