Skin Cancer Flashcards
What is the fastest increasing cancer in Scotland?
malignant melanoma
Where is malignant melanoma most common?
Sun exposed sites - scalp, face, neck, arms, legs
Where can a malignanct melanoma occur but this happens rarely?
eye, meninges, oesophagua, biliary tract, anus
Define the Breslow thickness.
the depth frm the granular layer of the epidermis to the deepest melanoma cell
What is the ABCDE of skin cancer?
A - aymmetry B - border C - colour D - diameter E - Evolution
Up to what diameter are you not concerned about a skin lesion?
6cm
Apart from Breslow thickness, what else is an adverse prognostic indicator of skin cancer?
Ulceration
Satellite deposits of melanoma
High itotic rate
Lymphovascular invasions
What are the 4 main types of malignant melanoma?
Superficial spreading melanoma
Acral/ mucosal lentiginous-acral and mucosal melanoma
Lentigo maligna melaoma
Nodular
What is the most common subtype of malignant melanoma and where is this most commonly found?
Superficial spreading melanoma
trunks of men and legs of women
Describe the appearance of a typical superficcial spreading melanoma.
Usually macule with irregular border and colour which may have been increasing in size for years (slow horizontal growth phase) before developing a nodule (rapid verticle growth phase)
Where are Acral/ mucosal lentiginous-acral and mucosal melanomas most commonly found?
palms, soles, nials and mucosal sites of elderly population
Where do Lentigo maligna melaoma usually appear?
Elderly face
Where are nodular maligant melanomas found?
Varied sites but often trunk
What is an amelanocytic melanoma?
Rare form of maligant melanoma where there is absent or minimal visible pigment
In nodular melanomas what is there no clinical evidence of?
Radial growth phase
Describe the typical appearance of a nodular melanoma.
Blue-black or red-skin coloured nodule whihc may be ulcerated or bleeding and has usually developed rapidly over preceding months
How do malignant melanomas spread?
Local dermal - satellite deposits
Regional lymph node mets - common pattern of disease progression
Haematogenous spread
How are MM treated?
Primary excision to give clear margins and SNB if indicated
Could give: chemo, immunotherapy, genetic therapies
Melanomas on intermittently sun-exposed skin may have what mutation?
BRAF mutation
What mutation do some acral melanomas have?
c-kit mutation
What are basal cell carcinoma and squamous cell carciomas classified as?
Non-melanoma skin cancer
How can basal cell carcinomas present?
Slow growing lump or non-healing ulcer painless, often ignored "pearly" or translucent but can be pigmented visible, arborising vessels scaly plaque - superficial BCC Infiltrative - morphoeic BCC Poory defined margins
Do BCC commonly metastasise?
No, locally invasive but rarely metastasie
How do SCC present?
hyperkeratotic (crusty) or warty ump or non-healing ulcer
grow relatively fast
may be painful and/or bleed
arise on sun damaged skin
Where are high risk sites for SCC?
ear
face
lip
scalp
What diseases are precursors to SCC?
Bowen’s disease
actinic keratosis
Viral lesions (esp on anogenital skin)
What is an adverse prognostic indicator of SCC?
Perineural spread
What is the risk of mets in SCC? How does this affect prognosis?
5% risk of mets
poor prognosis once metastatic
5 year survival rate of met SCC is 25%
If you have one SCC, what is the likelihood that you will get another?
50% further SCC at 5 years
What do actinic keratoses look like?
Erythematous sillver-scaly papules or patches with a conical surface and red base
With actinic keratoses what does the background skin tend to look like?
Often inelastic, wrinkled and may show flat brown macules (solar lentigos) reflecting diffuse solar damage
Where do actinic keratoses develop?
Sun exposed areas - scalp, face, hands
If a patient has several actinic keratoses in one area, how can this be described?
“field damage” or more sever “field cancerisation”
What treatment options are there for actinic keratoses?
cryotherapy
topical 5-fluoroacil cream
5% imiquimod cream
diclofenac gel
How is Bowen’s disease typicaly described?
“Isolated red scaly patch”
or patch looking ike psoriasis but ti has an irregular edge
What is the underlying mechanism behind Bowen’s disease?
Long term sun exposure leads to no maturation of cells giving parakeratosis on surface
What are the treatments available for Bowen’s disease?
cryotherapy
topical 5-fluoroacil cream
5% imiquimod cream
curettage
List the potentiall pre-maligant skin conditions.
Actinic keratsis Bowen's disease Atypical/ dysplastic naevus syndrome Giant congenital melanocytic naevi Viral precursors associated with HPV
What is the name for penile Bowen’s?
Erythroplasia of Queryat
In terms of sun damage, what is the typical description for that required to get SCC?
Chronic sumulative UV- exposure
In terms of sun damage, what is the typical description for that required for the development of BCC and MM?
Intermittent intense sunburn episodes
Does UVA directly cause DNA damage?
No - indirectly
UVB directly causes DNA damage
What is the proper term for “liver spots”?
Solar lentigo
Up to what % of sun damage occurs in the first 18 years of life?
Up to 80%
Childhodd sunburn increases the risk of melanoma … times?
4 x
Which genetic conditions put you at an increased risk of skin cancer?
Xeroderma pigmentosum
Albinism
Naevoid basal cell carcinoma (Gorlin’s) syndrome
What is Gorlin’s syndrome?
Autosomal dominant familial cancer syndrome
early onset and multiple BCCs
For transplant patients on immunosuppresants, what is the most common form of skin cancer they can develop?
SCC
Give some phototoxic drugs.
Vorconazole Anti-TNF BRAF inhibitors Thiazide diuretics NSAIDs
Why might a biopsy of a rash not provide a diganosis?
Different skin conditions may have same histology
One cause of a skin pathology may hvae different histology patterns
What is the most common form of skin surgery for skin lesions?
Elliptical excision
Give some benefits of punch biopsy?
Quick
produces good wound edges
Give some disavantages to using punch biopsy?
Difficult to judge depth
round holes do not always heal well
pathology sample may be too small
What complications can occur after skin surgery?
Bleeding wound dehisence infection scarring loss of function motor or sensory nerve damage
