Dermatology. Basal Cell Carcinoma (BCC)

Август 21, 2022

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Dermatology. Basal Cell Carcinoma (BCC)

Содержание

2. 3.001
3. Basal Cell Carcinoma (BCC) Age: usually >35 years More frequent in males Mostly on sun-exposed areas:
4. Basal Cell Carcinoma (BCC) Pearly edge
5. Implantation dermoid cysts as the result of implantation of epidermal fragments into the dermis by a
6. Amelanotic malignant melanoma Amelanotic melanoma is a form of melanoma The malignant cells have little to
7. Amelanotic malignant melanoma
8. External angular dermoids Looks like subcutaneous lumps at the lateral angle of the eye
9. Keratoacanthoma Tumour of keratinocytes Occur singly on light-exposed areas Raised crater with central keratin plug Grows
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11. Malignant melanoma
12. Melanoma Typical age range 30–50 years (average 40 years) Can occur anywhere on the body—more common:
13. Melanoma Prognosis thickness (Breslow classification) level or depth (worse in level IV or V) site (worse
14. Management points for naevi and melanomas
15. Neuropathic ulcer A neuropathic ulcer is one that occurs as a result of peripheral neuropathy Neuropathic
16. Diabetic foot ulcer A feature is a deep, punched-out lesion over pressure points. The ulcers may
17. Burkholderia pseudomallei Melioidosis is an uncommon tropical disease caused by the bacterium, Burkholderia pseudomallei a soil
18. Burkholderia pseudomallei
19. Necrotising fasciitis Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia
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Basal Cell Carcinoma (BCC)
Age: usually >35 years
More frequent in males
Mostly on

sun-exposed areas: face (mainly), neck, upper trunk, limbs
May ulcerate easily = ‘rodent ulcer’
Slow-growing over years
Has various forms: nodular, pigmented, ulcerated, etc.
Does not metastasise via lymph nodes or bloodstream

Management:
Simple elliptical excision (3–4 mm margin) is best.
Photodynamic therapy—response rate is >90% for nodular and superficial BCCs.
Cryotherapy is suitable for well-defined, histologically confirmed, superficial tumours at sites away from head and neck.

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Basal Cell Carcinoma (BCC)
Pearly edge

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Implantation dermoid cysts
as the result of implantation of epidermal fragments into

the dermis by a penetrating injury.
The epidermis continues to grow and forms a cyst lined with stratified squamous epithelium and filled with keratin

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Amelanotic malignant melanoma
Amelanotic melanoma is a form of melanoma
The malignant cells

have little to no pigment
Risk factors: Increasing age, Sun-exposed skin
May present as an erythematous scaly macule, plaque, or nodule with irregular borders

Treatment:
wide local excision of the wound with a 10–20 mm margin of normal tissue
Amelanotic melanoma can metastasis. These cases require individualized treatment that may include surgery, radiotherapy, chemotherapy

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Amelanotic malignant melanoma

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External angular dermoids
Looks like subcutaneous lumps at the lateral angle of

the eye

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Keratoacanthoma
Tumour of keratinocytes
Occur singly on light-exposed areas
Raised crater with central

keratin plug
Grows to 2 cm or more
Can be confused with SCC
Treatment is surgical excision and histological examination. Ensure a 2–3 mm margin for excision.

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Malignant melanoma

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Melanoma
Typical age range 30–50 years (average 40 years)
Can occur anywhere on

the body—more common: lower limbs in women, upper back in men
Often asymptomatic
Can bleed or itch

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Melanoma
Prognosis
thickness (Breslow classification)
level or depth (worse in level IV or V)

site (worse on head and neck, trunk)
sex (worse for men)
age (worse >50 years)
amelanotic melanoma
ulceration

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Management points for naevi and melanomas

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Neuropathic ulcer
A neuropathic ulcer is one that occurs as a result

of peripheral neuropathy
Neuropathic ulcers can develop with any condition with peripheral neuropathy
Associated with diabetes, syphilis, leprosy and other neuropathies.

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Diabetic foot ulcer
A feature is a deep, punched-out lesion over pressure

points.
The ulcers may extend to the bone and into joints.
They are prone to secondary infection.
Treatment is based on controlling the diabetes and clearing infection with appropriate antibiotics, but referral for surgical management is usually essential.

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Burkholderia pseudomallei
Melioidosis is an uncommon tropical disease caused by the bacterium,

Burkholderia pseudomallei
a soil saprophyte that infects humans mainly by penetrating through skin wounds, especially abrasions
It is mostly acquired while wading in rice paddies
fever + pneumonia + myalgia → melioidosis
Treatment: antibiotics are given intravenously initially for the first 10–14 days.

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Burkholderia pseudomallei

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Necrotising fasciitis
Necrotising fasciitis is a very serious bacterial infection of the

soft tissue and fascia
The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels.
The result is the destruction of the soft tissues and fascia.
There is poor adherence of tissue to the fascia on incising the site.
Necrotic tissue/pus oozes out of the fascial planes.
Dishwater-coloured fluid seeps out of the skin.
Typically, necrotising fasciitis does not bleed

Dermatology. Basal Cell Carcinoma (BCC)

Содержание

3.001

Basal Cell Carcinoma (BCC)Age: usually >35 yearsMore frequent in malesMostly on

Basal Cell Carcinoma (BCC)Pearly edge

Implantation dermoid cystsas the result of implantation of epidermal fragments into

Amelanotic malignant melanomaAmelanotic melanoma is a form of melanomaThe malignant cells

Amelanotic malignant melanoma

External angular dermoidsLooks like subcutaneous lumps at the lateral angle of

KeratoacanthomaTumour of keratinocytes Occur singly on light-exposed areasRaised crater with central

3.002

Malignant melanoma

MelanomaTypical age range 30–50 years (average 40 years)Can occur anywhere on

MelanomaPrognosisthickness (Breslow classification)level or depth (worse in level IV or V)