Skin Cancer Flashcards by Zoe Doak

What are the types of non-melanoma skin cancer?

Basal Cell Carcinoma (BCC)

Squamous Cell Carcinoma (SCC)

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What percentage increase has there been in Scotland for Squamous Cell Carcinoma between 1990 and 2011?

334%

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What factors may be responsible for the increase in squamous cell carcinoma rates in Scotland?

Cheaper air travel
More leisure time
Sun seeking Behaviour
Ageing Population

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Roughly how many skin cancers were diagnosed in the UK during 2015?

around 250,000

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What percentage of skin cancers are melanomas?

** BUT THEY ACCOUNT FOR 75% DEATHS**

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What feature of melanocytes makes their cancers more likely to metastasize?

They are motile cells

unlike keratinocytes

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What is the Breslow Thickness?

depth to which the tumour has invaded

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What is the 5 year survival of a tumour of Breslow thickness <1mm?

95-100%

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What is the 5 year survival of a tumour of Breslow thickness >4mm?

50%

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What is the ABCDE to early diagnosis of skin cancer?

A - Asymmetry
B - Border (irregular)
C - Colour (multiple)
D - Diameter (large)
E - Evolution (changing quickly over weeks/months)

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What other features should you look out for when diagnosing skin cancer?

The “ugly duckling” sign
=> lesion is different from all others that patient has

Excision scars (particularly in same place as current mole)

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What cancer is often confused with melanoma in younger people?

Pyogenic Granuloma

- type of vascular lesion

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What piece of equipment is used to visualise lesions more closely?

Dermatoscope

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How quickly do Basal Cell Carcinomas arise?

Slowly growing lump (OR non healing ulcer)

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Are basal cell carcinomas painful?

No, therefore patients often ignore them

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Do basal cell carcinomas normally metastasize?

No, they are locally invasive but don’t spread

What treatment can be used for a Basal Cell Carcinoma?

Surgical Excision

Describe the appearance of a Squamous Cell Carcinoma

warty or crusted lump or ulcer
arises on sun-damaged skin
grow faster, may be painful &/or bleed
if neglected may spread

Describe the appearance of a basal cell carcinoma

‘pearly’ or translucent
visible, arborising blood vessels
central ulceration - “rodent ulcer”

What other forms of Basal Cell Carcinoma exist?

may present as scaly plaque - ‘superficial’
nodular or nodulocystic
infiltrative - ‘morphoeic’
pigmented

What is the risk of metastases in squamous cell carcinoma?

3 - 5%

What precursor lesions can be responsible for the development of a squamous cell carcinoma?

actinic keratoses

Bowen’s disease (carcinoma-in-situ)

What percentage of people with a squamous cell carcinoma with develop another keratinocyte cancer within 5 years?

50%

Name 3 high risk sites fro squamous cell carcinomas

Ear
Lip
Scalp

Where do squamous cell carcinomas commonly metastasize to?

Lymph nodes | Bone

What percentage of patients with metastatic squamous cell carcinoma are still alive after 5 years?

25%

What do multiple actinic keratosis lesions on an area of skin indicate?

The whole are of skin underneath the multiple lesions has been sun damaged

Describe the appearance of Bowens disease

erythematous plaque

What are the main risk factors for skin cancer?

1. Sun exposure 2. Genetic predisposition 3. Immunosuppression (HPV infection) 4. Other environmental carcinogens

What genetic conditions increase the risk of skin cancer?

- DNA repair syndromes, e.g. Xeroderma Pigmentosum - Albinism - Naevoid basal cell carcinoma (Gorlin’s) syndrome - Epidermolysis bullosa

How do DNA Repair syndromes e.g. Xeroderma Pigmentosum cause an increased risk of skin cancer?

DNA damage by UV cant be repaired and cells replicate with this damage

How does Gorlin’s) syndrome predispose to skin cancer?

autosomal dominant familial cancer syndrome

How does epidermolysis bullosa predispose to skin cancer?

- Abnormality of Collagen 7 - This usually anchors epidermis and dermis together - Without it, the skin blisters and the epidermis is lost - SCC can develop on these chronically wounded sites

Why does albinism increase skin cancer risk?

lack of melanin pigment => no natural sun protection

What immunosuppressed patients are most at risk of skin cancer?

``` organ transplant recipients chronic inflammatory diseases: - arthritis - vasculitis - inflammatory bowel disease ```

What environmental carcinogens can be respoinsible for an increase in skin cancer?

- ionising radiation - arsenic, coal tar, - trauma, chronic wounding, scarring

What symptoms are common in Xeroderma Pigmentosum

Photosensitivity Photodamage Neurological degeneration Increased risk all skin cancers and other cancers

What methods can be used to prevent skin cancer

1. Behaviour - avoid sun at its height (11am-3pm) - use shade wherever possible - particular care of babies/children - avoid sunbeds 2. Clothing - tightly woven, loose fitting clothing (dark) - long sleeves, trousers, skirts 3. Sunscreens - broad spectrum (SPF25+) with UVA protection - application important – twice, sufficient quantities, re-apply after swimming/towelling 4. Regular (self-) surveillance