Skin cancer Flashcards
What is a BCC?
BCC is the most common keratinocyte cancer (KC)/nonmelanoma skin cancer (NMSC). It is a slow‐growing, locally invasive malignancy that very rarely metastasises.
What are the clinical subtypes of BCC?
Nodular
Cystic
Superficial morphoeic (sclerosing)
Keratotic
Pigmented
What are the histological subtypes of BCC?
Nodular
Superficial
Pigmented
More invasive:
Morphoeic
Micronodular
Infiltrative
Basosquamous
Name some high risk features of BCC
Size >2cm
Site – eyes, nose, lips, ears
Poorly defined
Histological subtype – morphoeic/infiltrative
Aggressive histological features – perineural/vasc invasion
Failure of previous treatment
Immunosuppresion
Name some histological subtypes of SCC
Acantholytic
Desmoplastic
Splindle
Verrucous
How would you assess an abnormal pigmented lesion?
A - Asymmetry
B – Border (irregular)
C – Colour (variety of colours)
D – Diameter (>6mm)
E – Evolving
What would be your differentials for MM?
Benign
Seborrhoeic keratosis
Junctional or compound naevus
Campbell De Morgan spot
Pyogenic granuloma
Malignant
Pigmented BCC (or SCC)
Kaposi sarcoma
Name some important risk factors for melanoma
UV light exposure
Skin type I or II
Xeroderma pigmentosa
Giant pigmented naevus
Family history of melanoma or pancreatic cancer
Organ transplant/immunosuppression
Giant congenital melanocytic naevus
Previous sunburn with blistering (increases melanoma risk by three-fold)
Name some subtypes of melanoma
Superficial spreading (60%)
Nodular (30%)
Lentigo maligna melanoma
A lentigo is a macular lesion with an increased number of microscopically noramal melanocytes.
A lentigo maligna has an increased number of abnormal melanocytes
A lentigo maligna melanoma is a lentigo maligna which has invaded into the dermis.
Acral lentiginous (palms, soles and nailbed)
Amelanotic melanoma
Desmoplastic
What are the excision margins for MM based on TNM staging?
Stage 0: 0.5cm
Stage I: 1cm
Stage II: 2cm
Stage III & IV: At least 2cm, however, needs to be considered in the context of lymphatic spread and distant metastases
Which patients should be offered a SLNB?
Any patient with a stage 1b or above melanoma (i.e. any ulcerated primary melanoma, or melanoma with mitoses >=1/mm2) should be offered an SNB according to NICE guidance.
How often should MM patients be followed up?
Stage 0: discharge
Stage 1A: 2 – 4 times during first year then discharge
Stage 1B-2B (or stage 2C with negative SNB): 5 years (3 monthly for 3 years, then 6 monthly for 2 years).
Stage 3 (or 2C with no SNB): 5 years (3 monthly for 3 years, then 6 monthly for 2 years).
Consider surveillance imaging in those who would become eligible for systemic therapy as a result of early detection of mets.
Stage 4 – according to need
Name some immunomodulators used for the treatment of MM
Pembrolizumab (anti-PD-1)
Nivolumab (anti PD-1)
Ipilimumab (CTLA-4 blocker)
