Skin Cancer Flashcards
(91 cards)
1
Q
What classifies skin types
A
Fitzpatrick
2
Q
What are the 6 skin types
A
1 - never tans, burns (red hair, blue eyes)
2 - tans but burns
1+2 have increased cancer risk
3 - always tans, sometimes burns (dark hair and eyes)
4 - always tans, rarly burn (olive skin)
5 - sunburn and tan after extreme UV (brown / Asian)
6 - black (never tans or burns)
3
Q
What are the non-melanoma skin cancers and most common
A
Basal cell = 70%
Squamous cell
4
Q
What are the RF for BCC / SCC
A
UV light exposure - SCC = chronic long term - BCC = sporadic burning Skin type 1 +2 Age Male FH skin cancer PMH skin cancer Photo chemotherpay Chemical carcinogens X-ray / radiation HPV Smoking
5
Q
What are RF for SCC
A
Chronic inflammation Marjolins ulcer = excision Pre-malignant condition Organ transplant Immunosuppressoin
6
Q
Where does BCC commonly affect
A
Head and neck
7
Q
What is prognosis
A
Slow growing
Locally invasive causing destruction
Don’t tend to metastasis
Depends on tumour size, site, growth and histiological subtype
Failure of Rx / recurrent of immunosuppression = poorer prognosis
8
Q
What is the presentation of BCC
A
Most common Pearly pink lesion Flesh coloured lesion Erythemtous keratotic papule or nodule Areas of sun exposure Irregular border May have central erosion o ulceration Telangiectasia around Rolled edge
9
Q
What is BBC and types
A
Slow growing locally invasive malignant tumour of keratinocytes Superficial - plaque like Nodular = most common Ulcerative - rodent ulcer Pigmented Morphoeic = aggressive
10
Q
How do superficial BCC present
A
Scaly and crusty Pigmented Pink to red brown Erosions / ulceration = less common Often resembles eczema or psoriasis
11
Q
How do you manage superficial
A
Can be Rx conervatively
Cyrosurgery
Curettage and cautery
12
Q
What do you do if high risk site or large
A
Excision
RT
Mohs procedure if high risk or cosmesis
13
Q
What do nodular lesions tend to have
A
Smooth elevated surface
Telengiectasia’s
Arborizing vessel on dermoscopy
Central ulceration
14
Q
How do you Rx
A
Excision
15
Q
How does ulcerative present
A
Cycles of crusting and bleeding
May progress from nodular
16
Q
What do you do if suspect BCC
A
Refer
Dermascope
Biopsy
17
Q
What is gold standard Rx for BCC
A
Excision with margins
18
Q
What are other options
A
Mohs = highly specalised
Curettage / cyroterhapy if unfit
RT
19
Q
What can be used if not suitable for surgery / RT or metastatic
A
Vismodegib
Shrinks tumour and heals lesions
20
Q
What are SE
A
Hair loss Weight loss Taste Muscle spasms Nausea
21
Q
Where do SCC arise from
A
Keratinising squamous cells
Potential to metastasise
22
Q
What are predisposing pre-malignancy conditions / RF
A
Bowen's - well defined Marjolins ulcer - chronic inflamation Acitinic keratitis - crust HPV Post transplant on immunosuppressants Chronic granuloma Chronic radiant heat - erythema ab igne Chronic UV Age Smoking
23
Q
What are 1st signs of SCC and where does it affect
A
Induration of skin
Skin coloured papule
Head / ear / neck
24
Q
How does it then go on to present
A
Plaque like Keratotic - scaly / crusty Ulceration Firm on palpation Irregular border Asymmetrical Hard to define Tender Scaly / crusting Common on sun exposed sites Grows more rapidly
25
Does SCC metastasis
Yes
| 3% at Dx have nodal mets
26
How do you Dx
Excision biopsy
| Urgent referral if no response to 2 weeks topical Ax
27
How do you Rx SCC if insitu
5FU / imiquimod 2 week course with steroid
Excision
Mohs micrographic surgery may be needed for ill-defined large recurrent tumour
28
How do you Rx if +Ve nodes + what margins
Chemo / RT + block dissection
>4mm margin if low risk
>6mm if high risk
29
What is high risk requiring follow up
```
Immunosuppressed
>20mm or 2cm
>4mm depth
On ear, nose, lip, perineurial invasion
Poorly differentiated
Recurrent
2 to chronic inflammation
```
30
What do you follow up for
Local recurrence
| Nodal involvement
31
If in situ how do you follow up
No follow up - immediate Dx
32
If well differentiated + no other features
Discharge in 6 months
33
How do you follow up high risk
5 years
| 3/3/6 monthly
34
What factors affect malignant potential
```
Anatomical site
Size >2cm or >4mm depth
Rate of growth
Aetiology
Degree of differentiation - if poor = high risk
Host immunosuppression
```
35
What sites are high and low risk
Radiation / thermal injury / chronic inflammation or Bowen = high risk
Sunexposed = low risk
36
What are pre-malignant conditions
```
Acitinic keratosis
Bowen's
Dysplastic naevi
Sebaceous naevi
Erythema ab igne
Keratocanthoma
Giant Congenital Hairy Naevus
```
37
What is actinic keratosis
Chronic pre-malignant condition to SCC
Low risk of progression
May referee
38
What are the features
```
Start as telanigiectasis capillary
Rough, crusty, erythematous plaque
White-yellow scale
Flat, scaly, hyperkeratotic skin
May be pink, brown or same colour
Can form cutaneous horn
On areas of chronic skin exposure
```
39
What are RF
Age
Proximity to equator
Fair skin
Outdoors
40
How do you Rx
```
Sun avoidance / cream
Fluorouracil cream for 2-3 weeks then hydrocortisone to settle inflammation
Topical diclofenac - mild
Topical imiquimod - good result
Cryotherapy or curettage to remove
```
41
If any doubt what do you do
Excision biopsy
42
What is Bowen's disease
Intra-epidermal SCC in situ
Full thickness dysplasia contains within epidermis
Risk of becoming invasive
43
What are RF
```
Female
Sun exposure UV
Radiation
Immunosuppression
HPV
Age
Agricultural work
```
44
How does it present
```
3/4 of lesions on legs
Irregular scaly erythematous persistent red plaque
Non elevated
Crust or scaling
Clear border
No bleeding
Well demarcated
Slower growing than SCC
```
45
What is 1st line Rx
Excision
46
What are other Rx options
Local 5-flouracicil cream + steroid if small
Imiquimod
Cryotherapy or curettage
Photodynamic therapy
47
What are sebaceous naevi
```
Circumscibed lesions / plaque
Comprised of sebaceous glands
Vary between yellow-ten
Velevety
Commonly present with bald patch
Usually present from birth
```
48
What is risk
Small risk of malignancy change to BCC / SCC
49
How do you Rx
Excision due to malignant potential
50
What causes erythema ab igne
Overexposure to infrared e.g. sitting next to open fire
51
How does it present
Reticulated erythematous patches
Hyperpigmentation
Telangiectasia
52
What may develop
SCC
53
What is a keratocanthoma
Benign epithelial tumour of SCC in situ
54
How does it present
```
Erupt from hair follicles in sun damaged skin
Rapid
Initially a small domed pink papule
Hyperkeratotic crater forms
Most common on face
```
55
What is it related to
Sun exposure
Immunosuppression
Age
56
How does it progress
Can shrink and resolve in healthy skin
| Small risk of SCC if >3 months so refer to exclude
57
How do you Rx
Excision
| Topical 5-fu or RT if no surgery
58
How do you classify congenital hairy naves
Small <1.5cm
Medium 1.5-19.5
Large >20cm or >5% of BSA
59
What are features
Flat, round oval pigmented lesion
| Covered in coarse hair
60
What is risk
Melanoma if multiple or large
61
How do you Rx
Surgical
Grafting
Laser to improve cosmoses but does not deal with malignancy risk
62
What are RF for melanoma
```
UV radiation
Skin type 1
Hx of moles
Sunburn
Tropical country
Outdoor work
Previous history
FH of melanoma
Genetics- fair skin , red hair
```
63
What is melanoma and what are types
```
Invasive malignant tumour of melanocytes
70% related to BRAF mutation - role of Vemurafinib
Potential to metastasise
Superficial spreading = 70%
Nodular
Lentingo maligna
Acral lentiginous
Ocular
Amelanotic
```
64
What are superficial spreading melanoma
```
Growing moles
Affect young and middle aged adult
Related to high intensity UV
Commonly LL
Common in arm, leg, back and chest
```
65
What s nodular
```
Sun exposed skin in middle age
Commonly on trunk
Red or black lump which bleeds and grows rapidly and invades deep
Most aggressive with early mets
Related to high intensity UV exposure
```
66
What is acral letiginous
```
Affects nails, palms or soles
Subungual pigemntaiton
Hutchinson's nail
Very rare
Common in elderly and black
No clear relation with UV
```
67
What is amelanotic
Lack pigmentation
| Dx more difficult
68
What is lentigno maligna
Melanoma in situ (confined to epidermis)
Does not invade into dermis
Common on face
Related to Lon term cumulative exposure
Common in chronic sun exposed skin in elderly
Can become invasive
More slowly growing than superficial spreading
69
What are features of letigno maligna
Flat
Two tone brown lesion
Irregular boder
70
What is ABCDE of suspicious melanoma
```
Asymmetrry
Border irregular
Colour irregular
Diameter >6mm
Evolution of size and shape
Symptoms - bleeding or itching or change in sensation
```
71
How do you investigate
Refer 2WW if any suspicion
Dermoscopy
Biopsy
72
How do you Rx melanoma
can do topical 5FU or cryotherapy but high risk of recurrence
Urgent surgical excision with 2-5mm margin = definite
If lesion >1mm = SLNB
RT is sometimes useful
Chemotherapy for metastatic disease
Immunotherapy
- Targeted therapy against BRAF v 600 (Darbrafenib) has revolutionised Rx
Regular follow up
73
What does prognosis depend on
```
Breslow thickness = main determinant
Depth of invasion
<2mm = TNM1
>2m = TNM 2
N = 3
M = 4
Mets rare
```
74
How do you Rx metastatic
Immunotherapy revolutionised Rx
75
What can cutenaeous mets be from
Primary skin malignant - melanoma
Breast
Colon
Lung
76
How do you Rx
Treat malignancy
Excision
RT
77
How does sebaceous gland carcinoma present
Thick eyelid
Recurrent infection - Chalazion / unilateral blepharitis
Nodular, indurated lid
Yellow discolouration
78
How do you Rx
Excision
79
How can cutaneous lymphoma arise
Secondary from nodes
| Primary disease from abnormal proliferation of lymphocytes in skin
80
What types do you get
T cell
| B cell
81
What are T cell lymphomas
Mycosis fungiodes = most common
| Sezary syndrome
82
How does mycosis fungiodes present
Flat,red dry oval patch
May itch
Can be difficult to differentiate from eczema/ psoriasis
Patch becomes thickened to form a plaque
Tumour can then cause large irregular lumps
Ulceration
83
Can it metastasis
Yes
84
How do you investigate
Blood - look for sezary cells
| CT to stage
85
What is Sezary syndrome
Entire body affected
Thick scaly red skin
Very itch
LN involvement
86
What is seen on blood
Sezary cells
87
What else can cause
Vancomycin
88
How do you Rx cutaneous lymphoma
```
Steroid
Photochemotherapy
RT
Total skin electron bean therapy
Chemotherapy - low dose methotrexate
Interferon
Extracorporeal photophoresis
Bone marrow transplant
```
89
What is extracorporeal photophoresis
```
Luekocytes collected
Mixed which psoralen which makes T cells sensitive to UVA
Exposed to UVA
This damages diseased cells
Reinfuse patient
```
90
What is Marjolin's ulcer
```
SCC arising in chronically damaged skin
Presents as non-healing sore of granulation tissue
- Burns
- Scar
- Ulcer - venous
- OM
- RT
- Vaccination
Usually 30+ years after injury
```
91
How do you Ix
Biopsy = very important
| Very aggressive form of SCC
