SU18.2 | Skin Tumors — Summary & Reflection

KEY TAKEAWAYS

Skin tumors are classified into benign (naevi, sebaceous/epidermoid cyst, lipoma, dermatofibroma), premalignant (actinic keratosis, Bowen's disease) and malignant groups, and management follows that classification. The three skin cancers are distinguished by cell of origin and behaviour. Basal cell carcinoma (basal keratinocyte) is the rodent ulcer — rolled pearly edge, locally destructive, rarely metastasises — treated by complete excision. Squamous cell carcinoma (squamous keratinocyte) has an everted edge, can spread to regional nodes, and includes Marjolin's ulcer arising in a chronic wound or burn scar; it is excised more widely with nodal assessment. Malignant melanoma (melanocyte) is the most aggressive — types superficial spreading (commonest), nodular, lentigo maligna and acral lentiginous — recognised by the ABCDE rule, with Breslow thickness the key prognostic factor. A suspected melanoma is removed by excision biopsy to measure that thickness, then by margin-based wide local excision ± sentinel node biopsy. The cardinal warning sign across all is change in a lesion or a non-healing ulcer.

REFLECT

Recall a skin lesion you have examined — a mole, a cyst, an ulcer that would not heal — or imagine assessing one in your next clinic. Did you describe it systematically (site, size, edge, surface, colour, base) and, for a pigmented lesion, apply the ABCDE rule, and did you remember to palpate the draining lymph nodes? Now consider the decisions that follow: would you have recognised a rolled pearly edge as a rodent ulcer, suspected a Marjolin's ulcer in an old scar, and known to remove a suspected melanoma by complete excision biopsy so the Breslow thickness could be measured? Reflect on one habit you will build — never reassuring a patient about a changing mole without arranging excision biopsy, or always examining the nodes in a non-healing ulcer — so that the dangerous lesion is never missed.