Non-Melanoma Skin Cancers Flashcards
What are the main types of NMSCs? [2]
Indicate which is most common
70% - Basal Cell Carcinoma (BCC)
30% - Squamous Cell Carcinoma (SCC)
Compare the growth, spread of BCC [3] and SCC [2]?
BCC - slow growing, locally invasive and rarely metastasise
SCC - Fast growing and frequently metastasise
What are the risk factors common across all NMSCs?
What is the main risk factor for Actinic Keratosis?
What are risk factors for Bowen’s disease? [4]
UV exposure Radiation Immunosuppression Previous history of skin cancer Familial cancer syndromes Increasing age
AK - UV exposure
Bowens disease
- UV exposure
- radiation, immunosuppression
- arsenic
- HPV (ano-genital disease)
BCC Presentation
Superficial lesions [3]
Nodular presentations [3]
Risk factors [6]
Superficial lesions may appear as red scaly plaques with raised smooth edge - trunk, shoulders
Nodular with a pearly rolled edge. Telangiectasia (visible vessels). Central ulceration
Risk factors:
- UV exposure
- Immunosuppressants
- Hx of frequent/severe sunburn as child
- Skin Type 1
- Increasing age, M>F
- Previous hx, FMH
What would an unusual Basal cell carcinoma look like? [4]
Cystic
Morphoeic/sclerosing
Keratotic
Pigmented
What are the treatments for BCCs? [6]
- Gold standard is surgical excision
- Best way is Moh’s Surgery - Curettage
- Cryotherapy
- Radiotherapy
- Photodynaic therapy
- Rx: Vismodegib, imiquimod, 5-fluororacil
Explain Moh’s surgery? [2]
Indications [3]
- Excision of lesion and tissue borders progressively excised - until specimens microscopically free of tumour.
Indications:
- so its used when the cancer is morphoeic making it harder to determine the margins
- when the tumour is nearing important stuff eg nerves. vessels, eye, areas that need minimal excision
When is curettage indicated for BCC? [1]
When is 5-FU and imiquimod indicated? [1]
If the patient is too old or frail for surgery
5-FU, imiquimod indications: superficial lesions at low risk sites
How does Vismodegib work?
It inhibits abnormal signalling in the hedgehog pathway, which is the molecular driver for BCCs
When do you use vismodegib? [1]
SE [5]
For BCCs unsuitable for surgery such as advanced or metastatic tumours
It can cause hair loss, weight loss, taste abnormalities, fatigue, nausea and muscle spasms
How do SCCs appear?
Risk factors [6]
Fast growing
Tender irregular growths either scaly/crusted or fleshy
They may ulcerate
On sun exposed sites
Increased risk of SCC if:
- Lip, ear, non sun exposed site
- > 2cm diameter
- arsenic
- HPV (ano-genital disease)
- Chronic inflammation eg leg ulcers
- Smoking is associated
How do you treat SCCs? [3]
- Local complete excision
- Mohs micrographic surgery: for large, ill-defined recurrent tumours
- RT: large, non-resectable tumours
Differentiating BCCs & SCCs?
BCCs take a long time to grow
They have a pearly rolled edge, frequent central ulceration and telangiectasia
SCCs take a matter of months to grow
They are scaly/crusted or fleshy and feel tender
Older patients often present with rough crumbly yellow scaly patches, particularly on sun-damaged areas e.g. ears or hands. what are they? [3]
Actinic Keratoses
Pre-malignant areas of dysplastic intra-epidermal proliferation of atypical keratinocytes
How would you manage actinic keratoses? [6]
They need to be treated to pre-empt SCC. But if mild, they require no management
- DICLOFENAC gel: twice daily for 60-90d
- FLUOROURACIL 5% cream: causes inflammatory reaction; once or twice daily for 6w (can be effective for up to 12 months)
- IMIQUIMOD 5%: augments cell mediated immunity by stimulating interferon alpha; 3x weekly for 4w and assess after 4w free gap
- Cryotherapy: 75% effective
- Photodynamic therapy: 91% effective
- Surgical excision and cutterage: if atypical, unresponsive to mx or SCC suspected
