Skin Malignancies : Mnemonics

Malignant Melanoma

Diagnosis or Clinical features:

Mnemonic: ABCDE

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

Risk factors:

Mnemonic: MM RISK

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

Pathologic Types:

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

MnemonicTypeIncidenceSiteGrowth pattern
MelanomaMaligna – lentiginous10-15%Face (Precursor – Hutchison’s freckles/lentigo maligna)long in-situ stage before vertical growth
AlwaysAcral lentiginous30-70% 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 toSuperficial spreading50% (most common)Trunks (male), legs (female)grows radially before vertically
NodesNodular15% (5% are amelanocytic)Trunks & legsonly vertically
nodular melanoma
“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)

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

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

StageBreslow thickness5-year survivalResection margin
InsituInsitu90-100%0.5 cm
I<1 mm80-90%1 cm
II1-2 mm70-80%1-2 cm
III2-4 mm60-70%2-3 cm
IV>4 mm50%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.

Involvement: Basal cell layer of epidermis

Risk factors:

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

Site: uPPer lip or above

Histology: Peripheral Palisading

Clinical features:

  1. Telangiectasia
  2. Ulceration
  3. Rolled edges
  4. Pearly papule
basal cell carcinoma
“Basal cell carcinoma and cataract” by Community Eye Health is licensed under CC BY-NC 2.0.


  1. Morphoeic: Scar like
  2. Nodular: most common, pearly papule
  3. Pigmented: Melanoma like
  4. Superficial: Multifocal
  5. SCC mixed (Baso-squamous): More aggressive

Treatment options:

Chemotherapy e.g. 5-FU creamCurettage & Cautery
CryotherapySurgical excision
PhototherapyMoh’s micrographic surgery
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.
BCCTypeExcision margins
PrimarySmall (<2 cm)3 mm = 85% clearance
4-5 mm = 95% clearance
Large (>2 cm) or Morpheic5 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)
Recurrent5-10 mm
Consider Moh’s micrographic surgery
+/- Radiotherapy
Incomplete excisionRe-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:

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

Clinical features:

Mnemonic: NO SUN

  1. Nodular
  2. Opaque
  3. Sun-exposed areas
  4. Ulcerating
  5. Non-distinct borders
squamous cell carcinoma
“squamous cell carcinoma” by safoocat is licensed under CC BY-NC-ND 2.0.


SCCExcision margins
<2 cm4 mm = 95% cure
>2 cm>5 mm = 95% cure
Consider Moh’s micrographic surgery

Merkel cell carcinoma

  1. Asymptomatic/lack of pain
  2. Expanding rapidly (≤ 3 months)
  3. Immunosuppression (HIV, CLL, Organ transplant, Polyomavirus)
  4. Older than age 50
  5. Ultraviolet light skin exposed
merkel cell cancer
Klaus D. Peter, Wiehl, Germany, CC BY 3.0 DE, via Wikimedia Commons


Lesion <2 cm: Excision with 1 cm margin

Lesion 2 cm or more: Excision with 2 cm margin

Sentinel Lymph Node Biopsy (SLNB) Positive: Complete Lymph Node Dissection + Radiotherapy

Metastases: Chemotherapy + Radiotherapy

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