Lecture 8 Skin Cancer Flashcards
Name non melanoma skin cancer
BCC and SCC
Risk factors for non-melanoma skin cancer
- UV radiation
- Photochemotherapy (PUVA)
- Chemical carcinogens
- Ionising radiation
- Human papilloma virus
- Familial cancer syndromes
- Immunosuppression
Features of BCC
- Slow growing
- Locally invasive
- Rarely metastasise
- Can be pigmented or morphoeic
- Pearly rolled edge
- Telangiectasia
- Central ulceration
- Arborising vessels on dermoscopy
Treatment of BCC
Excision-gold standard
Curettage
Imiquimod
Mohs surgery
What treatment would you use for locallybadvanced BCC that’s not suitable for surgery or radiotherapy
Vismodegib
How does Vismodegib work
- Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
- Can shrinks tumour and heal visible lesions in some
Side effects of Vismodegib
– Hair loss, weight loss, altered taste
– Muscle spasms, nausea, fatigue
What is SCC
- Derived from keratinising squamous cells
- Usually on sun exposed sites
- Can metastasise and ulcerate
How is SCC treated
Excision
Radiotherapy
What is considered a high risk SCC
– Immunosuppressed – >20mm diameter – >4mm depth – Ear, nose, lip, eyelid – Perineural invasion – Poorly differentiated Follow up needed
What is a Keratoacanthoma
Variant of squamous cell carcinoma
Erupts from hair follicles in sun damaged skin
How is Keratoacanthoma treatd
Surgical excision
Risk factors for melanoma
Keratoacanthoma
What is the ABCDE rule
Asymmetry Border Colour Diameter Evolution
What is the 7 point checklist
features
• Change in size
• Change in shape
• Change in colour
Minor features • Diameter more than 5 mm • Inflammation • Oozing or bleeding • Mild itch or altered sensation
How can skin lesions be examined
Using dermoscope
Name subtypes of melanoma
Superficial spreading malignant melanoma Lntigo maligna melanoma (in situ) Nodular melanoma Acral lentiginous melanoma Ocular melanoma
Treatment of melanoma
• Urgent surgical excision – Subtype – Breslow thickness • Wide local excision • Sentinel lymph node biopsy • Chemotherapy – almost never • Radiotherapy - rarely • Immunotherapy – metastasis or adjuvant therapy
What are the 2 main groups of cutaneous lymphoma
- Secondary cutaneous disease from systemic/nodal involvement
- Primary cutaneous disease – abnormal neoplastic proliferation of lymphocytes in the skin
Primary cutaneous lymphoma can be divided into what 2 groups
Cutaneous T cell lymphoma
Cutaneous B cell lymphoma
What is the most common CTCL
Mycosis fungoides
– More common in older patients
– More common in men than women
What is the stages of development of mycosis fungoides
Patch
Plaque
Tumour
Metastatic
What is Sezary syndrome
– CD30+ lymphoproliferative disorders – Subcutaneous panniculitis like T cell lymphoma – CTCL affecting skin of entire body o Skin thickened, scaly and red o Itchy++ – Lymph node involvement – Sezary cells in peripheral blood o Atypical T cells
What are the 3 types of cutaneous B cell lymphoma
- Cutaneous follicle centre lymphoma
- Cutaneous marginal zone lymphoma
- Cutaneous diffuse large B Cell lymphoma
What is the treatment for cutaneous lymphoma
– Topical steroids – PUVA or UVB – Localised radiotherapy – Interferon – Bexarotene – Low dose Methotrexate – Chemotherapy – Total skin electron beam therapy
What is total skin electron beam therapy
- Type of radiotherapy consisting of very small electrically charged particles
- Delivers radiation primarily to superficial layers i.e. Epidermis and Dermis
- Spares deeper tissues and organs
What are the stages of extracorporeal photophoresis
• Step 1
– Patients blood is drawn and leucocytes collected
• Step 2
– Collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation
• Step 3
– Exposed to UVA radiation, damaging diseased cells
• Step 4
– Treated cells re-infused back to patient
What is cutaneous metastases
- Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy
- Most commonly breast, colon and lung
what is the management of cutaneous metastases
- Treat the underlying malignancy
- Local excision
- Localised radiotherapy
