Dermatology – Skin Tumours: By Ally-Khan Somani M.D.

Dermatology – Skin Tumours: By Ally-Khan Somani M.D.


Tumours of the skin and subcutis can be benign
or malignant. The most common malignant skin tumours are
basal cell carcinomas (BCC), squamous cell carcinomas (SCC), and melanoma. Sometimes, a definitive diagnosis is only
possible with a skin biopsy. Even with histopathology, some tumours are
difficult to characterize. When in doubt about the diagnosis, refer the
patient to dermatology. Here are some things to consider in your evaluation
of a patient: Patient characteristics such as: fair skin
easy sun burning history of significant sun exposure
history of immunosuppression personal or family history of skin cancers
or other malignancies, skin cancer onset at a young age can identify
subsets of patients at higher risk for skin cancer BCCs tend to be erythematous papules with
pearly rolled border and central dell or ulceration. SCCs tend to be irregular erythematous scaly
plaques. Melanomas are typically, but not always, pigmented
lesions similar to a ‘mole’ or nevus, but with more unusual features. Typically the lesion will stand out as the
‘ugly duckling’ – the lesion that looks unlike the patient’s other moles. It may meet criteria in the ABCDE mnemonic
often used to evaluate pigmented lesions. Lesions suspicious for melanoma may be Asymmetric
have irregular Borders have variations in Color
have a Diameter>6mm demonstrate change or Evolution in size, shape
or colour Any lesion of concern to the patient or of
which you are uncertain may warrant a biopsy or referral to a dermatologist. In the event that you elect to biopsy the
lesion, sample adequately. If the biopsy is indeterminate, speak to the
pathologist and/or consider re-sampling or referring to dermatology. Lastly, take the visit as an opportunity to
educate patients on sun safety measures, skin self-examination and the characteristic features
of a skin cancer.

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