Cancerous Lumps and Bumps Flashcards
What 2 pre-cancerous lesions can evolve into Squamous Cell Cancers?
- Acitinic Keratosis
- Squamous Cell Carcinoma in Situ (e.g. Intraepidermal Carcinoma)
What type of pre-cancer is this?
Erythroplasia of Queyrat
(IEC of the glans penis)
Apart from BCC and SCC,
What are some other forms of skin cancer?
(Not including Melanoma)
- Cutaneous Lymphoma - B or T Cell Lineage.
- Merkel Cell Carcinoma
- Porocarcinoma - in immunocompromised patients.
What is the average age of?
BCC?
SCC?
BCC = 60 years
SCC = 70 years
What is the most common NMSC?
BCC
What are the risk factors for NMSC?
- Sunlight
- PUVA
- Arsenic
- HPV - anogenital and periungal SCCs.
What NMSC comes from chronic sunexposure +/- acute episodes of sunlight?
SCC
What NMSC comes from acute episodes of suburn (especially in childhood)?
BCC
What risk factors are important for oral SCC?
- Smoking
- Poor oral hygeine
What condition is this?
Xeroderma Pigmentosum
- Autosomal recessive
- Defective DNA repair
- Freckling and sunsensitivity
- Increased risk of NMSC
- Strict sun avoidance.
At what rate do Solar keratoses progress to SCC?
Only 2-5%
What % of Solar Keratoses remit?
25%
Decribe the field treatments for solar keratoses.
- Efudix (5-FU) -nightly for 3-4 weeks.
- Solaraze (Diclofenac) - nightly for 3 months
- Aldara (5% Imiquimod) - 3 times per week for 4 weeks.
- Picato (Ingenol Mebutate) - 3 days to face or 2 days to body.
Describe the treatment instructions with Efudix (5-FU) and why we would choose that?
- Nightly for 3-4 weeks
- Effective but can cause painful blisters.
Describe the treatment instructions with Solaraze (Diclofenac) and why we would choose that?
- Nightly for 3 months
- Gentle but less effecive than 5-FU
Describe the treatment instructions with Aldara (5% Imiquimod) and why we would choose that?
- 3 times per week for 4 weeks.
- Expensive
- Gentle
Describe the treatment instructions with Picato (Ingenol Mebutate) and why we would choose that?
-
Short course of treatment
- 3 days to face
- 2 days to body
- Local reactions -aggresive like 5FU
What is the management of IEC?
- Topical 5-FU
- Topical Imiquimod
-
Gentle cryotherapy
- Avoid overzealous in lower leg due to risk of ulceration.
- Curetage & Cautery
- Excision
What is the treatmentfor Erythoplasia of Queyrat?
Refer to urologist or dermatologist
- Medical treatments -5-FU or Imiquimod
- Surgical - Mohs Micrographic Surgery or CO2 laser ablation.
SCCs are more likely to metastasise on what sites of the body?
Ears or lips
If an SCC is found in a skin type of 4-6, what might this indicate?
Immunosuppression
BCCs grow slowly over months to years. How do SCCs grow?
Quickly over 6-12 weeks.
What type of biopsy is peferred?
Punch or incisional biopsy.
- Superficial shaves give diagnostic uncertainty so therefore ensure it is deep enough if done.
What SCCs are more likely to metastasize?
- 2cm diameter are 3x more likely to metastasise.
- Subcutis invasion
- Poorly differentiated
- Perineural invasion.
- Host immunosupression
What is the recommended margin for SCC excision?
4mm
What is the follow up for high risk SCCs?
4 monthly for 2-3 years.
What is this?
Keratocanthoma
- Treated like an SCC - excise.
- Though to be SCCs but can involute whereas SCCs get larger.
What are the 3 types of BCC?
- Nodular - most common
- Superficial
- Morphoeic
What is the most common type of BCC?
Nodular BCC
Where do nodular BCC’s usually ocur?
Head and neck
Where do superficial BCC’s usually ocur?
Chest and Upper back
What is Mohs Micrographic Surgery?
- Intraoperative margins are looked at under a microscope in real time in order to minimise normal tissue destruction.
- Closure can then occur at a later date.
- It has the highest cure rate
What are the medical options for managing BCCs?
-
5-FU - superficial BCCs
- Apply nightly for 3 weeks - apply for another 3 weeks if needed.
-
Imiquimod - superficial BCCs
- Apply 5 times weekly for 6 weeks.
What are some non-medical treatments for BCCs?
- Radiotherapy
- Curettage & Cautery - 2 cycles are recommended
-
Photodynamictherapy - veryuseful for Gorlin’s syndrome patients.
- Better for small and superficial lesions.
What is the follow up for patients with BCC?
Routine follow up is not usually needed.
Teach self examination and sun-protection.
What are the more common cutaneous lymphomas:
T-Cell lymphomas,
B-Cell Lymphomas
or NK Cell Lymphomas?
75-80% of Cutaneous lymphomas are cutaneous T-Cell Lymphomas.
20-25% are B-Cell cutaneous lymphomas.
What type of Cutaneous T Cell Lymphoma might this be?
Mycosis Fungoides
- The most common cause of Cutaneous T-Cell Lymphoma.
What age group and gender get Mycosis Fungoides?
55-60 year old
Males > Females
Describe the progression of Mycosis Fungoides.
Why is it late to diagnose.
- It progresses from a patch phase to a plaque phase over many years. And then to a tumour stage.
- Clinicians often think it is psoriasis or eczema during the patch phase.
During the plaque stage of mycosis fungoides, what can be concurrently common?
Bacterial infections
What examinations/investigations should be done if someone is found to have Mycosis Fungoides?
- Lymph node palpation.
- CT scan of chest, Abdo and Pelvis
- Consider a bone marrow biopsy.
What is the treatment for mycosis fungoides?
-
Topical therapy - for early patch disease.
- Emollients + Potent steroids
- Nitrogen mustard
- 1% Targretin - a retinoid gel
- Phototherapy - Plaque disease
- Radiotherapy - for thick Plaque disease and tumours.
What is the triad of Sezary syndrome?
- Erythroderma
- Generalised lyphadenopathy
- Neoplastic T Cells in the skin, lymph nodes and peripheral blood
What is the treatment for Sezary Syndrome?
Systemic treatment
- Prednisolone + Chlorambucil + Methotrexate & CHOP-chemotherapy.
In dark skinned people, Mycosis fungoides can appear as….
Hypopigmented patches
What is this and how does it usually present?
B Cell Lymphoma
- Deep red, smooth firm nodules or tumours
- Typically on the head & neck
If someone is found to have a B Cell Cutaneous Lymphoma, what further investigations and treatment should be done?
Ensure you liase with an oncologist
- Physical examination
- Full Blood Count
- CT Scan
- Consider Bone Marrow Biopsy
What can people develop if they have B-Cell Cutaneous Lymphoma?
Leonine Fasces
(Lion Face)
What is the treatment of B-Cell Cutaneous Lyphoma?
Liase with Oncologist
Respond well to intralesional steroids and treated with systemic agents (though systemic agents may be over treatment)
