Skin Cancer Flashcards
1
Q
Give 2 examples of cancers that come under the category non-melanoma skin cancer
A
- Basal cell cancer
- Squamous cell cancer
2
Q
Which non-melanoma skin cancer is there more incidence of?
A
Basal cell carcinoma
3
Q
What are the risk factors for non-melanoma skin cancer?
A
- UV radiation
- Photochemotherapy
- Chemical carcinogens
- X-ray and thermal radiation
- Human papilloma virus
- Familial cancer syndromes
- Immunosuppression
4
Q
What is the appearance of basal cell carcinoma?
A
- Superficial
- Pigmented
- Morphoeic
- Nodular
- Pearly rolled edge
- Telangiectasia
- Central ulceration
- Arborising vessels on dermoscopy
5
Q
Describe the features of basal cell carcinomas.
A
- Slow growing
- Locally invasive
- Rarely metastasise
6
Q
What is the gold standard treatment for BCC?
A
Excision
7
Q
What will excision of BCCs result in?
A
- Ellipse with rim of unaffected skin
- Curative if fully excised
- Will scar
8
Q
Other than excision and Mohs surgery, what can be done in some cases of BCC?
A
Curettage
9
Q
What are the indications for Mohs surgery?
A
- Site
- Size
- Subtype
- Poor clinical margin definition
- Recurrent
- Perineural or perivascular involvement
10
Q
What does vismodegib do?
A
- Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
- Can shrink tumour and heal visible lesions in some
11
Q
What are the indication for the use of vismodegib?
A
- Locally advanced BCC not suitable for surgery or radiotherapy
- Metastatic BCC
12
Q
What are the side effects of vismodegig?
A
- Hair loss
- Weight loss
- Altered taste
- Muscle spasms
- Nausea
- Fatigue
13
Q
How effective if vismodegib?
A
Median progression free survival 9.5 months
14
Q
What is squamous cell carcinoma derived from?
A
Keratinising squamous cells
15
Q
Where does SCC usually occur?
A
Sun exposed sites
16
Q
Describe the appearance of SCC.
A
- Fats growing, tender, scaly/crusted or fleshy growths
- Can ulcerate and metastasise
17
Q
How is SCC treated?
A
- Excision
- +/- Radiotherapy
18
Q
How is considered high risk and should be followed up following treatment of SCC?
A
- Immunosuppressed
- > 20mm diameter
- > 4mm depth
- Ear, nose, lip, eyelid
- Perineural invasion
- Poorly differentiated
19
Q
What is keratoacanthoma?
A
Variant of SCC which erupts from hair follicles in sun damaged skin
20
Q
How is keratoacanthoma treated?
A
- Surgical excision
- Undergoes period of rapid growth but may then shrink and resolve on its own after a few months
21
Q
What is the epidemiology if melanoma?
A
- The incidence of malignant melanoma has increased by 360% since the 1970s in the UK
- About 10 to 40 per 100000 per annum
- Mortality is about 1.9 per 100000 per annum
22
Q
What are the risk factors for melanoma?
A
- UV Radiation
- Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily
- Familial melanoma and melanoma susceptibility genes
23
Q
What is the ABCDE rule of melanoma?
A
- Asymmetry
- Border
- Colour
- Diameter
- Evolution
24
Q
What is the 7 point checklist of melanoma?
A
Major features
- Change in size
- Change in shape
- Change in colour
Minor features
- Diameter more than 5 mm
- Inflammation
- Oozing or bleeding
- Mild itch or altered sensation
25
What is the benefit of dermoscopy?
Improved clinical accuracy compared to unaided eye
26
Give examples of different types of melanoma.
- Superficial spreading malignant melanoma
- Lentigo maligna melanoma
- Nodular melanoma
- Acral lentiginous melanoma/ subungal melanoma
- Ocular melanoma
27
What is the treatment for melanoma?
- Urgent surgical excision (based on subtype and Breslow thickness)
- Wide local excision
- Sentinel lymph node biopsy
- Chemotherapy/immunotherapy
- Regular follow up
- Primary and Secondary Prevention
28
What drugs can be used in the management of metastatic melanoma?
- Ipilimumab
- Pembrolizumab
- Vemurafenib and Dabrafenib
29
What does ipilimumab do?
- Inhibits CTLA-4 molecule
| - Has a one year survival 47-51% (double those not on treatment)
30
What does pembrolizumab do?
- Targets PD-1 receptor on tumour cell
| - One year survival 68-74%
31
What do venurafenib and dabrafenib do?
- Blocks B-RAF proteins so only useful if B-RAF mutation
| - Median survival 10.5 months (7.8 months with standard chemotherapy)
32
What is cutaneous lymphoma?
- Primary cutaneous disease – abnormal neoplastic proliferation of lymphocytes in the skin
- Secondary cutaneous disease from systemic/nodal involvement
33
What are the 2 classifications of cutaneous lymphoma?
- Cutaneous T cell lymphoma (65%)
| - Cutaneous B cell lymphoma (20%)
34
What types of cutaneous T cell lymphomas are there?
- Mycosis fungoides
- Sezary syndrome
- CD30+ lymphoproliferative disorders
- Subcutaneous panniculitis like T cell lymphoma
- Cutaneous CD4+ lymphoma
- Extranodal NK/T cell lymphoma
35
What types of cutaneous B cell lymphomas are there?
- Cutaneous follicle centre lymphoma
- Cutaneous marginal zone lymphoma
- Cutaneous diffuse large B Cell lymphoma
36
What is the most common type of CTCL?
- Mycosis fungoides
| - It account for around 50% of all primary cutaneous lymphomas
37
What causes Mycosis fungoides?
Unknown
38
Who is MF more common in?
- Older patients
| - M>F
39
What kind of course does MF follow?
Indolent
40
What are the stages of MF?
- Patch
- Plaque
- Tumour
- Metastasis
41
Describe the patch stage of MF.
- Flat, red, dry oval lesions
- Usually covered sites
- May slowly enlarge of spontaneously resolve
- May itch
- Difficult to differentiate from eczema/psoriasis
42
Describe the plaque stage of MF
- Patches become thickened
| - Generally itch
43
Describe the tumour stage of MF.
- Large irregular lumps, can ulcerate
- Arise from existing plaques or in normal skin
- More likely to have metastatic spread
44
Describe the metastatic stage of MF
Infiltration of neoplastic cells in lymph nodes, blood and solid organs
45
What does the work up for MF include?
Work up includes bloods for sezary cells and CT imaging for staging
46
What is Sezary syndrome?
- Red man syndrome
- CTCL affecting skin of entire body (ski is thickened, scaly red and very itchy)
- Lymph nodes are involved
47
What is the prognosis of Sezary syndrome?
Poor prognosis
- Median survival 2-4 years
- Opportunistic infection
48
What can be seen in the peripheral blood with Sezary syndrome
- Sezary cells in peripheral blood
| - Atypical T cells
49
What is treatment of cutaneous lymphoma dependent on?
Stage
50
What are the possible treatment options for cutaneous lymphoma?
- Topical steroids
- PUVA or UVB
- Localised radiotherapy
- Interferon
- Bexarotene
- Low dose Methotrexate
- Chemotherapy
- Total skin electron beam therapy
- Extracorporeal photophoresis
- Bone marrow transplantation
51
What is total skin electron bean therapy?
- Type of radiotherapy consisting of very small electrically charged particles
- Delivers radiation primarily to superficial layers i.e. Epidermis and Dermis
- Spares deeper tissues and organs
52
What are the steps in extracorporeal photophoresis?
1. Patients blood is drawn and leucocytes collected
2. Collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation
3. Exposed to UVA radiation, damaging diseased cells
4. Treated cells re-infused back to patient
53
What can cutaneous metastases be due to?
Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy
54
Where does cutaneous metastases most commonly effect?
Most commonly breast, colon and lung
55
What are the management options for cutaneous metastases?
- Treat the underlying malignancy
- Local excision
- Localised radiotherapy
- Symptomatic
