Skin Cancer Flashcards
Non melanoma skin cancers? which one more?
Basal cell carcinoma and squamous cell carcinoma. More often is the Basal Cell Carcioma
NMSkin cancer risk factors?
Photochemotherapy (PUVA)
Chemical carcinogens
Ionising radiation
Human papilloma virus (esp squamous cell)
Familial cancer syndromes
Immunosuppression
Basal cell carcinoma look like and types
Slow growing. Area of ulceration at the core. vascular, raised rim around the edge.
Slow growing
Locally invasive
Rarely metastasise
Nodular
Pearly rolled edge
Telangiectasia
Central ulceration
Arborising vessels on dermoscopy
Pigmented, Mophoeic types.
What is the BCC treatment
Pigmented can look like a melanoma.
Mophoeic is like an ill defined area of scarring that hasn’t arisen from any trauma.
Treatment = excision, occasionally Curettage/Imiquimid
When would Mohs be used?
If in a difficult place to excise or if wanting to be definitly sure you have excised the whole basal cell carcinoma lesion.
It involves excising rea and then having a look to see if there is any more tumour further down, then excising that aswell.
What pathway drives the growth in BCC? What drug inhibits this?
Hedgehog. Vismodegib. Only used when surgery really isn’t an option.
SCC can mastastisise? SCC treatment
Yes, up to 16%
from keritiniosing squamous cells
Excision +/- radiotherapy
What nakes SCC high risk? Wha t does that mean in relatiob to the patient?
Immunosuppressed
>20mm diameter
>4mm depth
Ear, nose, lip, eyelid
Perineural invasion
Poorly differentiated
It means the patient is required to be followed up after treatment to ensure that it hasn’t come back in any form.
Keratiacanthoma?
Funky things that look like squamous cell carcinoma around hair follicles on the head. Treat as if squamous cell carcinoma but may resolve by itself.
ABCDE rule melanoma
A- Asymmetry
B - Border (unclear/undefined?)
C- Colour (multiple?)
D - Diameter (over 1cm?)
E - Evolution (changes?)
7 point checklist
Major features:
-Change in size
-Change in shape
-Change in colour
Minor features:
-Diameter more than 5 mm
-Inflammation
-Oozing or bleeding
-Mild itch or altered sensation
What is dermoscopy?
An investigation used if melanoma is suspected (basically a fancy magnifying glass to look at the mole in more detail)
Progression of melanoma
Benign nevus -> Dysplastic nevus (unusal behaviour in situ) -> Radical growth Phase (goes a bit crazy and will see the changes across the skin) -> Vertical growth phase (starts becoming more of a threat to become metastatic) -> Metastatic
Lentigo Maligna t Melanoma
Melanoma on the face
Nodular Melanoma
Melanoma that are like nodules/look like cysts, they skip the radical growth phase and so jsut start by growing down the way, so they’re a pretty aggressive form of cancer as they skip straight towards malignancy
Acral Lentiginous melanoma/ Subungal melanoma
Acral Lentiginous (Noah built his ARC with hands and feet…) so melanoma of the hands and the soles of the feet
Subungal - think subfungalnail - nail mealnoma under the nail
Ocular Melanoma
Eye melanoma - may need eye to be removed as treatment
Melanoma treatment
Excission,
Chemop ineffective, radio is sometimes used, but immunotherapy is the main winner
eg
-Ipilimumab (Inhibits CTLA-4 molecule)
-Pembrolizumab
(Targets PD-1 receptor on tumour cell)
-Nivolumab (also PD-1 antibody)
-Vemurafenib and Dabrafenib
(Blocks B-RAF protein)
-Trametinib
Used in combination with Dabrafenib
Reduced toxicity
Cutaneous Lymphoma
Cancer of the lymoph nodes, can be primary or secondary
Primary cutaneous disease – abnormal neoplastic proliferation of lymphocytes in the skin
Cutaneous T Cell lymphoma (65%)
Cutaneous B Cell lymphoma (20%)
CTCK (Cutaneous T Cell lymphoma (65%)) Mycosis Fungoides?
- most common
-unknown cause
-Indolent course (usually painless/unnoticable)
Patches/plaques simelar to eczema or psoriasis
Can formtumour/ metastatic disease. Need to check for Sezary syndrome
CTCL (Cutaneous T Cell lymphoma (65%)) Sezary Syndrome
-“Red Man Syndrome”
-CTCL affecting skin of entire body
-Skin thickened, scaly and red
-Itchy++
-Lymph node involvement
-Sezary cells in peripheral blood
-Atypical T cells
-Poor prognosis
-Median survival 2-4 years
-Opportunistic infection
Treatments of Cutaneous lymphoma
Topical steroids
PUVA or UVB
Localised radiotherapy
Interferon
Bexarotene
Low dose Methotrexate
Chemotherapy
Total skin electron beam therapy (like the full body scanners in airports, but targetted for the cancer)
Extracorporeal photophoresis ( blood involved, kill bad cells using light and ectra T cells)
Melanoma metastases from what usually?
Lung, Colon or breast
