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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What is the epidemiology of non-melanoma skin cancer?

A

Basal and squamous cell carcinoma
131000 cases every year in UK - underestimate
BBCs account for 70%

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2
Q

What are the risk factors for non-melanoma skin cancer?

A

UV radiation, photochemotherapy, chemical carcinogens, ionising radiation, human papilloma virus, familial cancer syndromes and immunosuppression

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3
Q

What are the characteristics of basal cell carcinoma?

A

Slow growing
Locally invasive
Rarely metastasise
Nodular
Can look pigmented or morphoeic (difficult to diagnosis as poorly defined)

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4
Q

Describe the nodular characteristic of BCC

A

Pearly rolled edge
Telangiectasia
Central ulceration
Arborizing vessels on dermoscopy

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5
Q

What is the surgery for BCCs?

A

Excision is gold standard - ellipse with rim of unaffected skin
Curettage is some circumstances
Imiquimod if superficial

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6
Q

What are the indications for Mohs surgery?

A

Site, size, subtype, poor clinical margin definition, recurrent, perineural or perivascular involvement

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7
Q

What is Mohs surgery?

A

Aim is to remove all cancer cells and preserve healthy tissue + prevent scarring
Thin layers are removed

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8
Q

What is the indications for Vismodegib?

A

Locally advanced BCC not suitable for surgery or RT
Metastatic BCC

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9
Q

How does Vismodegib work?

A

Selectively inhibits abnormal signalling in Hedgehog pathway
Shrinks tumour and heals visible lesions in some
Median progression free survival 9.5 months

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10
Q

What are the side effects of Visodegib?

A

Hair loss, weight loss, altered taste, muscle spasm, nausea and fatigue

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11
Q

Describe squamous cell carcinoma

A

Derived from keratinising squamous cells
Usually skin exposed areas
Can metastasise - 16%
Can ulcerate

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12
Q

What are the characteristics of squamous cell carcinomas?

A

Faster growing, tender, scaly/ crusted or fleshy growths
Well differentiated

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13
Q

What is the treatment for SCC?

A

Excision and maybe RT
Follow up if high risk

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14
Q

What is high risk for SCC and need follow up?

A

Immunosuppressed, >20mm diameter, >4mm depth, ear, nose, lip, eyelid, perineural invasion and poorly differentiated

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15
Q

What is keratoacanthoma?

A

Variant of SCC
Erupts from hair follicles in sun damaged skin
Grows rapidly and may shrink and resolve after a few months

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16
Q

What is the treatment for keratoacanthoma?

A

Surgical excision

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17
Q

What are the risk factors for melanoma skin cancer?

A

UV radiation
Genetic susceptibility - fair skin, red hair, blue eyes and tendency to burn easily
Familial melanoma and melanoma susceptibility genes

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18
Q

What is the ABCDE rule for melanoma skin cancer?

A

Asymmetry
Border - irregular
Colour - multiple colours
Diameter - >7mm
Evolution - is it changing

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19
Q

What is the 7 point checklist for melanoma skin cancer?

A

Major features - change in size, shape and colour
Minor features - diameter more than 5mm, inflammation, mild itch/ altered sensation and oozing or bleeding

20
Q

What tool can be used to help investigate melanoma skin cancer?

A

Dermatoscope

21
Q

Describe the biological progression of melanoma

A

Benign stage
Dysplastic stage
Rapid growth phase
Vertical growth phase - getting more into dermis
Metastatic melanoma

22
Q

What are the different types of melanomas?

A

Superficial spreading malignant melanoma - more common
Lentigo Maligna melanoma
Nodular melanoma
Acral lentiginous melanoma/ subungal melanoma
Ocular melanoma

23
Q

What is the treatment for melanomas?

A

Urgent surgical excision - subtype and Breslow thickness
Wide local excision
Sentinel lymph node biopsy
Chemotherapy - almost never
RT - rarely
Immunotherapy - metastasis or adjuvant therapy

24
Q

What is used for metastatic melanoma and adjuvant therapy?

A

Ipilimumab
Pembrolizumab
Nivolumab
Vemurafenib and Dabrafenib
Trametinib

25
Q

Describe Ipilimumab

A

Inhibits CTLA-4 molecule
One year survival 47-51%

26
Q

Describe pembrolizumab

A

Targets PD-1 receptor on tumour cell
One year survival 68-74%
Adjuvant therapy in those with complete resection of lymph node/ metastatic disease

27
Q

Describe Nivolumab

A

Single agent or in combination with Ipilimumab in metastatic disease
Adjuvant therapy in those with complete surgical resection of lymph node/ metastatic disease
Targets PD-1 antibody

28
Q

Describe Vemurafenib and Dabrafenib

A

Blocks B-RAF protein - only useful if B-RAF mutation
Median survival 10.5 months

29
Q

Describe Trametinib

A

Used in combination with Dabrafenib - reduced toxicity and increased response
MEK inhibitor
In those with B-RAF mutation in MEK pathway is hyperactive resulting in uncontrolled growth of melanocytes

30
Q

What is cutaneous lymphoma?

A

Secondary cutaneous disease from systemic/ nodular involvement
Primary cutaneous disease - abnormal neoplastic proliferation of lymphocytes in skin ( T cell and B cell lymphoma)

31
Q

What are the types of cutaneous T cell lymphoma (65%)?

A

Mycosis fungoides
Sezary syndrome
CD30+ lymphoproliferative disorders
Cutaneous CD4+ lymphoma
Extra-nodal NK/T cell lymphoma
Subcutaneous panniculitis like T cell lymphoma

32
Q

What are some types of cutaneous B cell lymphoma (20%)?

A

Cutaneous follicle centre lymphoma
Cutaneous marginal zone lymphoma
Cutaneous diffuse large B cell lymphoma

33
Q

Describe Mycosis Fungoides

A

Most common CTCL and 50% of all primary cutaneous lymphomas
Cause is unknown
Common in older patients and more men
Indolent course - no pain

34
Q

What are the stages of mycosis fungoides?

A

Patch, plaque, tumour and metastatic

35
Q

Describe the patch stage of mycosis fungoides

A

Flat, red, dry oval lesions
Usually covered sites
May itch, slowly enlarge or spontaneously resolve
Difficult to differentiate from eczema/ psoriasis

36
Q

Describe the plaque stage of mycosis fungoides

A

Patches become thickened
Generally itch

37
Q

Describe the tumour stage of mycosis fungoides

A

Large irregular lumps, can ulcerate
Arise from existing plaques or in normal skin
More likely to have metastatic spread

38
Q

Describe the metastatic stage of mycosis fungoides

A

Infiltration of neoplastic cells in lymph nodes, blood and solid organs

39
Q

What is the investigations for mycosis fungoides?

A

Work up includes bloods for sezary cells CT imaging for staging

40
Q

Describe Sezary syndrome

A

Red man syndrome
CTCL affecting skin of entire body - thick skin, scaly, red and very itchy
Lymph node involvement
Sezary cells in peripheral blood - atypical T cells

41
Q

What is the prognosis for red man syndrome?

A

Median survival 2-4 years
Opportunistic infection

42
Q

What is used for treatment of cutaneous lymphoma?

A

Topical steroids, PUVA or UVB, localised RT, interferon, bexarotene, lose dose methotrexate, chemotherapy and total skin electron beam therapy

43
Q

What is total skin electron beam therapy?

A

Type of RT consisting of very small electrically charged particles
Delivers radiation to superficial layers - epidermis and dermis
Spares deeper tissues and organs

44
Q

What are the steps of extracorporeal phonophoresis?

A

1 - patients blood is drawn and leucocytes collected
2 - collected white cells mixed with psoralen which makes T cells sensitive to UVA radiation
3 - exposed to UVA radiation damaging diseased cells
4 - treated cells re-infused back to patients

45
Q

What is used for extensive cutaneous lymphoma treatment?

A

Extracorporeal phonophoresis
Bone marrow transplantation

46
Q

Describe cutaneous metastases

A

Can be secondary or primary such as melanoma or due to primary solid organ malignancy
Most common is breast, colon and lung

47
Q

What is the management for cutaneous metastases?

A

Treat underlying malignancy
Local excision
Localised RT
Symptomatic

Dermatology (10 decks)

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