Skin cancer

Question 1

What are the 2 main types of non melanoma skin cancer?

Answer 1

BCC and SSC

Question 2

List some risk factors of non melanoma skin cancer

Answer 2

UV radiation - type 1+2 skin
photochemotherapy PUVA
chemical carcinogens 
ionising radiation eg CT
HPV 
Familial cancer syndromes eg gorlins syndrome
immunosuppression

Question 3

What are the features of a BCC?

Answer 3

slow growing and rarely metastasise

nodular - pearly rolled edge with telangiectasia and central ulceration

Question 4

What can a BCC invade?

Answer 4

local tissue and bone

Question 5

What is the key to think a BCC?

Answer 5

if it has not healed and gone away

Question 6

2 other rarer appearances of BCC

Answer 6

pigmented eg pre melanoma

morphoeic - scar like

Question 7

Treatment of BCC

Answer 7

excision

curative if fully excised but will scar

Question 8

When would curettage be used in BCC and what is it?

Answer 8

scrape and cauterise

elderly

Question 9

What is mohs surgery and when would it be used?

Answer 9

99.5% cure 
perineural or perivascular involvement 
poor clinical margin 
recurrent 
site, size, subtype

Question 10

What is vismodegib used for?

Answer 10

locally advanced BCC which has metastasised and not suitable for surgery or radiotherapy

Question 11

How did vismodegib work?

Answer 11

inhibits abnormal signalling in hedgehog pathway which drives BCC so hats progression

Question 12

Side effects of vismodegib

Answer 12

hair loss, weight loss, altered taste, muscle spasms, nausea and fatigue

Question 13

What is SCC derived from?

Answer 13

keratinisng squamous cells

Question 14

Where is SSC usually found and what is its appearance?

Answer 14

sun exposed sights
can metastasise
faster growing, scaly, crusted, tender, ulcerate

Question 15

Treatment of SSC?

Answer 15

excision +/- radiotherapy

Question 16

Why would there be a follow up of some SSC?

Answer 16

immunocompromised 
>20mm diameter 
>4mm depth 
ear, nose, lip, eyelid
perineural invasion 
poorly differentiated

Question 17

What is keratoacanthoma?

Answer 17

variant of SCC

erupts from hair follicles in sun damaged skin

Question 18

Progression and treatment of keratoacanthoma

Answer 18

grows rapidly and may shrink after a few months and resolve

surgical excision

Question 19

Risk factors for melanoma

Answer 19

UV radiation
genetic susceptibility
familial melanoma

Question 20

ABCDE melanoma rule

Answer 20

asymmetry 
border 
colour 
diameter 
evolution

Question 21

3 major feature for melanoma

Answer 21

change in size
change in shape
change in colour

Question 22

4 minor features for melanoma

Answer 22

> 5mm diameter
oozing or bleeding
itching
inflammation

Question 23

What is a dermatoscope used for?

Answer 23

to look at every lesion to improve clinical accuracy compared to unaided eye

Question 24

What tells us how aggressive a melanoma is?

Answer 24

how deep it has penetrated the layers of the skin

mets?

Question 25

List some subtypes of melanoma

Answer 25

ocular 
nodular 
subungal 
lentigo maligna melanoma
superficial spreading

Question 26

Treatment for melanoma

Answer 26

urgent surgical excision 
LN biopsy 
chemo/immunotherapy
regular follow up
primary and secondary prevention

Question 27

What is secondary cutaneous lymphoma due to?

Answer 27

from systemic or nodal involvement

Question 28

What is primary cutaneous disease due to and what are the 2 subtypes?

Answer 28

abnormal neoplastic proliferation of lymphocytes in the skin
CTCL
CBCL

Question 29

What are the 2 important CTCL?

Answer 29

sezary syndrome

mycosis fungoides

Question 30

Epidemiology of mycosis fungoides

Answer 30

older men - cause unkown
indolent course
most common CTCL

Question 31

Stage 1 of mycosis fungoides

Answer 31

patch - flat, red and oval
similar to eczema and psoriasis
may itch
usually on covered sites

Question 32

Clue to differentiate stage 1 patch of mycosis fungoides and eczema/psoriasis?

Answer 32

generally same areas and fixed

Question 33

Stage 2 of mycosis fungoides

Answer 33

plaque - thickened and general itch

Question 34

Stage 3 of mycosis fungoides

Answer 34

tumour - irregular lumps can ulcerate
mets more likely
arise from plaque or normal skin

Question 35

Stage 4 of mycosis fungoides

Answer 35

metastatic

infiltration of cells in LN, organs and blood

Question 36

What is sezary syndrome?

Answer 36

CTCL affecting whole body

red man syndrome

Question 37

Appearance of sezary syndrome

Answer 37

skin thickened, red, scaly, itch
LN involvement
sezary cells - atypical T cells

Question 38

Sezary syndrome prognosis

Answer 38

poor : 2-4 years

Question 39

Treatments of cutaneous lymphoma

Answer 39

topical steroids 
PUVA/PUVB 
localised radiotherapy 
chemotherapy 
interferon 
bexarotene 
methotrexate 
total skin electron beam therapy 
extracorpeal photophoresis 
bone marrow transplant

Question 40

Advantage of total skin electron beam therapy

Answer 40

spares deeper tissues and organs as only target epidermis and dermis

Question 41

Briefly explain extracorpeal photophoresis

Answer 41

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

Question 42

What is secondary cutaneous mets?

Answer 42

secondary to eg melanoma - primary skin malignancy

Question 43

What is primary skin mets usually due to?

Answer 43

breast, colon, lung cancer

Question 44

Management of cutaneous metastases

Answer 44

treat underlying malignancy
local excision
localised radiotherapy
symptomatic