skin cancer

Question 1

2 types of skin cancer

Answer 1

malignant melanoma
non-melanoma

Question 2

name 6 tx for malignant melanoma

Answer 2

surgery- wide local excision
topical cream - imiquimod
EBRT- only when inoperable
chemotherapy - cisplatin but not often
targeted therapies - BRAF +VE
immunotherapy - BRAF-VE ipilimumab

Question 3

when is WLE used for malignant melanoma

Answer 3

early stage tumour or recurrence in same place -removal of tumour and margin

Question 4

when is imiquimod used for MM

Answer 4

local tx for 6-8 weeks if surgery not desired and good for elderly as no chemo side effect (not systemic)

Question 5

when is EBRT used for MM

Answer 5

not often as radio resistant - but when surgery refused or cancer metastasised

Question 6

when is chemo used for MM

Answer 6

Cisplatin, not often as MM chemoresistant

Question 7

when is target therapies used for MM

Answer 7

BRAF+VE used for T3/T4 or in-transit mets

Question 8

when is immunotherapy used

Answer 8

BRAF-VE requires use of ipilimumab - being trialed

Question 9

name 5 surgeries for NMSC

Answer 9

Mohs micrographic surgery
lymphadenetomy
surgical excision
cryosurgery
curettage and electrolysis

Question 10

what is the role of Mohs surgery for NMSC

Answer 10

used for BCC that have relapsed or growing into surrounding tissue - surgery for large tumours or tumour in an area that reuqire minimal tissue removal

Question 11

when is lymphadenectomy used for NMSC

Answer 11

is LN involvement

Question 12

role of surgical excision for NMSC

Answer 12

excision biopsy available at GPs and complete removal of tumour - sometimes requires skin graph

Question 13

role for cryosurgery for NMSC

Answer 13

extreme cold to remove cancer - good for elderly as avoid surgery

Question 14

role or curettage and electrolysis for NMSC

Answer 14

only for small, well defined tumours- removal of cancer and hot needle inserted to kill any microscopic margins remaining

Question 15

name 3 stagings for MMSC

Answer 15

clarks scale - depth of melanoma
Breslows scale - thickness of melanoma
TNM

Question 16

explain 5 TNMs of MMSC

Answer 16

Tis=melanoma on top layer of skin
T1=<1mm thick
T2=inbetween 1mm-2mm
T3=2mm-4mm
T4=>4mm thick

Question 17

explain 5 TNMs of NMSC

Answer 17

Tis= carcinoma in situ
T1= tumour <2cm
T2= >2cm<= 5cm
T3=>5cm
T4=invasion of extra dermal layers (cartilage).

Question 18

role of Photodynamic therapy for NMSC

Answer 18

photosensitiser and light used in conjunction to produce o2 and kill nearby cells

Question 19

Imiquimod use for NMSC

Answer 19

alternative to RT or surgery for BCC

Question 20

EBRT role for NMSC

Answer 20

kV or electron treatments used when surgery may give poor cosmetic effect or pt unfit
immobilisation - sandbags, foam, lead,thermoplastics
care- worse before improvement and don’t pick scabs, open wounds risk infection

Question 21

difference between MM and NMSC

Answer 21

mm = from melanocytes
NM= basal cells, squamous cells and keratinocytes

Question 22

Aetiology of mm

Answer 22

UV radiation from sunbed and sun
Sunburn
hair col= ginger increases risk
eye col= blue/grey increase risk
moles and freckles

Question 23

aetiology of NMSC

Answer 23

UV radiation - SCC only effected by sun exposure but BCC affected by exposure and burn
moles and freckles
hair col
eye col

Question 24

signs of MM

Answer 24

moles change shape/ size/ itch/ bleed

Question 25

signs of NMSC

Answer 25

Spot or sore that won’t heal, itches, scabs, ulcerates

Question 26

2 types of MM investigations

Answer 26

dermatoscope - camera identifying changes in moles
excision biopsy - removal mole + 2mm margin

Question 27

2 investigations for NMSC

Answer 27

Punch biopsy - removal of deeper layer to identify depth of disease
Shave biopsy- obtain top layers to identify if BCC or SCC

Question 28

name 2 types of MM

Answer 28

superficial melanoma
nodular melanoma

Question 29

name 2 types of NMSC

Answer 29

In Situ - Bowens disease
Malignant - BCC or SCC