Cancer Flashcards
What is actinic keratosis?
AKA Solar keratosis
UV light induced skin lesion
Why is it important to keep an eye actinic keratosis?
Can progress to SCC
Where is actinic keratosis likely to appear?
Fair skinned people w/long sun exposure
Sun exposed areas: Face, ears, scalp, forearms, back of hands
What can sun damage lead to?
Telangiectasia
Elastosis
Pigmented lentigines
What are the different stages of actinic keratosis?
Stage 1 = Better felt than seen, single rough plaque on face 2-10mm
Stage 2 = EASILY FELT + SEEN, multiple plaques enlarge → red, scaly & confluent
Stage 3 = OBVIOUS thick& hyperkeratotic
How is actinic keratosis managed?
1) Limit sun exposure & USE SUNCREAM!
2) Emollients: Diprobase
3) TOP 5-FU cream BD 3-4w
4) Cryotherapy for small single plaques
What is Kaposi’s sarcoma?
Malignant lesions
Caused by Human HPV8
Who commonly gets Kaposi’s?
HIV patients
Where are Kaposi’s sarcomas commonly found?
Mouth
Nose
Throat
What do Kaposi’s sarcomas look like?
Purple/red/black nodular, papular, blotchy lesions on skin/mucosa
Usually Painless
Late: Ulcerate
What are signs of Kaposi’s sarcoma of the respiratory tract?
Pleural effusion + haemoptysis
How is Kaposi’s sarcoma confirmed?
Biopsy: Spindle cells & LANA Ag
Latency associated nuclear antigen
What are the risk factors for melanoma?
Genetics: BRAF V600 Freckles Large no. of naevi or >3 atypical naevi- MOST POWERFUL PREDICTOR!! Fair skin >3 episodes of sunburn Short bursts of intense UV Fhx Actinic keratosis
How are melanoma in situ and invasive melanoma defined?
In situ = Cells confined to epidermis
Invasive = Penetrates dermis
By how much do naevi increase the risk of melanoma?
> 100 common OR >2 atypical = x5-20 risk of melanoma
What are the typical features of a melanoma?
ABCDE A: Asymmetrical B: Border irregularity C: Colour irregularity (BLACK) D: Diameter >7mm E: Evolving- still growing
Blue veil- Pathognomic of melanoma
What are the 6 types of melanoma
1) Lentigo maligna: Flat brown papule/nodule spreads horizontally
2) Superficial melanoma: MOST COMMON-70%, Large, flat, irregular pigmented lesion, grows laterally BEFORE vertically (mets late) GOOD PROGNOSIS
3) Nodular Melanoma: MOST AGGRESSIVE, rapidly growing pigmented nodule that ulcerates & bleeds (mets early), rarely non-pigmented POOR PROGNOSIS
4) Acral lentiginous melanoma: Pigmented lesion on palm/sole/under nail
5) Subungal: Nailbed, crap prognosis
6) Amelanotic melanoma: No dark colour
How is melanoma investigated?
1) 2WEEK REFERAL TO DERM: Assess 7 point checklist
MAJOR: 2pts each (change in size/shape/colour)
MINOR: 1pt each (>7mm/inflammed/oozing/bleeding/ altered sensation)
2) Staging
3) Genetic testing
4) MEASURE VIT D LEVELS AT DIAGNOSIS
How is a melanoma staged?
1) Biopsy & histopathology: Based on BRESLOW THICKNESS, ulceration on presentation, mitoses, type of melanoma
2) Sentinel LN biopsy: Microscopic disease = S3
CONSIDER CT staging if 2c melanoma
What is the general advice for managing a melanoma?
ADVICE: SUNCREAM/AVOID long time in the sun
Vit D: Cholicalciferol if at risk of depletion
How is melanoma managed?
1) EXCISION: Margin 0.5cm= S0, 1cm = S1, 2cm = S2
MDT review
Sentinel node biopsy: For high risk, resection at S3b&c
Biologics: Verumafenib/ Ipilimumab
Immunotherapy: BRAF V600 (S4)
2) TOP Imiquimod: If surgery not appropriate
3) Unresectable: Talimogene laherparepvec
4)Palliative RT
Where does melanoma commonly metastasise to?
Bone
Spine
Brain
LN
What is the prognosis for melanoma?
Based on Breslow thickness
in situ: 95-100%
>4mm : 50%
What follow-up is recommended for melanomas?
Stage 1a: x2-4/yr + discharge at end of year
Stage 1b-3: 3m for 3yr then 6m for 2yr then discharge at end of 5th yr
