Skin cancer Flashcards
What are the 2 main types of non melanoma skin cancer?
BCC and SSC
List some risk factors of non melanoma skin cancer
UV radiation - type 1+2 skin photochemotherapy PUVA chemical carcinogens ionising radiation eg CT HPV Familial cancer syndromes eg gorlins syndrome immunosuppression
What are the features of a BCC?
slow growing and rarely metastasise
nodular - pearly rolled edge with telangiectasia and central ulceration
What can a BCC invade?
local tissue and bone
What is the key to think a BCC?
if it has not healed and gone away
2 other rarer appearances of BCC
pigmented eg pre melanoma
morphoeic - scar like
Treatment of BCC
excision
curative if fully excised but will scar
When would curettage be used in BCC and what is it?
scrape and cauterise
elderly
What is mohs surgery and when would it be used?
99.5% cure perineural or perivascular involvement poor clinical margin recurrent site, size, subtype
What is vismodegib used for?
locally advanced BCC which has metastasised and not suitable for surgery or radiotherapy
How did vismodegib work?
inhibits abnormal signalling in hedgehog pathway which drives BCC so hats progression
Side effects of vismodegib
hair loss, weight loss, altered taste, muscle spasms, nausea and fatigue
What is SCC derived from?
keratinisng squamous cells
Where is SSC usually found and what is its appearance?
sun exposed sights
can metastasise
faster growing, scaly, crusted, tender, ulcerate
Treatment of SSC?
excision +/- radiotherapy
Why would there be a follow up of some SSC?
immunocompromised >20mm diameter >4mm depth ear, nose, lip, eyelid perineural invasion poorly differentiated
What is keratoacanthoma?
variant of SCC
erupts from hair follicles in sun damaged skin
Progression and treatment of keratoacanthoma
grows rapidly and may shrink after a few months and resolve
surgical excision
Risk factors for melanoma
UV radiation
genetic susceptibility
familial melanoma
ABCDE melanoma rule
asymmetry border colour diameter evolution
3 major feature for melanoma
change in size
change in shape
change in colour
4 minor features for melanoma
> 5mm diameter
oozing or bleeding
itching
inflammation
What is a dermatoscope used for?
to look at every lesion to improve clinical accuracy compared to unaided eye
What tells us how aggressive a melanoma is?
how deep it has penetrated the layers of the skin
mets?
List some subtypes of melanoma
ocular nodular subungal lentigo maligna melanoma superficial spreading
Treatment for melanoma
urgent surgical excision LN biopsy chemo/immunotherapy regular follow up primary and secondary prevention
What is secondary cutaneous lymphoma due to?
from systemic or nodal involvement
What is primary cutaneous disease due to and what are the 2 subtypes?
abnormal neoplastic proliferation of lymphocytes in the skin
CTCL
CBCL
What are the 2 important CTCL?
sezary syndrome
mycosis fungoides
Epidemiology of mycosis fungoides
older men - cause unkown
indolent course
most common CTCL
Stage 1 of mycosis fungoides
patch - flat, red and oval
similar to eczema and psoriasis
may itch
usually on covered sites
Clue to differentiate stage 1 patch of mycosis fungoides and eczema/psoriasis?
generally same areas and fixed
Stage 2 of mycosis fungoides
plaque - thickened and general itch
Stage 3 of mycosis fungoides
tumour - irregular lumps can ulcerate
mets more likely
arise from plaque or normal skin
Stage 4 of mycosis fungoides
metastatic
infiltration of cells in LN, organs and blood
What is sezary syndrome?
CTCL affecting whole body
red man syndrome
Appearance of sezary syndrome
skin thickened, red, scaly, itch
LN involvement
sezary cells - atypical T cells
Sezary syndrome prognosis
poor : 2-4 years
Treatments of cutaneous lymphoma
topical steroids PUVA/PUVB localised radiotherapy chemotherapy interferon bexarotene methotrexate total skin electron beam therapy extracorpeal photophoresis bone marrow transplant
Advantage of total skin electron beam therapy
spares deeper tissues and organs as only target epidermis and dermis
Briefly explain extracorpeal photophoresis
take blood and collect leucocytes
collected white cells mixed with psoralen to make T cells sensitive to UVA
exposed to UVA damaging diseased cells
treated cells reinfused into patient
What is secondary cutaneous mets?
secondary to eg melanoma - primary skin malignancy
What is primary skin mets usually due to?
breast, colon, lung cancer
Management of cutaneous metastases
treat underlying malignancy
local excision
localised radiotherapy
symptomatic
