Skin Cancer Flashcards
Why is early diagnosis essential in MM?
What % of skin cancers does it make up?
What % of skin cancer deaths does it make up?
It is a cancer that spreads at an early stage and once spread is very difficult to treat.
5% of skin cancers
75% of deaths?
What does MM survival generally depend on
Tumour depth
- Less than 1mm, the 5 year survival is excellent
- Greater than 4mm, only half of the patients will survive
- Evidence of distant spread only 5% will survive 5 years
Which pnemonic should you use when diagnosing melanoma?
ABCDE rule
- A – Asymmetry
- B – Border
- C – Colour
- D – Diameter
- E – Evolution
What is the most common skin cancer?
- How does it present?
- Does it metastasize?
- What age?
Basal cell carcinoma
- Slow growing lump or non-healing ulcer; painless and often ignored
- ‘Pearly’ or translucent
- Visible, arborising blood vessels
- Central ulceration - “rodent ulcer”
- Can present as scaly plaque - ‘superficial’
- Can be infiltrative - ‘morphoeic’
- Locally invasive, but rarely metastasize
- > 40 yrs, but can be 3rd or 4th decade
How does squamous cell carcinoma tend to present?
Risk of metastasis?
SCCs can present in a number of ways including a warty or crusted growth or a non-healing ulcer. They usually arise on sun-damaged skin and tend to grow faster and may be painful.
- Hyperkeratotic (crusted) lump or ulcer
- Arises on sun-damaged skin
- Grow relatively fast, may be painful &/or bleed
- Majority - well differentiated low risk SCC
- Minority - poorly differentiated high risk SCC
- Risk of metastasis about 5%
What are two precursors to squamous cell carcinoma?
Actinic keratoses
Bowen’s disease
Where does SCC tend to metastasize to?
Lymph nodes & bone
Once it has metastasized, 5 year survival is 25%
Name some risk factors for skin cancer
- Sun exposure
- Genetic predisposition
- Immunosuppression
- (HPV infection)
- Other environmental carcinogens e.g. coal tar, smoking, ionising radiation, arsenic, trauma, chronic ulceration
- Genetic susceptibility
e. g. Xeroderma Pigmentosum, Albinism, Naevoid basal cell carcinoma (Gorlin’s) syndrome - Other environmental carcinogens e.g. ionising radiation, arsenic, chronic ulceration etc
What is xeroderma pigmentosum characterized by?
- Photosensitivity
- Skin cancers on UV-exposed sites
- Neurological degeneration
- Increased risk of other cancers
- Defect in one of seven Nucleotide
- Excision Repair (NER) genes (XPA - G)
What is Naevoid basal cell carcinoma (Gorlin’s) syndrome?
Major features?
Minor features?
This is an autosomal dominant familial cancer syndrome (1 in 57,000). Major features - Early onset/multiple BCCs - Palmar pits - Jaw cysts - Ectopic calcification falx Minor features - Skeletal abnormality - OFC >97th centile - Cardiac/ovarian fibroma - Medulloblastoma
Give some treatment options for non-melanoma skin cancer
- Surgery
- Photodynamic therapy
- Cryotherapy
- Chemo/radiotherapy
- 5-fluroucacil
- Solaraze
- Imiquimoid - an immune modifier; non-surgical; can be used on pre-cancer
What is the treatment for actinic keratosis?
ALA PDT (photodynamic light therapy) – aminolevulinic acid is put directly onto lesions of actinic keratosis, then blue light is used. It can show good results and is non-surgical.
How does imiquimoid cream work?
Immune modifier
Give three treatment options for pre-cancers e.g. sun aged skin
- Solaraze
- 5 FU
- Resurfacing
Give four methods of local anaesthesia
Topical – e.g. numbing gel at the dentist so you don’t feel the injection.
Local infiltration – local anaesthesia injected at site for minor procedures.
Nerve block – local anaesthetic is deposited within close proximity to the larger nerve branches e.g. at the dentist.
Field block – local anaesthetic is deposited toward larger nerve terminal branches; treatment is done away from the site of local anaesthetic.
