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5. Dermatology (Med) > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What are some examples of non-melanoma skin cancer?

A

Basal cell cancer (BCC)

Squamous cell cancer

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2
Q

What does BCC stand for?

A

Basal cell cancer

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3
Q

Is the incidence of non-melanoma skin cancer increasing or decreasing?

A

Increasing

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4
Q

What does NMSC stand for?

A

Non-melanoma skin cancer

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5
Q

What is the most common kind of non-melanoma skin cancer?

A

Basal cell cancers (BCC) - 70%

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6
Q

What are risk factors for non-melanoma skin cancer?

A
  • UV radiation
  • Photochemotherapy
  • Chemical carcinogens
  • X-ray and thermal radiation
  • Human papilloma virus
  • Familial cancer syndromes
  • Immunosuppression
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7
Q

Describe basal cell carcinoma?

A

Slow growing, locally invasive and rarely metastasis

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8
Q

Does basal cell carcinoma metastasis?

A

Slow growing, locally invasive and rarely metastasis

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9
Q

Describe the appearance of basal cell carcinoma?

A
  • Pearly rolled edge
  • Telangiectasia (widened venules cause threadlike patterns on skin)
  • Central ulceration
  • Arborising vessels on dermoscopy
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10
Q

What are the different kinds of basal cell carcinoma?

A
  • Superficial
  • Pigmented
  • Morphoeic
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11
Q

What is the treatment of basal cell carcinoma?

A
  • 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
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12
Q

What is curettage?

A

Use of curette to remove tissue by scraping or scooping

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13
Q

What is Mohs surgery?

A
  • Scrapping of layers of skin
  • Indications
    • Site
    • Size
    • Subtype
    • Poor clinical margin definition
    • Recurrent
    • Perineural or perivascular involvement
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14
Q

What are some indications for Mohs surgery?

A
  • Site
  • Size
  • Subtype
  • Poor clinical margin definition
  • Recurrent
  • Perineural or perivascular involvement
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15
Q

What treatment is used for locally advanced BCC?

A

Vismodegib

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16
Q

What are indications for vismodegib?

A
  • Locally advanced BCC not suitable for surgery or radiotherapy
  • Metastatic BCC
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17
Q

What is the mechanism of action of vismodegib?

A
  • Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
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18
Q

What effect does vismodegib have?

A
  • Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
  • Can shrink tumours and heal visible lesions in some
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19
Q

What is the molecular driver in BCC?

A

Hedgehog pathway

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20
Q

What are some side effects of vismodegib?

A
  • Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

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21
Q

What does SCC stand for?

A

Squamous cell carcinoma

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22
Q

What is squamous cell carcinoma derived from?

A

Keratinising squamous cells

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23
Q

Can squamous cell carcinoma (SCC) metastasis?

A

Yes

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24
Q

Does SCC or BCC grow faster?

A

SCC

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25
Describe the lesions due to SCC?
Faster growing, tender, scaly/crusted or fleshy growths Can ulcerate
26
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
27
What should be done for patients with a SCC that is considered to be high risk?
Followed up
28
When is a SCC considered to be high risk?
* Immunosuppressed * \>20mm diameter * \>4mm depth * Ear, nose, lip, eyelid * Perineural invasion * Poorly differentiated
29
What diameter makes a SCC high risk?
\>20mm
30
What depth makes a SCC high risk\>
\>4mm
31
What is keratoacanthoma?
Variant of squamous cell carcinoma, erupts form hair follicles in sun damaged skin
32
Describe the lesion due to keratoacanthoma?
Grows rapidly, may shrink after a few months and resolve
33
What is the treatment of keratoacanthoma?
Treatment is surgical excision
34
Is the incidence of melanoma skin cancer increasing or decreasing?
Increasing
35
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
36
What genetic aspects are risk factors for melanoma skin cancers?
Fair skin Red hair Blue eyes Tendency to burn easily
37
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
38
What is the ABCDE rule?
* Asymmetry * Border * Colour * Diameter * Evolution
39
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
40
What are some major features for the 7 point checklist for melanoma?
* Change in size * Change in colour * Change in shape
41
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
42
What is melanoma investigated by?
Investigated by dermoscopy: * Uses dermosocpe * Improved clinical accuracy compared to unaided eye
43
Describe the biologic progression of melanoma?
44
What are the different kinds of melanoma?
* Superficial spreading malignant melanoma * Lentigo maligna melanoma * Nodular melanoma * Acral lentiginous melanoma/subungal melanoma * Ocular melanoma
45
What is the treatment of melanoma?
* Urgent surgical excision * Subtype * Breslow thickness
46
How does prognosis of melanoma change with Bewslow depth?
The greater the depth the worse the prognosis
47
What does Brewslow depth range from?
0mm to 5mm
48
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
49
What is the mechanism of action of ipilmumab?
* Inhibits CTLA-4 molecule
50
What is the mechanism of action of pembrolizumab?
* Blocks activity of PD-1
51
What is the mechanism of action of vemurafenib and dabrafenib?
* Blocks B-RAF protein
52
What are examples of treatment for metastatic melanoma that is only useful if B-RAF mutation is present?
* Vemurafenib and dabrafenib
53
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
54
When can cutaneous lymphoma be secondary?
Secondary cutaneous disease from systemic/nodal involvement
55
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
56
What is the most common primary cutaneous lymphoma?
Cutaneous T cell lymphoma (65%)
57
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
58
What are different kinds of cutaneous B cell lymphoma?
* Cutaneous follicle centre lymphoma * Cutaneous marginal zone lymphoma * Cutaneous diffuse large B Cell lymphoma
59
What does MF stand for?
Mycosis fungoides
60
What is the most common cutaenous T cell lymphoma?
Mycosis fungoides (MF)
61
What does CTCL stand for?
Cutaneous T cell lymphoma
62
What is the aetiology of mycosis fungoides (MF)?
Unknown
63
Who does mycosis fungoides more common in?
Older people Men affected more than woman
64
Does mycosis fungoides affect more men or woman?
Men
65
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
66
What investigations are done for mycosis fungoides?
* Bloods for sezary cells * CT imaging for staging
67
What re sezary cells?
Lymphoid cells with prominently folded
68
What is sezary syndrome?
* CTCL affecting skin of entire body * Skin thickened, red and scaly * Very itchy
69
What is sezary syndrome also known as?
"Red man syndrome"
70
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
71
What is the prognosis of sezary syndrome?
Poor
72
What does the treatment of cutaneous lymphoma depend on?
The stage
73
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
74
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
75
What is a major advantage of total skin electron beam therapy?
Spares deeper tissues and organs
76
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
77
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
78
What cancers commonly metastasis to the skin?
* Most commonly breast, colon and lung
79
What is the management of cutaneous metastasis?
* Treat the underlying malignancy * Local excision * Localised radiotherapy * Symptomatic
80
What are the commonest skin cancers?
BCC and SCC
81
What is the most serious skin cancer?
Melanoma

5. Dermatology (Med) (11 decks)

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