Skin cancer Flashcards
What are the types of non melanoma skin cancer?
Basal cell cancer
Squamous cell cancer
What are the risk factors for basal cell cancer?
UV radiation Photochemotherapy Chemical carcinogens Ionising radiation HPV Familial cancer syndromes Immunosuppression
What is the appearance of basal cell cancer?
P{early, rolled edge
Telangiectasia
Central ulceration
Aboring vessels on dermoscopy
Slow grwingWhat is the progression of basal cell cancer?
Locally invasive but rarely metastacise
What are the surgical treatment options of basal cell cancer?
Excision
Curettage
Mohs surgery
How is a basal cell cancer excised?
Ellipse with rim of unaffected skin
What are the pros and cons of excision of basal cell cancer?
Curative if fully excised but will scar
What are the indications for Mohs surgery?
Site Size Subtype Poor clinical margin definition Recurrent Perineural or perivascular involvement
What are the non surgical treatment options of basal cell cancer?
Vismodegib
When is vismodegib used in BCC?
Locally advanced BCC not suitable for surgery of radiotherapy
How does vismodegib treat BCC?
Selectively inhibits signalling in molecular driver of BC
What are the side effects of vismodegib?
Hair loss, weight loss, altered taste
Muscle spasms, nausea, fatigue
What are the risk factors for squamous cell cancer?
UV radiation Photochemotherapy Chemical carcinogens Ionising radiation HPV Familial cancer syndromes Immunosuppression
What are SCCs derived from?
Keratinising squamous cells
What are the clinical features of SCC?
Can metastasise
Faster growing
Tender, scaly/crusted or fleshy gorwht
Can ucerate
Where are SCCs most common?
Sun exposed sites
What is the treatment of SCC?
Excision +/- radiotherapy
When should SCC treatment be followed up?
If high risk
- immuno suppressed
- > 20mm diameter
- > 4mm depth
- eyelid, nose, ear or lip
- perineural invasion
- poorly differentiated
What is a keratocanthoma?
Kind of SCC that erupts from hair follicles in sun damaged skin
Grows rapidly, may shrink after a few months and resolve but can be excised
What are the risk factors for melanoma?
UV radiation
Genetic susceptibility
Familial melanoma and melanoma susceptibility genes
What is the ABCDE rule?
Diagnosing melanoma, look for Asymmetry Border Colour Diameter Evolution
What is the 7 point checklist in the diagnosis of melanoma?
Major features- change in size, shape and colour
Minor features- diameter >5mm, inflammation, oozing or bleeding, mild itch or altered sensation
What are the types of melanoma?
Superficial spreading malignant melanoma Lentigo maligna melanoma Nodular melanoma ACral lentiginous melanoma/subungal melanoma Ocular melanoma
What is the treatment of melanoma?
Urgent surgical excision
Chemo/immunotherapy
Regular followup
What are the requirements for excision of a melanoma?
Wide local excision
Sentinel lymph node biopsy
What chemo is used for metastatic melanoma?
Ipilimumab
Pembrolixumab
Vemurafenib and dabrafenib for BRAF mutation
What are the causes of cutaneous lymphoma?
Primary cutaneous disease
Secondary cutaneous disease
What causes secondary cutaneous disease?
Systemic/nodular disease
What causes primary cutaneous disease?
Abnormal neoplastic proliferation of lymphocytes in the skin
What are the kinds of primary cutaneous disease?
Cutaneous T cell lymphoma
Cutaneous B cell lymphoma
What are the types of cutaneous T cell lymphoma?
Mycosis fungoides
Sezary syndrome
Who is mycosis fungoides most common in?
Older patients and men
What are the stages of mycosis fungoides?
Patch
Plaque
Tumour
Metastatic
What are the clinical features of patch mycosis fungoides?
Flat, red, dry oval lesions, usually on covered sites
May slowly enlarge or spontaneously resolve
May itch
Difficult to differentiate from eczema or psoriasis
What are the clinical features of plaque mycosis fungoides?
Patches become thickened and are generally itchy
What are the clinical stages of a tumour mycosis fungoides?
Large irregular lumps that can ulcerate that can arise from either existing plaques or normal skin
What are the clinical features of metastatic mycosis fungoides?
Infiltration of neoplastic cells in lymph nodes, blood and solid organs
What is Sezary syndrome?
Cutaneous T cell lymphoma affecting skin of entire body
What are the clinical features of Sezary syndrome?
Skin thickened, scaly, red and itchy
Lymph node involvement
Atypical T cells in blood
What is the treatment of cutaneous lymphoma?
Topical steroids UVA or UVB therapy Localised radiotherapy Interferon Bexarotene Low dose methotrexate Chemo Total skin electron beam therapy Extracorporeal photophoresis Bone marrow transplant
What is total skin electron beam therapy?
Type of radiotherapy involving very small electrically charged particles
Delivers radiation primarily to superficial layers and spares deeper tissues
What pacers most commonly metastasise to the skin?
Breast, colon or lung
What is the treatment of cutaneous metastases?
Treat underlying malignancy’
Local excision
Localised radiotherapy
Symptomatic
