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Skin and soft tissue covers the cutaneous malignancies and the lumps a plastic surgeon is asked to diagnose and treat. Basal cell carcinoma, cutaneous squamous cell carcinoma and melanoma form the core: risk stratification, excision margins, Mohs surgery, and when to involve the specialist skin cancer multidisciplinary team. Melanoma questions span diagnosis, Breslow thickness and staging, and sentinel lymph node biopsy. Vascular anomalies are classified by ISSVA into tumours, chiefly infantile haemangioma, and malformations, and that distinction drives management. The category also covers soft tissue tumours and sarcoma, where the safe answer is often to image and refer before any biopsy, and benign and premalignant lesions such as actinic keratosis, Bowen’s disease and naevi. Thresholds here are precise and guideline-based, so they make natural discriminators.
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A 71-year-old man has a slowly enlarging, flat, ivory-coloured indurated plaque on the forehead with indistinct edges, which he attributes to an old scar although he recalls no injury. Histology shows thin strands of basaloid cells one to two cells thick embedded in a dense sclerotic stroma.
Which subtype of basal cell carcinoma is this?
Nine months after excision of a 20 mm squamous cell carcinoma of the cheek with clear margins, a 72-year-old man develops numbness of the cheek and upper lip with intermittent shooting pain below the orbit. The scar is soft and no nodes are palpable.
Which investigation is most appropriate?
Those in NICE NG14 (2022): consider at least 0.5 cm for stage 0, 1 cm for stage I and 2 cm for stage II, with 1 cm acceptable where 2 cm would cause unacceptable disfigurement or morbidity. Questions usually test applying them to a specific patient and site.
Not routinely. Outside a clinical trial or a specialist MDT decision it is not standard care in cSCC, which makes it a common distractor, because sentinel node biopsy is standard staging in melanoma and Merkel cell carcinoma.
Both. They sit in skin and soft tissue in the curriculum and recur in paediatric practice. The ISSVA division into vascular tumours and vascular malformations is the starting point either way.
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