skin cancer Flashcards
2 types of skin cancer
malignant melanoma
non-melanoma
name 6 tx for malignant melanoma
surgery- wide local excision
topical cream - imiquimod
EBRT- only when inoperable
chemotherapy - cisplatin but not often
targeted therapies - BRAF +VE
immunotherapy - BRAF-VE ipilimumab
when is WLE used for malignant melanoma
early stage tumour or recurrence in same place -removal of tumour and margin
when is imiquimod used for MM
local tx for 6-8 weeks if surgery not desired and good for elderly as no chemo side effect (not systemic)
when is EBRT used for MM
not often as radio resistant - but when surgery refused or cancer metastasised
when is chemo used for MM
Cisplatin, not often as MM chemoresistant
when is target therapies used for MM
BRAF+VE used for T3/T4 or in-transit mets
when is immunotherapy used
BRAF-VE requires use of ipilimumab - being trialed
name 5 surgeries for NMSC
Mohs micrographic surgery
lymphadenetomy
surgical excision
cryosurgery
curettage and electrolysis
what is the role of Mohs surgery for NMSC
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
when is lymphadenectomy used for NMSC
is LN involvement
role of surgical excision for NMSC
excision biopsy available at GPs and complete removal of tumour - sometimes requires skin graph
role for cryosurgery for NMSC
extreme cold to remove cancer - good for elderly as avoid surgery
role or curettage and electrolysis for NMSC
only for small, well defined tumours- removal of cancer and hot needle inserted to kill any microscopic margins remaining
name 3 stagings for MMSC
clarks scale - depth of melanoma
Breslows scale - thickness of melanoma
TNM
explain 5 TNMs of MMSC
Tis=melanoma on top layer of skin
T1=<1mm thick
T2=inbetween 1mm-2mm
T3=2mm-4mm
T4=>4mm thick
explain 5 TNMs of NMSC
Tis= carcinoma in situ
T1= tumour <2cm
T2= >2cm<= 5cm
T3=>5cm
T4=invasion of extra dermal layers (cartilage).
role of Photodynamic therapy for NMSC
photosensitiser and light used in conjunction to produce o2 and kill nearby cells
Imiquimod use for NMSC
alternative to RT or surgery for BCC
EBRT role for NMSC
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
difference between MM and NMSC
mm = from melanocytes
NM= basal cells, squamous cells and keratinocytes
Aetiology of mm
UV radiation from sunbed and sun
Sunburn
hair col= ginger increases risk
eye col= blue/grey increase risk
moles and freckles
aetiology of NMSC
UV radiation - SCC only effected by sun exposure but BCC affected by exposure and burn
moles and freckles
hair col
eye col
signs of MM
moles change shape/ size/ itch/ bleed
