Skin cancer Flashcards by Anna McCallum

What are the types of non melanoma skin cancer?

Basal cell cancer

Squamous cell cancer

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What are the risk factors for basal cell cancer?

UV radiation
Photochemotherapy
Chemical carcinogens
Ionising radiation
HPV
Familial cancer syndromes
Immunosuppression

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What is the appearance of basal cell cancer?

P{early, rolled edge
Telangiectasia
Central ulceration
Aboring vessels on dermoscopy
Slow grwing

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What is the progression of basal cell cancer?

Locally invasive but rarely metastacise

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What are the surgical treatment options of basal cell cancer?

Excision
Curettage
Mohs surgery

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How is a basal cell cancer excised?

Ellipse with rim of unaffected skin

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What are the pros and cons of excision of basal cell cancer?

Curative if fully excised but will scar

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What are the indications for Mohs surgery?

Site
Size
Subtype
Poor clinical margin definition
Recurrent
Perineural or perivascular involvement

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What are the non surgical treatment options of basal cell cancer?

Vismodegib

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When is vismodegib used in BCC?

Locally advanced BCC not suitable for surgery of radiotherapy

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How does vismodegib treat BCC?

Selectively inhibits signalling in molecular driver of BC

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What are the side effects of vismodegib?

Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

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What are the risk factors for squamous cell cancer?

UV radiation
Photochemotherapy
Chemical carcinogens
Ionising radiation
HPV
Familial cancer syndromes
Immunosuppression

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What are SCCs derived from?

Keratinising squamous cells

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What are the clinical features of SCC?

Can metastasise
Faster growing
Tender, scaly/crusted or fleshy gorwht
Can ucerate

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Where are SCCs most common?

Sun exposed sites

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What is the treatment of SCC?

Excision +/- radiotherapy

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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