Skin cancers

Melanoma

  • ABCDE rule
  • Types
    • Superficial spreading melanoma
    • Acral-lentiginous melanoma – on the soles, palms, under nails (subungal)
    • Amelanotic – growing more rapidly than a BCC
    • Nodular melanoma – a red-brown nodule

SCC

  • Risk factors: elderly, immunosuppressed, AK, chronic ulcers
  • Sun exposed sites (arms, face, lower lip, pinna)
  • Firm to palpate (induration)
  • Nodular, plaque-like, ulcerated
  • Surrounding tissue may be inflamed
  • Pain, bleeding, sensory changes

BCC

  • Shiny, nodule, surface telangiectasia
  • May contain pigment
  • Slow growing
  • May bleed or produce a scab

Others

  • Pyogenic granulomas
    • May mimic melanoma – all bleeding nodules need 2ww referral
  • Multiple naevi
    • >50 typical appearance or >5 atypical but none suspicious of melanoma- routine referral for monitoring
  • Spitz naevi
    • consider 2ww referral (regardless of how young child is)
  • Keratocanthoma
    • assume these are SCC until biopsied – 2ww
  • Leukoplakia on lip
    • high risk for SCC – 2ww
  • Bowens disease (pink scaly lesion)
    • routine referral to dermatology

http://www.pcds.org.uk/clinical-guidance/squamous-cell-carcinoma
http://www.cityandhackneyccg.nhs.uk/Downloads/gp/Education%20and%20events/Education%20Presentations/SKIN%20CANCER%20REFERRAL%20PATHWAY%20word.pdf