Skin Cancer Flashcards
What are the 3 main types of skin cancers and what layer of the skin do they occur in?
Squamous cell carcinoma, Basal cell carcinoma, Malignant Melanoma. All occur in the epidermis.
What are the different types of biopsies used for investigating skin cancer?
Incisional, excisional, punch, and shave
Name the different ways a BCC can present?
Nodular, superficial, morpheoic, pigmented, and ulcerated
What are the properties of a nodular BCC?
- Slow growing pearly nodule that may ulcerate
- Pink hue
- Elevated shiny border
- May be cystic
Where do nodular BCCs often arise?
The face (forehead, temples, nose, upper lip)
What are the properties of a superficial BCC?
- Thin erythematous plaques with a blue tinge
- Dry or scaly
- Eroded or crusted
- Shiny rim
- Often asymptomatic
Where do superficial BCCs most often arise?
Trunk and limbs
What are the properties of a morphoeic BCC?
- Scar-like plaque or dent
- Often deeply invasive
Where do morphoeic BCCs most often arise?
Mid-face
What are the properties of a SCC?
- Irregular, red papule or plaque
- Scaly, warty, crusted surface
- May become nodular
Where do SCCs most often arise?
Face, ears, neck, lips, dorsum of hands
Which type of non-melanoma (BCC and SCC) is the most common?
BCC (~80%)
What is Bower’s disease?
Early form of SCC. Spreads along the skin surface rather than into the skin. Very slow growing; only a risk if neglected.
What are the subtypes of Malignant Melonoma?
Superficial spreading
Nodular
Acral lentiginous
Lentigo maligna melanoma
What are the 5 signs of malignant melanoma?
Asymmetrical
Borders (uneven)
Colours (variety)
Diameter (larger than 6mm)
Evolving
What staging system is used for non-melanomas?
TNM
What is the Breslow thickness of an melanoma and how is this used in staging?
How deep the melanoma goes in the skin. There are 5 stages and this is used in place of the T in the TNM staging for melanomas.
What are the main forms of treatment for BCCs and SCCs?
Surgery
Chemo
Photodynamic therapy
RT
What surgical techniques may be considered for treatment of a BCC or an SCC?
Surgical Excision
Cryosurgery
Moh’s micrographic surgery
What specific type of non-melanoma is photodynamic therapy used for?
Superficial BCC only
When is RT indicated for BCCs and SCCs?
-Older patients where long term cosmesis not an issue
- Large lesions
- Position of legion makes surgery difficult
- Multiple lesions
- Patient unfit for surgery
- To reduce chance of recurrence post-surgery
- Treat recurrence after surgery
When is RT indicated for melanomas?
Stage III: areas where lymph nodes are removed
Stage IV: to metastases
What are the 4 types of RT that are used to treat skin cancer?
kV
electrons
VMAT MV with bolus
Total body electrons
What doses are prescribed for VMAT RT for skin cancer?
60 Gy 30#
45 Gy 10# (>4cm)
35 Gy 5# (<4cm)
28 Gy 2# (7 weeks apart)
18 Gy 1#
What are the main side-effects of RT for skin cancer?
Skin scab over
Depigmentation
Loss of hair follicles
Loss of sweat glands
Lacrimal gland damage
What is apposition and why is it important for kV and electron treatment?
Where the applicator is positioned on a flat surface. It is needed for an even dose distribution.
What steps are occur in the diagnosis of skin cancer?
Attend GP
Refer dermatology
Dermoscopy
Biopsy
Lymph Node Biopsy
CT/MRI
What aetiological factors contribute towards melanomas?
Over exposure to UV radiation
Tar and soot
What aetiological factors contribute towards non-melanomas?
UV
Family history of SCC
Psoriasis
HIV
CT brain scan before age 20
