skin 6 Flashcards
what is the symptoms of skin cancer?
Presentation and symptoms vary significantly between patients, and symptoms can be similar to other conditions.
Common symptoms of skin cancerinclude asore orarea of skin that:
doesn’t heal within 4 weeks
looks unusual
hurts, is itchy, bleeds, crusts or scabs for more than 4 weeks
what is Basal cell carcinoma (rodent ulcer)
treatment
least malignant and most common form of skin cancer (>30% of all Caucasians get it during their lifetime).
Most common skin types 1 & 2; rare in types 4 & 5
common in later life on exposed sites. Lesions often on sun-exposed areas of face (rare on ear) and appear as shiny, dome-shaped nodules that later develop central ulcer with pearly, beaded edge. Can have small visible blood vessels (telangiectasia’s)
relatively slow-growing and metastasis seldom occurs before detection.
Treatment: full cure in >99% of cases by
surgical excision. Radiotherapy can be
useful for large superficial forms. Cryo-
therapy also can be used for very superficial
forms although follow up advised. Fluorouracil,
imiquimod.
what is Squamous cell carcinoma
causes
risk factor
treatment
Arises from keratinocytes of stratified squamous epithelium.
Linked to exposure to UV radiation (sun / tanning beds)
UV can lead directly to a SCC or can cause actinic keratosis (a scaly skin area) that if untreated can develop into SCC
Grows rapidly and metastasises if not removed.
RISK FACTORS
- Risk factor is skin that easily burns (types 1 and 2)
- Any body site, especially where sun exposed
- Multiple tumours can occur in people who have had long periods on immunosuppression (e.g. renal transplant)
TREATMENT
Treatment: if caught early and removed surgically or by radiation therapy then chances of complete cure are good.
what is Actinic (solar) keratosis:
treatment
pre-cancerous dry scaly patch that can develop into SCC
Treatment: most common / early stage:
Solaraze (3% diclofenac and hyaluronic acid)
Topical 5 fluorouracil (0.5 – 5%)
what is Malignant Melanoma
causes
risk factors
treatment
Most dangerous of all skin cancers (can also occur in the eye). Accounts for only ~5% of all skin cancers (but increasing due to sun exposure & tanning).
RISK FACTORS
- History of childhood sun exposure (sun burn) particularly important for development of MM. Positive family history of MM also strong risk factor
- Common on sun exposed areas
- Highly metastatic and resistant to chemotherapy.
-Occurs spontaneously in melanocytes and can begin wherever there is pigment. Approx. 30% arise from pre-existing moles.
-more men die
TREATMENT
Treatment: urgent, wide surgical excision plus chemotherapy, possibly immunotherapy e.g. IL2. Depth of invasion and thickness of tumour predict prognosis and 5-yr survival rates.
Key to survival is early detection. Chance of survival is poor if lesion >4mm thick.
how can pharmacist help and advice about skin cancer?
Pharmacists/healthcare workers play an important role in advising people of the dangers of sunbathing and tanning beds and to encourage the appropriate use of sunscreens as being of utmost importance when trying to prevent skin cancer.
Advice includes: avoiding sun exposure during hours of 11am-3pm, wear a sun hat, apply a high protection sunscreen (e.g. SPF30) and re-apply at regular intervals.
more people will die with tanning beds than smoking
how can you recognise melanoma?
ABCD(E) - USA critera ?
Asymmetry. One half doesn’t match the appearance of the other half.
Border irregularity. The edges are ragged, notched, or blurred.
Colour. The colour (pigmentation) is not uniform. Shades of tan, brown, and black are present.
Diameter. The size of the mole is greater than 6 mm, about the size of a pencil eraser. Any growth of a mole should be evaluated.
Evolution (Elevation). Has the mole changed in size, shape or colour
4/5 = concern
recognising melanoma using Glasgow 7-point checklist of melanoma (UK criteria
Major criteria Change in size
Change in shape
Change in colour
Minor criteria Diameter >6mm
Inflammation
Oozing/bleeding
Mild itch or altered sensation
what is the role of the pharmacist for skin cancer
NOT to diagnose / recommend therapy
Unless in hospital as consultant oncology pharmacist!
Important to be able to recognise suspicious lesions / moles etc
Advise to see GP
But without terrifying patient…
Advise on common tinea infections
If mild and localised
Athletes’ foot, Jock itch, nail infections etc
OTC preparation available
If infection has spread and oral therapy may be necessary, refer to GP
Tinea capitis
what is fungal infections
“Dermatophyte” infections caused by 3 main fungi:
Trichophyton, Microsporum and Epidermophyton
“Candidaisis” infections from Candida albicans (yeast)
Thrush
Organisms identified by microscopy and culture of skin, hair or nail samples
Clinical appearance of fungal skin infections (mycoses) depends on infecting organism, site of infection and host reaction
All are spread by direct contact from other humans or infected animals
Use of communal showers and swimming pools and sharing of towels or sportswear aids transmission of infection
what is
Tinea capitis:
Tinea corporis:
Tinea cruris:
Tinea pedis:
Tinea capitis: scalp
Tinea corporis: body
Tinea cruris: groin
Tinea pedis: feet
what is tinea capitis
how is it spread
where does it occur
who is it most common in
treatment
Usually seen in children in UK.
Due to Microsporum or Trichophyton species of human or animal (often a kitten).
Spread by close contact (esp. in schools and households).
May be spread indirectly by hairdressers.
Fungus may confine itself to within hair shaft or spread out over hair surface.
Patches of alopecia typically seen on head.
Can be inflammatory.
TREATMENT
Tinea capitis: Topical antifungals can’t easily penetrate the follicle
Due to the risk of scaring, alopecia treatment is usually systemic, normally terbinafine for two to four weeks
The use of a topical treatment eg ketoconazole shampoo is recommended at least twice weekly during the first two weeks of therapy
Treat all family members with ketoconazole shampoo at least twice weekly for two weeks
what is tinea pedis
treatment
Ringworm of the foot (athlete’s foot) appears in toe clefts.
Caused by Trichophyton species.
Presents as red, scaly eruption that itches.
Can develop into macerated and fissured area.
Can spread to other parts
Athletes foot: Terbinafine 1% cream or spray / in situ film
Cochrane review and trials show terbinafine better than imidazoles for AF
what is tinea corpis
Ringworm infection of trunk and/or limbs.
May be contracted from animals or humans.
Usually due to Trichophyton species.
Isolated erythematous and scaly lesions or clusters of round or oval red patches.
what is tinea cruris
symptoms
treatment?
“Jock itch”; “Gym itch”; “Crotch rot”
Very common, especially in warmer climates
Itching in groin, thigh skin folds, or anus
Red, raised, scaly patches that may blister and ooze
Usually responds to self-care within a couple of weeks:
Keep the skin clean and dry.
Don’t wear clothing that rubs and irritates the area.
Apply topical over-the-counter antifungal or drying powders,
If infections not responded in 2 weeks, see GP.
