Nodular malignant melanoma
Presentation
- Malignant tumour of melanocytes
- More common in fair skin types
- Genetic component in some cases with a positive family history
- Two-thirds arise in normal skin, the rest in existing moles
- ABCDE rule aids diagnosis
- Survival rates are improving
Management
- Excision is the mainstay of treatment
- Prognosis dependent on tumour thickness
- Research continues, but no curative treatments as yet, except for excision
Nodular basal cell carcinoma
Presentation
- Most common skin cancer
- Often called rodent ulcer, as thought to look like a rat bite
- More common on sun-exposed areas in fair-skinned individuals
- Incidence increases with age
- Usually has a rolled, pearly edge, with central ulceration
- Slow growing, often over years
- No metastatic potential
Management
- Treatment of choice is usually local excision
- In recurrent cases or large facial lesions, Mohs micrographic surgery can be very helpful
- In the elderly with large lesions not amenable to surgery, radiotherapy is an alternative
Amelanotic melanoma
Presentation
- Malignant tumour of melanocytes
- Do not make melanin, so lesions are not pigmented
- Colour usually pink, purple or normal skin colour
- Diagnosis often late owing to atypical appearance, leading to a poor prognosis
- Usually have an asymmetrical shape with an irregular border
Management
- Treatment of choice is surgical excision
- Metastatic spread can occur, with potential to be fatal
Squamous cell carcinoma
Presentation
- Usually occurs on areas of maximum sun exposure
- Can arise in normal skin, or in lesions such as ulcers
- May produce keratin, so surface is often scaly or horn-like
- May ulcerate and bleed
- Much faster growing than basal cell carcinoma
Management
- Treatment of choice is surgical excision
- Potential to metastasise to lymph nodes
- May be fatal if left untreated
- Radiotherapy is an alternative if surgery cannot be tolerated
Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary
