Skin Malignancies : Mnemonics

Malignant Melanoma

Diagnosis or Clinical features:

Mnemonic: ABCDE

Asymmetric with non-matching sides
Borders are irregular
Color is not uniform (variegated)
Diameter >6 mm (pencil eraser)
Evolving lesions (size, shape, surface, color, symptoms)

Risk factors:

Mnemonic: MM RISK

Moles: atypical nevus (>5)
Moles: common moles (>50)
Red hair and/or freckling
Inability to tan (skin types I and II)
Sunburn history (severe sunburn before age 14)
Kindred (family history of melanoma)

Pathologic Types:

Mnemonic: Melanoma Always Spreads to Nodes (in order of worsening prognosis)

Mnemonic	Type	Incidence	Site	Growth pattern
Melanoma	Maligna – lentiginous	10-15%	Face (Precursor – Hutchison’s freckles/lentigo maligna)	long in-situ stage before vertical growth
Always	Acral lentiginous	30-70% dark skinned (most common in dark skinned) 5% fair skinned	Palm, soles, nail beds Hutchison’s sign – extension of acral lentiginous melanoma to nail folds
Spreads to	Superficial spreading	50% (most common)	Trunks (male), legs (female)	grows radially before vertically
Nodes	Nodular	15% (5% are amelanocytic)	Trunks & legs	only vertically

“nodular melanoma – October 10, 2015” by |E|E| is licensed under CC BY-NC-SA 2.0.

Clarke’s level: Anatomical measure of tumor depth –

Mnemonic for layers of skin: E-D-F; Dermis has 2 layers (P comes before R)

Epidermis (level I; best porgnosis)
Dermis – Papillary (level II)
Dermis – Papillary and Reticular junction (level III)
Dermis – Reticular (level IV)
Fat (level V; worst prognosis – 75% chance of 5-year recurrence)

Breslow’s thickness: the depth of invasion from the stratum granulosum

Stage	Breslow thickness	5-year survival	Resection margin
Insitu	Insitu	90-100%	0.5 cm
I	<1 mm	80-90%	1 cm
II	1-2 mm	70-80%	1-2 cm
III	2-4 mm	60-70%	2-3 cm
IV	>4 mm	50%	3 cm

If ≥ Clarke level IV, thickness >1 mm or ulceration: consider Sentinel Lymph Node Biopsy (SLNB) and possible lymphadenectomy.

Malignant MElanoma is more likely to MEtastasize.

Basal Cell Carcinoma (BCC)

It is the most common skin cancer.

Mnemonic: B’s and P’s

Involvement: Basal cell layer of epidermis

Risk factors:

uvB
Basal cell nevus syndrome (Gorlin syndrome)
Bazex syndrome (acral psoriasiform dermatosis associated with internal malignancies)
xeroderma Pigmentosum
Pale skin (Fitzpatrick type 1 and 2)
Previous skin cancer
Poor immune system

Site: uPPer lip or above

Histology: Peripheral Palisading

Clinical features:

Mnemonic: TURP

Telangiectasia
Ulceration
Rolled edges
Pearly papule

basal cell carcinoma — “Basal cell carcinoma and cataract” by Community Eye Health is licensed under CC BY-NC 2.0.

Types:

Mnemonic: MNoPSS

Morphoeic: Scar like
Nodular: most common, pearly papule
Pigmented: Melanoma like
Superficial: Multifocal
SCC mixed (Baso-squamous): More aggressive

Treatment options:

Medical	Surgical
Chemotherapy e.g. 5-FU cream	Curettage & Cautery
Cryotherapy	Surgical excision
Phototherapy	Moh’s micrographic surgery
Radiotherapy

Lesions should be excised down to subcutaneous fat to ensure that the entirely of skin (epidermis and dermis) has been included in the excision sample.

BCC	Type	Excision margins
Primary	Small (<2 cm)	3 mm = 85% clearance 4-5 mm = 95% clearance
	Large (>2 cm) or Morpheic	5 mm = 85% clearance 13-15 mm = 95% clearance Consider Moh’s micrographic surgery (sequential horizontal tumor excision with immediate frozen section examination until clear margins are achieved)
Recurrent		5-10 mm Consider Moh’s micrographic surgery +/- Radiotherapy
Incomplete excision		Re-excision Consider surveillance

Squamous Cell Carcinoma (SCC)

Involvement: Squamous keratinocytes in the stratum spinosum

Risk factors: Like in BCC

However, SCC is the most common skin cancer in brown & black skin (Fitzpatrick type 5 and 6)

Premalignant conditions:

Mnemonic: ABC

Actinic keratosis (10-15% progress to SCC)
Bowen’s disease (SCC in-situ; 5% progress to SCC)
Cheek mucosa white that cannot be brushed off (Leukoplakia; 15% progress to SCC)

Clinical features:

Mnemonic: NO SUN