Skin Cancer Flashcards
What are some examples of non-melanoma skin cancer?
Basal cell cancer (BCC)
Squamous cell cancer
What does BCC stand for?
Basal cell cancer
Is the incidence of non-melanoma skin cancer increasing or decreasing?
Increasing
What does NMSC stand for?
Non-melanoma skin cancer
What is the most common kind of non-melanoma skin cancer?
Basal cell cancers (BCC) - 70%
What are risk factors for non-melanoma skin cancer?
- UV radiation
- Photochemotherapy
- Chemical carcinogens
- X-ray and thermal radiation
- Human papilloma virus
- Familial cancer syndromes
- Immunosuppression
Describe basal cell carcinoma?
Slow growing, locally invasive and rarely metastasis
Does basal cell carcinoma metastasis?
Slow growing, locally invasive and rarely metastasis
Describe the appearance of basal cell carcinoma?
- Pearly rolled edge
- Telangiectasia (widened venules cause threadlike patterns on skin)
- Central ulceration
- Arborising vessels on dermoscopy
What are the different kinds of basal cell carcinoma?
- Superficial
- Pigmented
- Morphoeic
What is the treatment of basal cell carcinoma?
- Excision is gold standard
- Ellipse with rim of unaffected skin
- Curative if fully excised
- Will scar
- Curettage (use of curette to remove tissue by scraping or scoping) used sometimes
What is curettage?
Use of curette to remove tissue by scraping or scooping
What is Mohs surgery?
- Scrapping of layers of skin
- Indications
- Site
- Size
- Subtype
- Poor clinical margin definition
- Recurrent
- Perineural or perivascular involvement
What are some indications for Mohs surgery?
- Site
- Size
- Subtype
- Poor clinical margin definition
- Recurrent
- Perineural or perivascular involvement
What treatment is used for locally advanced BCC?
Vismodegib
What are indications for vismodegib?
- Locally advanced BCC not suitable for surgery or radiotherapy
- Metastatic BCC
What is the mechanism of action of vismodegib?
- Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
What effect does vismodegib have?
- Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
- Can shrink tumours and heal visible lesions in some
What is the molecular driver in BCC?
Hedgehog pathway
What are some side effects of vismodegib?
- Hair loss, weight loss, altered taste
Muscle spasms, nausea, fatigue
What does SCC stand for?
Squamous cell carcinoma
What is squamous cell carcinoma derived from?
Keratinising squamous cells
Can squamous cell carcinoma (SCC) metastasis?
Yes
Does SCC or BCC grow faster?
SCC
Describe the lesions due to SCC?
Faster growing, tender, scaly/crusted or fleshy growths
Can ulcerate
What is the treatment of SCC?
- Excision
- With or without radiotherapy
- Follow up if high risk
- Immunosuppressed
- >20mm diameter
- >4mm depth
- Ear, nose, lip, eyelid
- Perineural invasion
- Poorly differentiated
What should be done for patients with a SCC that is considered to be high risk?
Followed up
When is a SCC considered to be high risk?
- Immunosuppressed
- >20mm diameter
- >4mm depth
- Ear, nose, lip, eyelid
- Perineural invasion
- Poorly differentiated
What diameter makes a SCC high risk?
>20mm
What depth makes a SCC high risk>
>4mm
What is keratoacanthoma?
Variant of squamous cell carcinoma, erupts form hair follicles in sun damaged skin
Describe the lesion due to keratoacanthoma?
Grows rapidly, may shrink after a few months and resolve
What is the treatment of keratoacanthoma?
Treatment is surgical excision
Is the incidence of melanoma skin cancer increasing or decreasing?
Increasing
What are some risk factors for melanoma skin cancer?
- UV radiation
- Genetic susceptibility
- Fair skin, red hair, blue eyes and tendency to burn easily
- Familial melanoma and melanoma susceptibility genes
What genetic aspects are risk factors for melanoma skin cancers?
Fair skin
Red hair
Blue eyes
Tendency to burn easily
What rule should be used when evaluating a lesion to be melanoma?
ABCDE rule:
- Asymmetry
- Border
- Colour
- Diameter
- Evolution
7 point checklist:
- Major features
- Change in size
- Change in colour
- Change in shape
- Minor features
- Diameter more than 5mm
- Inflammation
- Oozing or bleeding
- Mild itch or altered sensation
What is the ABCDE rule?
- Asymmetry
- Border
- Colour
- Diameter
- Evolution
What is the 7 point checklist for melanoma?
- Major features
- Change in size
- Change in colour
- Change in shape
- Minor features
- Diameter more than 5mm
- Inflammation
- Oozing or bleeding
- Mild itch or altered sensation
What are some major features for the 7 point checklist for melanoma?
- Change in size
- Change in colour
- Change in shape
What are some minor features for the 7 point checklist for melanoma?
- Diameter more than 5mm
- Inflammation
- Oozing or bleeding
- Mild itch or altered sensation
What is melanoma investigated by?
Investigated by dermoscopy:
- Uses dermosocpe
- Improved clinical accuracy compared to unaided eye
Describe the biologic progression of melanoma?
What are the different kinds of melanoma?
- Superficial spreading malignant melanoma
- Lentigo maligna melanoma
- Nodular melanoma
- Acral lentiginous melanoma/subungal melanoma
- Ocular melanoma
What is the treatment of melanoma?
- Urgent surgical excision
- Subtype
- Breslow thickness
How does prognosis of melanoma change with Bewslow depth?
The greater the depth the worse the prognosis
What does Brewslow depth range from?
0mm to 5mm
What is the treatment of metastatic melanoma?
- Ipilimumab
- Inhibits CTLA-4 molecule
- Pembrolizumab
- Blocks activity of PD-1
- Vemurafenib and dabrafenib
- Blocks B-RAF protein
- Only useful if B-RAF mutation
What is the mechanism of action of ipilmumab?
- Inhibits CTLA-4 molecule
What is the mechanism of action of pembrolizumab?
- Blocks activity of PD-1
What is the mechanism of action of vemurafenib and dabrafenib?
- Blocks B-RAF protein
What are examples of treatment for metastatic melanoma that is only useful if B-RAF mutation is present?
- Vemurafenib and dabrafenib
What is cutaneous lymphoma?
Rare subtype of non-Hodgkin lymphoma that starts in the skin. It is not classified as a skin cancer because the cancer cells originate in white blood cells called lymphocytes, whereas skin cancers develop from other non-lymphoid cells
When can cutaneous lymphoma be secondary?
Secondary cutaneous disease from systemic/nodal involvement
What are examples of primary cutaneous lymphoma?
- Cutaneous T cell lymphoma (65%)
- Mycosis fungoides
- MF varients
- Sezary syndrome
- CD30+ lymphoproliferative disorders
- Subcutaneous panniculitis like T cell lymphoma
- Cutaneous CD4+ lymphoma
- Extranodal NK/T cell lymphoma
- Cutaneous B cell lymphoma (20%)
- Cutaneous follicle centre lymphoma
- Cutaneous marginal zone lymphoma
- Cutaneous diffuse large B Cell lymphoma
What is the most common primary cutaneous lymphoma?
Cutaneous T cell lymphoma (65%)
What are different kinds of cutaneous T cell lymphoma?
- Mycosis fungoides
- MF varients
- Sezary syndrome
- CD30+ lymphoproliferative disorders
- Subcutaneous panniculitis like T cell lymphoma
- Cutaneous CD4+ lymphoma
- Extranodal NK/T cell lymphoma
What are different kinds of cutaneous B cell lymphoma?
- Cutaneous follicle centre lymphoma
- Cutaneous marginal zone lymphoma
- Cutaneous diffuse large B Cell lymphoma
What does MF stand for?
Mycosis fungoides
What is the most common cutaenous T cell lymphoma?
Mycosis fungoides (MF)
What does CTCL stand for?
Cutaneous T cell lymphoma
What is the aetiology of mycosis fungoides (MF)?
Unknown
Who does mycosis fungoides more common in?
Older people
Men affected more than woman
Does mycosis fungoides affect more men or woman?
Men
What are the different stages of mycosis fungoides?
- Patch
- Flat, red, dry oval lesions
- Usually covered sites
- May slowly enlarge of spontaneously resolve
- May itch
- Difficult to differentiate from eczema/psoriasis
- Plaque
- Patches become thickened
- Generally itch
- Tumour
- Large irregular lumps, can ulcerate
- Arise from existing plaques or in normal skin
- More likely to have metastatic spread
- Metastatic
- Infiltration of neoplastic cells in lymph nodes, blood and solid organs
What investigations are done for mycosis fungoides?
- Bloods for sezary cells
- CT imaging for staging
What re sezary cells?
Lymphoid cells with prominently folded
What is sezary syndrome?
- CTCL affecting skin of entire body
- Skin thickened, red and scaly
- Very itchy
What is sezary syndrome also known as?
“Red man syndrome”
What is the clinical presentation of sezary syndrome?
- CTCL affecting skin of entire body
- Skin thickened, red and scaly
- Very itchy
- Lymph node involvement
- Sezary cells in peripheral blood
- Atypical T cells
What is the prognosis of sezary syndrome?
Poor
What does the treatment of cutaneous lymphoma depend on?
The stage
What are possible treatments for cutaneous lymphoma?
- Topical steroids
- PUVA or UVB
- Localised radiotherapy
- Interferon
- Bexarotene
- Low dose Methotrexate
- Chemotherapy
- Total skin electron beam therapy
- Type of radiotherapy consisting of very small electrically charged particles
- Delivers radiation primarily to superficial layers (ie epidermis and dermis)
- Spares deeper tissues and organs
- Extracorporeal photophoresis
- 1) Patients blood drawn and leukocytes collected
- 2) Collected white cells wixed with psoralen which makes T cells sensitive to UVA radiation
- 3) Exposed to UVA radiation, damaging diseased cells
- 4) Treated cell reinfused back to patient
- Bone marrow transplantation
What is total skin electron beam therapy?
- Type of radiotherapy consisting of very small electrically charged particles
- Delivers radiation primarily to superficial layers (ie epidermis and dermis)
- Spares deeper tissues and organs
What is a major advantage of total skin electron beam therapy?
Spares deeper tissues and organs
Explain the process of extracorporeal photophoresis?
- 1) Patients blood drawn and leukocytes collected
- 2) Collected white cells wixed with psoralen which makes T cells sensitive to UVA radiation
- 3) Exposed to UVA radiation, damaging diseased cells
- 4) Treated cell reinfused back to patient
What are the different kinds of cutaneous metastasis?
Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy:
- Most commonly breast, colon and lung
What cancers commonly metastasis to the skin?
- Most commonly breast, colon and lung
What is the management of cutaneous metastasis?
- Treat the underlying malignancy
- Local excision
- Localised radiotherapy
- Symptomatic
What are the commonest skin cancers?
BCC and SCC
What is the most serious skin cancer?
Melanoma
