Cancers Flashcards
Melanoma?
Malignant tumour arising from melanocytes
Leads to >75% of skin cancer deaths
Can arise on mucosal surfaces (e.g. oral, conjunctival, vaginal) and within uveal tract of eye
Rising incidence rates observed worldwide
Melanoma risk factors?
Genetic - FHx, red hair, light skin
Environment - sun exposure, sunbeds, immunosuppression
Phenotypic - >100 melanocytic nevi, atypical melanocytic mevi
Melanoma subtypes?
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Superficial spreading melanoma?
Most frequently on trunk of men, legs of women
In 2/3 - regression = hypo or depigmented area showing host immunity
Horizontal then vertical growth
Nodular melanoma?
Usually blue to black, sometimes pink to red, nodule - may be ulcerated, bleeding
Develops rapidly
Only verticals growth
Lentigo maligna melanoma
> 60, chronically sun-damaged skin, most common on face
Slow growing, asymmetric brown black machine with colour variation and an irregular indented border
Acral Lentiginous melanoma?
Typically palms and soles OR around nail apparatus
Incidence similar across all racial and ethnic groups - disproportionate percentage in BAME
Melanoma self-detection?
ABCDE
Asymmetry
Border irregularity
Colour variation
Diameter greater than 5mm
Evolving
Garbe’s rule?
If a patient is worried about a single skin lesion, do not ignore their suspicion and have a low threshold for performing a biopsy
Melanoma poor prognostic factors?
Increased Breslow thickness >1mm
Ulceration
Age
Male gender
Anatomical site – trunk, head, neck
Lymph node involvement
Breslow thickness?
Measurement from granular layer to bottom of tumour
Dermoscopy?
Can improve correct diagnosis of melanoma by nearly 50%
Melanoma management?
Primary excision down to subcutaneous fat - 2mm peripheral margin
Wide excision - 5mm for in situ, 10mm for </=1mm
Sentinel lymphoma node biopsy?
Lymphatic drainage of finite regions of skin drain specifically to an initial node within a given nodal basin - the ‘sentinel node’
Currently offered for pT1b+
LDH?
Major prognostic indicator in melanoma
If melanoma unresectable or metastatic?
Immunotherapy or mutated oncogene targeted therapy
Melanoma immunotherapy?
CTLA-4 inhibition
PD-L1 inhibitors
Mutated oncogene targeted therapy for melanoma?
Combination of BRAF inhibitor and MEK inhibitor
Keratinocyte dysplasia/carcinoma subtypes?
Actinic keratoses
Bowen’s disease
Squamous cell carcinoma
Basal cell carcinoma
BCC pathogenesis
UV radiation
Has proteolytic activity
Loss of function in chromosome 8a, p53 mutations
SCC pathogenesis?
UV radiation
p53 alteration
NOTCH1 or NOTCH2 plays role
Actinic keratoses?
Atypical keratinocytes confined to epidermis
Develop on sundamaged skin
Macules or papules, red or pink, some scale
Bowen’s disease?
SCC in situ
Erythematosus scaly patch or slightly elevated plaque
Actinic keratoses and Bowen’s disease treatment?
5-fluorouracil cream
Cryotherapy
Imiquimod cream
Photodynamic therapy
Excision
Curettage and cautery
SCC may be?
Erythematous to skin
Papule
Plaque-like
Exophytic
Hyperkeratotic
Ulceration
SCC clinical features - high risk?
Localisation and size - trunk and limbs >2cm, head and neck >1cm
Ill-defined margins
Rapidly growing
Immunosuppressed
Previous radiotherapy or chronic inflammation
Keratoacanthoma?
Rapidly enlarging papule that evolves into sharply circumscribed, crateriform nodule with keratotic core
Resolves slowly over months
Most on head or neck/sun exposed areas
SCC treatment?
Excision
Radiotherapy
Cemiplimab for metastatic
Secondary prevention - skin monitoring advice, sun protection
BCC subtypes?
Nodular
Superficial
Morpheic
Infiltrators
Basisquamous
Micronodular
Nodular BCC?
Most common, typically presents as shiny, pearly papule or nodule
Superficial BCC?
Well-circumscribed, erythematous macule/patch or thin papule/plaque
Morpheic BCC?
Slightly elevated or depressed area of induration, usually light-pink to white in colour
More aggressive behaviour
Basisquamous BCC?
Histological features of both BCC + SCC
Micronodular BCC?
Resembles nodular BCC
More destructive - high rates of recurrence and sub clinical spread
BCC treatment?
Surgical excision
Mohs micrographic surgery
Topical therapy, photodynamic therapy, radiotherapy, vismodegib
Breadloaf method
Merkel cell carcinoma?
Highly anaplastic cells which share features with neuroectodermally derived cells
Solitary, rapidly growing nodule - pink-red to violaceous, firm, dome shaped
Ulceration can occur
AGGRESSIVE, MALIGNANT BEHAVIOUR
Melanoma common mutations and pathway dysregulation?
Commonest mutation is BRAF, KIT and NRAS.
MAPK pathway is dysregulated in most melanomas
Melanoma risk factors?
Intense intermittent sun exposure
Immunosupression
Family history
Melanoma thicker than 1mm investigation?
Sentinel lymphoma node biopsy
Breslow’s depth with stage?
I - 0.75mm or less
II - 0.76-1.5mm
III - 1.51-4mm
IV - >4mm
Non-metastatic vs metastatic melanoma treatment?
Non-metastatic - excision: primary or wide excision, depending on extension
Metastatic - oncogene targeted therapy(kills cancer cells as stops them to grow and survive) or Immunotherapy (boosts immune response)
