skin cancer Flashcards
What is the majority of non melanoma skin cancers
basal cell cancer
What are the risk factors for skin cancer
UV radiation
photochemotherapy
chemical carcinogens
ionising radiation
Human papilloma virus
familial cancer syndromes
immunosuppression
Which cancer is human papilloma specifically linked to
squamous cell carcinoma
What is the presentation of a basal cell carcinoma
slow growing
locally invasive
rarely metastatic
The nodules have :
pearly rolled edges
telangiectasia
central ulceration
What are morphoeic basal cell carcinomas
basal cell carcinoma but with the appearance of a scar with no history of trauma
What is the treatment of basal cell carcinoma
gold standard is elliptical excision - draw around the carcinoma with a 4 mm of unaffected skin - then excise that - it will leave a large scar - curative treatment
Mohs surgery can also be done - cut into the tumour site and then biopsy in a lab there and then find the margins of the tumour
Vismodegib when the other treatments are not indicated - shrinks tumour but has large side effects
How do squamous cell carcinomas present
Sun exposed sites
16% metastasise
Has fast growing, tender, scaly/crusted or fleshy growths
They can ulcerate
What is the treatment of squamous cell carcinoma
Excision plus or minus radiotherapy
What is keratoacanthoma
Varient of squamous cell carcinoma which erupts from the hair follicles in sun damaged skin
how does keratoacanthoma present
rapidly growing and can shrink after a few months and resolve
What is the treatment of keratoancanthoma
surgical excision and treat as squamous cell carcinoma as hard to differentiate
What are the risk factors of melanoma
UV radiation
fair skin, red hair, blue eyes and tendency to burn easily
familial melanoma and melanoma susceptibility genes
What is the rule used for melanoma
A - asymmetry in shape and colour
B - border - nice clearly defined edge
C - colour - consistent colour - blue white veil is a significant feature of melanoma
D - diameter - greater than 7mm
E - evolution - is it changing - very important
What is a dermoscope used for
Improved clinical accuracy of what a mole looks like
what is Lentigo maligna melanoma
melanoma which Commonly appears on face
What are nodular melanomas
More aggressive melanomas that spread downwards immediately instead of out along the skin - diagnosed late usually
What are acral lentiginous melanoma
Appear on the palms of the hands and the soles of the feet
What is a subungal melanoma
Melanoma within the nail
What is an ocular melanoma
Melanoma of the eye
What is the treatment of melanoma
Urgent surgical excision
This gives the subtype of melanoma and the breslow thickness
Breslow thickness - the depth of the melanoma from the stratum granulosum
Wide local excision - going back to the excision and taking slightly larger excision to remove any remaining melanoma cells
chemotherapy and radiotherapy are rare
Immunotherapy can be used in metastasis or as adjuvant therapy
What is the correlation between depth of melanoma and prognosis
The deeper the melanoma, the worse the prognosis (breslow depth)
What is a cutaneous lymphoma
abnormal neoplastic proliferation of lympohocytes in the skin
T cell lymphomas are most common
What is mycosis fungoides
Most common cutaneous T cell lymphoma
More common in older patients and in men
Patients normally live with the disease till they die
What are the stages of mycosis fungoides
patch stage: flat, red, dry oval lesions
Usually in covered sites
may itch
hard to differentiate eczema and psoriasis
plaque stage - patches become thickened and itchy
Tumour stage - large irregular bumps that ulcerate - have chance of metastatic spread
metastatic stage - infiltration of neoplastic cells in lymph nodes, blood and solid organs
What is sezary syndrome
cutaneous T cell lymphoma which affects all the skin in the body - skin becomes thickened, scaly and red - causes ERYTHRODERMA
There is node involvement and the cells are in the peripheral blood
Poor prognosis
What is the treatment of cutaneous lymphoma
topical steroids
UVB
radiotherapy
interferon
Bexarotene
low dose methotrexate
chemotherapy
total skin electron beam therapy
What is total skin electron beam therapy
radiotherapy consisting of very small electrically charged particles - delivers radiation to the superficial layers mainly
What are the most common cutaneous metastases
breast, colon and lung
