With respect to basal cell carcinoma:
There is a higher recurrence rate with the infiltrative subtype. Recurrence is greatest in the infiltrative subtype. Morpheaform (sclerosing) subtype is also associated with a high recurrence rate. Metastases are limited to case reports/small case series.
The following best describes a 3.1mm nonulcerated melanoma with no nodal or distant metastasis:
T3aN0M0 (Stage IIA). The AJCC classification for melanoma is widely reproduced.
References: 1. Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, Fleming ID, Gershenwald JE, Houghton A Jr, Kirkwood JM, McMasters KM, Mihm MF, Morton DL, Reintgen DS, Ross MI, Sober A, Thompson JA, Thompson JF. Final version of the American Joint Committee on Cancer Staging system for cutaneous melanoma. J Clin Oncol 2001; 19(16): 3635-48.
Which of the following skin pathologies and their classic histologic features are correctly matched?
Merkel cell carcinoma (MCC) and small basophilic neuroendocrine cells. Basophilic cells with peripheral pallisading is a feature of nodular BCC. Keratin production is rare in melanoma, but common in SCC, and storeiform arrangement of fibroblasts is associated with dermatofibroma sarcoma protuberans.
The following best describes a 3.5mm ulcerated melanoma with no nodal or distant metastasis:
Stage 2B. The AJCC classification for melanoma is widely published.
A patient with a 1cm diameter SCC of the lower lip vermillion:
Requires excision with a minimum 4mm margin. Guidelines published by Motley et al recommend 4mm margins for low-risk lesions and 6mm margins for high-risk lesions. Metastasis from an SCC of this size is relatively uncommon, but depends on the grade of tumour and depth of infiltration. Those greater than 4mm in depth are especially prone to metastasize. Combined photodynamic therapy with CO2 laser has been shown to be effective in selected cases of BCC. PDT monotherapy is also effective in small and superficial lesions, and is also especially useful in cases of Bowen’s disease. However, PDT is not indicated at present in the management of SCC. Experimental evidence does, however, show some potential for non-surgical modalities in the treatment of melanoma and SCC.
References: 1. Motley R, Kersey P, Lawrence C; British Association of Dermatologists; British Association of Plastic Surgeons. Multiprofessional guidelines for the management of 7 Cutaneous malignancy and sarcoma 227 section 7 answers_section 7 answers.qxd 26-04-2013 16:47 Page 227 the patient with primary cutaneous squamous cell carcinoma. Br J Plast Surg 2003; 56(2): 85-91. (Dermatologists use this reference: Br J Dermatol 2002; 146(1): 18-25. which is the same article).
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