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Cancer care (Y4) > 8- Skin cancer > Flashcards

8- Skin cancer Flashcards

1
Q

main types of skin cancer

A

Skin cancers
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma

Skin cancers (best -> worse : BBC -> SCC -> Melanoma)

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2
Q

basal cell carcinoma background

A
  • Most common skin cancer
  • Best prognosis
  • Slow growing, locally invasive -> arise from hair follicle
  • Subtypes include nodular, morphoeic, superficial and pigmented
  • Slow growing with low metastatic potential
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3
Q

types of basal cell carcinoma

A
  • Subtypes include nodular, morphoeic, superficial and pigmented
  • Types >20
    o Nodular basal cell carcinoma (most common)
    o Superficial BBC
    o Infilatrative

Rarer may not look like classical cancer e.g. like. a scar or fungal infection

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4
Q

RF for basal cell carcinoma

A

Risk factors
- Caucasian (type I and II)- fair
- Sun exposure (UV)/ sun burn
- Older age
- Previous skin cancer
- Immunosuppression e.g. organ transplant on tacrolimus
- Albinism
- Inherited syndrome e.g. Gorlin syndrome

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5
Q

presentation of BCC

A

Presentation
- Slow growing plaques or nodules
- Early lesions are small, translucent or pearly and have raised areas with telangiectasia
- Varies in size
- pearly with curved edges
- Spontaneous bleeding
- Occurs in sun exposed sites apart from the ear
- Indurated edge and ulcerated centre
- Slow growing but can spread deeply to cause considerable destruction

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6
Q

Investigations for BCC

A
  • Visual inspection
  • Punch biopsy if treatment other than standard surgical excision is planned
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7
Q

Management of BCC

A

Depends on size, type and location.
- Can be managed in primary care as long as GP trained to perform skin surgery

Surgical excision is the mainstay of treatment
1) Normal surgical excision of cancer

Best treatment: Gold standard but not used that often
2) Mohs micrographic surgery (4mm margins)
–> Involves examining carefully marked excised tissue under microscope later by layer to ensure complete excision
->Very high cure rates

Non-surgical
e.g. superficial BBC or if they decline or unfit for surgery
- Curettage and cautery
- Cryotherapy (liquid nitrogen)
- Imiquimod cream
- 5-Fluorouracil
- Radiotherapy if margins incomplete

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8
Q

management of advanced or metastatic basal cell carcinoma

A
  • Surgery
  • Radiotherapy
  • Target therapy
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9
Q

prevention of BCC

A

Prevention
- Avoid sunburn esp in fair skinned
- Oral nicotinamide (vitamin B3)

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10
Q

Prognosis for BCC

A
  • Most BCCs cured by treatment
  • 50% develop second one within 3 years of first
    o At increased risk of melanoma
  • Advanced BCC very rare- often neglected tumours
  • Metastaic BCC very rare
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11
Q

squamous cell carcinoma background

A
  • Malignant tumour arising from keratinising cells of the epidermis
  • Locally invasive (passes basement membrane) and has the potential to metastasise
  • 5% metastasise (much higher than BBC)
  • Types e.g.
    o Cutaneous horn
    o Keratoacanthoma
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12
Q

causes of SCC

A

Causes
- Older patients
- Previous skin cancer
- Smoking
- Inherited syndromes e.g. xeroderma pigmentosum
- Related to sun exposure (UVR)
- Fair skin
- Chemical carcinogens- arsenic
- HPV
- Chronic inflammation
- May arise in pre-existing solar keratoses
- Immunosuppression after transplant

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13
Q

Presentation of SCC

A
  • Grow over weeks to months (much faster than BBC)
  • Indurated nodular keratinising or crusted tumour that may ulcerate without evidence of keratinisation
  • Non healing ulcer or growth in one of the highest risk sun exposed area
  • Centre becomes necrotic and becomes an ulcer
  • Ulcer with hard, raised edges
  • Slow growing
  • Bleeding
  • Size varies from a few mm to several CM
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14
Q

investigations for SCC

A

Investigations
- Visual inspection
- Biopsy for histology
- If high risk: imaging using US, Xray, CT, MRI, lymph node biopsy

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15
Q

Classification of SCC

A

Based on low-risk or high-risk, depending on the chance of the tumour recurrening or metastasing

High-risk
- Diameter greater than or equal to 2 cm
- Location on the ear, vermilion of the lip, central face, hands, feet, genitalia
- Arising in elderly or immune suppressed patient
- Histological thickness greater than 2 mm, poorly differentiated histology, or with the invasion of the subcutaneous tissue, nerves and blood vessels.

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16
Q

staging of SCC

A

TNM
and also
low risk
high risk
very high risk

17
Q

management of SCC

A

- Nearly always treated surgically
- Wide local excision – repeat surgery to gain adequate margins may eb required
- Mohs’ micrographic surgery- precise technique in which excision of skin lesion is carried out in stages and checked histologically

Other non-surgical procedures
 Curettage and cautery
 Crytotherapy
 Imiquimod cream
 Photodynamic therapy (PDT)
 Electrochemotherapy
 Radiotherapy

18
Q

prevention of SCC

A
  • Avoid sunburn esp in fair skinned
  • Oral nicotinamide (vitamin B3)
  • Patients with multiple SCC may be prescribed oral retinoid (acitretin or isotretinoin)
  • Self examination important
19
Q

Prognosis of SCC

A
  • Most SCCs cured by treatment
  • Very high risk of recurrence (50% develop a second within 5 years) -> must have check up for 3 years
  • Increased risk of melanomas
20
Q

Melanoma background

A
  • In situ- tumour confined to epidermis
  • Invasive- tumour spread into dermis
  • Metastatic- tumour spread to other tissues
21
Q

pathophysiology of melancoma

A
  • Melanocytes are found in equal numbers in black and in white skin; however, the melanocytes in black skin produce much more melanin. People with dark brown or black skin are very much less likely to be damaged by ultraviolet (UV) radiation than those with white skin.
  • Non-cancerous growth of melanocytes results in moles (benign melanocytic naevi) and freckles (ephelides and lentigines).
  • Most skin melanomas spread out within the epidermis. If all the melanoma cells are confined to the epidermis then the lesion is a melanoma in situ, which can be cured by excision because it has no potential to spread around the body.
  • When the cancer has grown through the dermis it is known as invasive melanoma  malignant melanoma
22
Q

Metastasis for melanoma

A
  • Lymph nodes
  • Lungs
  • Liver
  • Bone
  • Brain
23
Q

Risk factors for melanoma

A
  • Previous primary invasive melanoma
  • Fair – highest incidence in Australia and new Zealand
  • Increasing age
  • Many melanocytic naevi – moles
  • Sun exposure
  • Family history
  • Immunosuppressed
24
Q

presentation of melanoma

A
  • Can occur anywhere on the body e.g. the back or legs
    Usually start as skin lesions- can also grow on mucus membranes e.g. lips or genitals
    Key features- ABCDE
  • Asymmetry.
  • Border irregular.
  • Colour irregular.
  • Tan, dark borwn, black, blue, red
  • Diameter greater than 6 mm.
  • Evolving.

Other symptoms
- Itching or bleeding

Metastatic features
Fever, night sweats, weight loss, or infection

25
Q

investigations for melanoma

A

Investigations
- Visual inspection
- Dermatoscopy
- Removal for histology
- Imaging to look for metastasis e.g. PET CT

26
Q

Staging melanoma

A

TNM or AJCC

27
Q

management of stage 0-III melanoma

A

Surgery: Wide local excision (look for margins)

28
Q

management of stage III_IV melanoma

A
  • Surgery
  • Immunotherapy e.g. ipilimumab
  • Targeted therapy such as dabrafenib and vemurafenib may be used in patients with BRAF V600 mutation-positivity.

Less affective
- Chemotherapy e.g. dacarbazine
- Radiotherapy

Others
- Vitamin D should be optimal
- Palliative care treatment

29
Q

Follow up for melanoma

A

for 5 years
- Detect recurrence and metastasise early
- Skin self examination
- Sun-smart behaviour

30
Q

prognosis for melanoma

A
  • Melanoma in situ cured by excision because no potential to spread around the body
  • Metastasis- depends on Breslow thickness of melanoma at time of surgery
  • immunotherapy has transformed care
31
Q

subtypes melanoma

A

in darker people - subuncal most common

arms and feat- acral melanoma

Cancer care (Y4) (30 decks)

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