Skin Cancer Flashcards by Lucy Jefford

What are the two most common skin cancers seen>

Basal cells cancer
Squamous cell cancer

How well did you know this?

Not at all

Perfectly

What are some of the risk factors for skin cancer?

UV radiation
Photochemotherapy
Chemical carcinogens
Ionising radiation
HPV
Familial cancer syndromes
Immunosuppression

How well did you know this?

Not at all

Perfectly

When may photochemotherapy, a risk for skin cancer, be given?

As part of psoriasis treatment

How well did you know this?

Not at all

Perfectly

Are basal cell carcinomas fast or slow growing?

Slow growing

How well did you know this?

Not at all

Perfectly

Describe basal cell carcinomas

Slow growing, locally invasive, rarely metastasise
Pearly rolled edged lesions w central ulceration

How well did you know this?

Not at all

Perfectly

What is the gold standard treatment for basal cell carcinomas?

Excision
Will leave a scar which is bigger than the carcinoma and a fair bit of unaffected skin is also removed to give a neater scar

->curettage in some circumstances, imiquimod if superficial

How well did you know this?

Not at all

Perfectly

Mohs surgery can be used in the removal of skin carcinomas too.
When is it particularly useful?

If the carcinoma is in an awkward place like the nose

Removed piece by piece until fully removed

How well did you know this?

Not at all

Perfectly

What are some of the indications for Mohs surgery?

Site e.g. nose
Size
Subtype
Poor clinical margin
Recurrent
Perineural or perivascular involvement

How well did you know this?

Not at all

Perfectly

There is a therapy known as Vismodegib, what are the indications for this?

Locally advanced basal cell carcinoma which is not suitable for surgery or radiotherapy

Metastatic basal cell carcinoma

How well did you know this?

Not at all

Perfectly

What does Vismodegib do?

Selectively inhibits abnormal signalling in the Hedgehog pathway
Can shrink tumours and heal visible lesions in some

How well did you know this?

Not at all

Perfectly

What are some of the side effects of Vismodegib?

Hair loss
Weight loss
Altered taste
Muscle spasms
Nausea
Fatigue

How well did you know this?

Not at all

Perfectly

Which cells is squamous cell carcinoma derived from?

Keratinising squamous cells

How well did you know this?

Not at all

Perfectly

Where on the body are squamous cell carcinomas more common?

Sun exposed regions

How well did you know this?

Not at all

Perfectly

Can squamous cell carcinomas metastasise?

Yes, up to 16%

How well did you know this?

Not at all

Perfectly

Describe squamous cell carcinomas.

Faster growing, tender, scaly/crusted or fleshy growths
Can ulcerate

How well did you know this?

Not at all

Perfectly

What is the treatment of squamous cell carcinomas?

Excision +/- radiotherapy

How well did you know this?

Not at all

Perfectly

After excision of a basal cell carcinoma, follow up is not needed.
Following excision of a squamous cell carcinoma, follow up is needed if high risk. What are these high risk indications?

Immunosuppressed
>20mm diameter
>4mm depth
On the ear, nose, lip or eyelid
Perineural invasion
Poorly differentiated

How well did you know this?

Not at all

Perfectly

Keratoacanthoma?

Variant of squamous cell carcinoma
Erupts from hair follicles in sun damaged skin
Grows rapidly but may shrink after a few months

->uncertainty to whether it is classified as benign or malignant

How well did you know this?

Not at all

Perfectly

What is the management of keratoacanthoma?

Surgical excision

How well did you know this?

Not at all

Perfectly

What are the risk factors for melanoma skin cancer?

UV radiation
Genetic susceptibility
Familial melanoma

How well did you know this?

Not at all

Perfectly

The ABCDE rule can be used when looking at skin lesions. What does this stand for?

Asymmetry
Border
Colour
Discharge
Evolution

How well did you know this?

Not at all

Perfectly

Regarding colour, what is worrying about a skin lesion?

Multiple colours of one lesion

How well did you know this?

Not at all

Perfectly

Regarding border, what is worrying in a skin lesion?

If border is unclear and it is hard to figure out when the lesion stops and the skin starts

Regarding diameter, what is worrying in a skin lesion?

Diameter > 7mm

What is meant by evolution of a skin lesion?

Is the mole changing?

In the seven point checklist when looking at moles or skin lesions, what are the three major features?

Change in size Change is shape Change in colour

In the seven point checklist when looking at moles or skin lesions, what are the four minor features?

Diameter >5mm Inflammation Oozing or bleeding Mild itch or altered sensation

Which investigation can be used to look at a mole more closely?

Dermoscopy

When is a melanoma considered to be metastatic?

When it penetrates into the dermis layer of the skin ->known as melanoma in situ when only in epidermis

As a melanoma increases in length, what happens to its severity?

Becomes more severe as it is of higher risk of metastasising

What is the most common type of melanoma seen?

Superficial spreading malignant melanoma

Where is Lentigo Maligna Melanoma usually found on the body?

The face

Do melanoma's usually grow out or down first?

Out first, spreads along skin and then down

Which type of melanoma doesn't follow the rule and spreads down without going out first?

Nodular melanoma

Which type of melanoma tends to appear on palms and soles and can be missed by patients as they often don't know what it on the soles of their feet?

Acral Lentiginous Melanoma/Subungal Melanoma

What is the treatment for ocular melanoma?

Removal of the eye

What is the treatment fir melanomas?

Urgent surgical excision

What does surgical excision of melanoma allow for?

Allows identification of the subtype of melanoma Assess Breslow thickness (depth of melanoma from outermost layer of skin) ->deeper the Breslow thickness, poorer the survival rate

After the urgent surgical excision, what else in done in the treatment of melanoma?

Wide local skin excision to ensure no cancer cells have been left Sentinel lymph node biopsy ->sentinel lymph nodes are the first lymph nodes that the skin drains to

Is chemo ever carried out for melanoma?

Almost never

Is radiotherapy ever carried out in melanoma patients?

Rarely ->used more commonly for squamous cell carcinomas

What extra treatment for be given for melanoma when there is metastatic disease?

Immunotherapy ->~can also be used if there is no metastatic disease but disease in the lymph nodes

What do immunotherapies do?

Boost the immune system to try and get it to respond more quickly

If you have had a melanoma, are you followed up?

Yes- stage one for 3 months to 1 year Everyone else followed up 3 monthly for three years and then a further 2 years, 6 monthly ->this is because high risk of melanoma coming back or developing a new one

What is cutaneous lymphoma?

Usually secondary cutaneous disease from systemic/nodal involvement ->can be primary but rarer

What causes primary cutaneous disease?

Abnormal neoplastic proliferation of lymphocytes in the skin ->primary can be T cell lymphomas or B cell lymphomas, T cell more common

What is the most common cutaneous T cell lymphoma?

Mycosis Fungoides ->although most common, still very rare more common in older patients, M>F

What are the different stages of mycosis fungoides?

Patch- flat, red, dry lesions- can itch Plaque- generally itch Tumour- large irregular lumps which can ulcerate Metastatic

What is sezary syndrome often known as?

Red man syndrome

Which investigations are done in someone with suspected mycosis fungosis?

Bloods for sezary cells CT for staging (if metastatic and has spread to solid organs)

What type of lymphoma is sezary syndrome?

Cutaneous T cell lymphoma ->there is lymph node involvement

How does Sezary syndrome affect the skin?

Affects skin of whole body Causes thickening, scaly and red itchy skin

What is the treatment of cutaenous lymphoma?

Dependant on stage Early stage: Topical steroids Phototherapy e.g. PUVA or UVB Localised radiotherapy Interferon or Bexarotene Low dose methotrexate Extensive: Chemotherapy Total skin electron beam therapy Bone marrow transplant

What does total skin electron beam therapy allow?

Delivers radiation to superficial layers i.e. epidermis and dermis, while sparing the deeper tissues ad organs

Cutaneous metastases can be primary or secondary or due to primary organ malignancy. Which solid organs does a cutaneous malignancy usually spread from?

Breast, colon and lung

What is the treatment for cutaneous metastases?

Treat underlying malignancy Local excision Localised radiotherapy Symptomatic treatment