Lecture 9: Skin Cancer

Question 1

skin cancer risk factors

Answer 1

• UV radiation
• photochemotherapy (PUVA)
• chemical carcinogens
• ionising radiation
• human papilloma virus
• familial cancer syndromes
• immunosuppression

Question 2

describe basal cell carcinoma

Answer 2

• a slow-growing, locally-invasive skin cancer that rarely metastasises.
• has a nodular appearance with a pearly rolled edge, telangiectasia, central ulceration and arborising vessels on dermoscopy.

Question 3

what is the treatment of basal cell carcinoma?

Answer 3

• excision is gold standard: ellipse incision, with rim of unaffected skin.
• curettage in some circumstances
• imiquimod if superficial

Question 4

when would treatment of basal cell carcinoma with Vismodegid be indicated?

Answer 4

• locally advanced BCC not suitable for surgery or radiotherapy
• metastatic BCC

Question 5

how does Vismodegid work?

Answer 5

• selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
• can shrink tumours and heal visible lesions in some

Question 6

Vismodegib side effects

Answer 6

• hair loss, weight loss, altered state
• muscle spasms, nausea, fatigue

Question 7

describe squamous cell carcinoma and its appearance

Answer 7

• derived from keratinising squamous cells
• usually on sun exposured sites
• can metastasise in up to 16% depending on study
• faster growing, tender, scaly/crusted or fleshy growths
• can ulcerate

Question 8

what is the treatment of SCC?

Answer 8

• excision
• +/- radiotherapy
• follow up if high risk

Question 9

describe Keratoacanthoma

Answer 9

• varient of squamous cell carcinoma
• erupts from hair follicles in sun damaged skin
• grows rapidly, may shrink after a few months and resolve
• surgical excision

Question 10

what is the ABCDE rule when assessing a potential malignant melanoma?

Answer 10

Asymmetry
Border
Colour
Diameter
Evolution

Question 11

what tool is used by dermatologists to get a better look at a skin lesion?

Answer 11

dermoscope or dermatoscope

Question 12

melanoma treatment

Answer 12

• wide local excision
• sentinel lymph node biopsy
• chemotherapy: almost never
• radiotherapy: rarely
• immunotherapy: metastasis or adjuvant therapy
• regular follow up
• primary and secondary prevention

Question 13

what are the different types of cutaneous lymphoma?

Answer 13

• secondary cutaneous disease from systemic/nodal involvement#
• primary cutaneous disease - abnormal neoplastic proliferation of lymphocytes in the skin: cutaneous T cell lymphoma (65%) and cutaneous B cell lymphoma (20%)

Question 14

give examples of 2 cutaneous T cell lymphoma disorders

Answer 14

• mycosis fungoides
• sezary syndrome

Question 15

what is the most common type of cutaneous t cell lymphoma?

Answer 15

mycosis fungoides
- accounts for around 50% of all primary cutaneous lymphomas

Question 16

describe the progression of mycosis fungoides starting from a patch

Answer 16

• patch: flat, red, dry oval lesions to
• plaque: patches become thickened, generally itch
• tumour: large, irregular lumps, can ulcerate
• metastatic: infiltration of neoplastic cells in lymph nodes, blood and solid organs.

Question 17

describe Sezary syndrome, its appearance and prognosis

‘ Red Man Syndrome ‘

Answer 17

• Cutaneous T cell lymphoma affecting skin of entire body
• skin thickened, scaly, red and itchy
• lymph node involvement
• sezary cells in peripheral blood: atypical T cells
• poor prognosis: median survival 2-4 years, opportunistic infection

Question 18

list the treatments of cutaneous lymphoma

Answer 18

Dependant on stage:
- topical steroids
- PUVA or UVB
- localised radiotherapy
- interferon
- bexarotene
- low dose methotrexate
- chemotherapy
- total skin electron beam therapy
- extracorporeal photophoresis
- bone marrow transplantation

Question 19

what are the most common malignancies that cause secondary cutaneous metastases?

Answer 19

breast, colon and lung