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Clinical Oncology > Non-Melanoma Skin Cancers > Flashcards

Non-Melanoma Skin Cancers Flashcards

1
Q

Epidemiology

A
  • M:F is 2:1 but BCC increasing in younger women
  • skin cancer is the most common of all cancer types
  • accounts for 1/3rd of new cancer cases in Canada
  • Average age is greater or equal to 60 years
  • BCC:SCC is 5:1
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2
Q

Why is the incidence of skin cancer rising?

A

Rising due to:

  • Changes in lifestyles/fashion (e.g. tanning, increased exposure)
  • Occupation
  • Geographic location
  • Fair skinned, light coloured eyes and hair
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3
Q

Etiology

A
  • Exposure to UV light (UVA and UVB)
  • ionizing radiation exposure
  • immunologic deficiencies
  • chemical carcinogens
  • ulcers
  • history of keratosis pilaris
  • HPV infections
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4
Q

BCC/SCC precursors

A
  • Actinic keratosis: in-situ dysplasias resulting from chronic sun exposure
  • Arsenical keratosis: caused by arsenic
  • Bowen’s disease: SCC in-situ
  • Keratoacanthoma: pilosebaceous glands, resembles SCC
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5
Q

BCC

A

Arise from basal layer of epidermis

Common on head, neck, face (central portion of body)

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6
Q

SCC

A

Arise from keratinocytes of epidermis

Common on face, lips, back of hand, ears, preauricular, temporal, scalp, skin of neck

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7
Q

BCC appearance

A
  • Shiny translucent or pearly nodule
  • pearly borders with telangiectasia and central ulceration (rolled border)
  • a pink slightly elevated growth
  • reddish irritated patches of skin
  • waxy scar
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8
Q

BCC spread/growth

A
  • local, lateral growth
  • slow growing; good prognosis
  • if left untreated it can cause extensive damage but it’s rare to spread to other parts of the body
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9
Q

SCC

A
  • rough or scaly area of the skin
  • non-healing ulcer or crusted over patch of skin
  • wart like growth
  • lacks pearly rolled border and telangiectasia of BCC lesions
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10
Q

SCC spread/growth

A
  • grows more rapidly than BCC
  • more likely to spread
  • locally invasion at depth
  • hematogenous spread 10%
  • lymphatics involved
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11
Q

Investigation of all skin lesions

A
  1. Physical observation-non healing lesion is indurated, scaly and hypertonic
  2. History (of duration and changes)
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12
Q

Types of biopsy’s

A
  • Shave biopsy: raised lesions
  • Punch biopsy: 2-4 mm of most abnormal looking skin
  • Incisional biopsy: remove piece of tissue from lesion
  • Excisional biopsy: remove whole mass/lesion
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13
Q

Type of treatment dependent on: (7)

A
  1. size of lesion
  2. anatomic location
  3. depth of invasion (risk of recurrence)
  4. degree of cellular differentiation (risk of recurrence)
  5. history of previous tx (risk of recurrence)
  6. patient condition-age, health status
  7. location of lesion with respect to cosmoses
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14
Q

High risk factors

A

Disease factors:

  1. depth of invasion >2mm thickness
  2. anatomic location (ear, lip)
  3. differentiation (poorly or undifferentiated)
  4. rapidly growing

Patient factors:

  1. immunosuppression
  2. unprotected exposure to UV light
  3. History of skin cancer
  4. Xeroderma pigmentosum
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15
Q

TNM staging

A

Review slides

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16
Q

Primary treatment for NMSC?

A

Surgery is primary tx

  1. Excisional
  2. Moh’s surgery
  3. Curretage and electrodessication
  4. Cryosurgery
  5. Laser

Can also have RT, photodynamic therapy or topical chemo

17
Q

When is surgery recommended for NMSC?

A
  1. radiation-induced tumors
  2. persistent or recurrent disease following RT
  3. scarred or unhealthy skin
  4. age < 50 years (cosmesis)
  5. sites where RT is poorly tolerated (dorm of hand, perineum, sole of foot)
  6. very large tumors
  7. tutors involving cartilage or bone
18
Q

When is RT recommended for NMSC?

A
  1. when the tumor is large
  2. patient is a non-surgical candidate
  3. lesion is not resectable
  4. extensive disease
  5. recurrent after surgery
19
Q

Advantages and disadvantages of orthovoltage for NMSC

A

Advantages:

  1. high surface dose
  2. doesn’t penetrate deeply
  3. treatment simple, same or next day RT

Disadvantages:

  1. greater absorption in bone
  2. isocurve are bowed out at edges
  3. doesn’t effectively treat at depths greater than 2-3 cm deep
20
Q

Orthovoltage dose

A

Dependent on:

  1. size
  2. pathology
  3. number of fractions
  4. total time

3000-5500 cGy/ 10-15 fractions
50-300 kV energy

21
Q

When is mega voltage used to treat NMSC

A

for treating associated nodal disease

  • spares bone and cartilage
  • penetrates deeper
  • requires use of bolus
22
Q

Advantages and disadvantages of electron therapy for NMSC

A

6-10 MeV

Advantages:

  1. surface dose (75-95%)
  2. nose/ear lesions
  3. lesions >3 cm in diameter and >0.5 cm thick

Disadvantages:

  1. shape of isodose curve (dec dose at edges)
  2. surface curvature affects isodose distribution
  3. practicality of apportioning large applicators
23
Q

Electron therapy doses

A

4500 cGy/ 10 fractions

5000 cGy/ 15 fractions

5500 cGy/ 20 fractions

24
Q

Advantages and disadvantages of mould brachytherapy for NMSC

A

Advantages:

  1. short treatment times (3-7 days)
  2. Sharp fall off in %DD (useful over bone or cartilage)

Disadvantages:

  1. Time consuming/ careful planning
  2. inferior cosmesis
25
Q

Advantages and disadvantages of Interstitial brachytherapy for NMSC

A

Advantages:

  1. short treatment times
  2. works well for lesion thickness of 1-1.5 cm
  3. often external RT came first

Disadvantages:

  1. difficulty obtaining even dose distribution
  2. time/cost to plan
  3. unsuitable near eye or cartilage due to increased local dose
26
Q

Acute and chronic side effects of RT

A

Acute:

  • erythema
  • dry/moist desquamation
  • scab formation
  • epilation

Chronic:

  • hyper or hypo pigmentation
  • atrophy
  • telangiectasia
  • fibrosis
  • hypersensitivity
27
Q

5 year survival for low risk disease (T1)?

A

95-99% but 30-50% will have another NMSC within 5 years

28
Q

Merkel Cell Tumor

A
  • arises from neural crest cells
  • situated in the basal layer of epidermis and hair follicles
  • fleshy nodule, red or blue in colour, H&N
  • merkel cells important for tactile function
  • rare tumor
  • aggressive early spread via lymphatics and blood
  • surgery then RT then chemo
  • RT fields large to cover enough skin
  • poor prognosis in later staged disease
29
Q

Merkel cell epidemiology

A
  • 80% caused by Merkel cell polyomavirus (MPV), 20% unknown
  • excessive exposure to UV light
  • immunocompromised
  • older age (average 75 years)
  • fair-skinned women
30
Q

Merkel cell carcinoma diagnosis

A
  • physical
  • biopsy
  • SLB
  • chest xray or CT
  • PET
31
Q

TNM staging

A

Review slides

32
Q

Treatment options for Merkel cell carcinoma

A
  1. Surgery: 1-2mm margin; Moh’s
  2. Radiation: 60 Gy/ 30 fractions
  3. Chemo: adjuvant (cisplatin or carboplatin)
  4. Systemic immunotherapy: Avelumab
33
Q

Merkel cell carcinoma 5 year survival

A

Early stage: >80%
Once metastases occurs: <50%

Recurrence 5 year survival: 30-64%
Local recurrence rate: 26-44% after primary tx

Clinical Oncology (5 decks)

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