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Cancer Pharmacology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What are the three types of skin cancer?

A

Melanoma
Squamous cell carcinoma
Basal cell carcinoma

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2
Q

What are the keratinocyte skin cancers?

A

Squamous cell carcinoma

Basal cell carcinoma

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3
Q

where are keratinocytes?

A

in the epidermis

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4
Q

What layer of the epidermis does basal cell carcinoma arise?

A

the basal layer

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5
Q

What layer of the epidermis does squamous cell carcinoma arise?

A

the suprabasal layer

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6
Q

Where does melanoma arise from?

A

Melanocytes

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7
Q

Where are melanocytes?

A

Scattered along the basal layer

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8
Q

What percentage of cancers are non-melanoma skin cancers?

A

1/3

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9
Q

of non-melanoma skin cancers, how many are basal cell carcinomas?

A

3/4

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10
Q

of non-melanoma skin cancers, how many are squamous cell carcinomas?

A

1/4

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11
Q

What is the difference between basal cell carcinomas and squamous cell carcinomas?

A

Basal cell carcinomas cannot metastasis

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12
Q

What is squamous cell carcinoma associated with? Therefore who does it effect the most?

A

Cumulative UV-exposure

Elderly people

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13
Q

Who are at higher risk of developing squamous cell carcinoma?

A

Those who are immunosuppressed

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14
Q

What percentage of squamous cell carcinomas are linked to immunosuppression?

A

11%

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15
Q

What percentage of metastatic squamous cell carcinomas are linked to immunosuppression?

A

40%

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16
Q

What is the issue with UVA?

A

It is very prevalent
Longer wavelength and therefore penetrates deeper in the skin
Causes indirect DNA damage

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17
Q

What is the issue with UVB?

A

It causes direct DNA damage

1,000 times more damaging than UVA

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18
Q

How does UVB induce DNA damage?

A

It is incorportated into the DNA helix -> forms covalent linkages to form cycloburane pyramidine dimers (CPDs) and 6,4 photoproducts -> interferes with base pairs during DNA replication -> mutation

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19
Q

Which photoproduct is more common, CPD or 6,4 photoproduct?

A

CPDs

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20
Q

Which photoproduct is more mutagenc, CPD or 6,4 photoproduct?

A

6,4 photoproducts

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21
Q

What are sun sensitive people?

A

Burn easily

Tan poorly

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22
Q

What increased your risk of skin cancer?

A 
Being sun sensitive 
Sun exposure 
Genetic 
Immunological factors 
Environmental carcinogens 
Age 
Photosensitising drugs 
Human papillomavirus
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23
Q

How can sun exposure increase your chance of developing skin cancer?

A

Dose and pattern
The latitude
If you burnt in childhood
Intensive intermittent exposure

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24
Q

How can genetics increase your chance of developing skin cancer?

A

Skin type
Albinism
Xeroderma pigmentosum

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25
Q

How can immunological factors increase your chance of developing skin cancer?

A

Immunosuppression
Malignancies
HIV

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26
Q

What environmental carcinogens increase your chance of developing skin cancer?

A

Ionising radiation
Arsenic
Trauma

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27
Q

What is xeroderma pigmentosum?

A

When you cannot repair the damage

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28
Q

why do sun sensitive people burn and not tan?

A

they produce pheomelanin instead of eumelanin

Pheomelanin absorbs UV less effectively

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29
Q

What do freckles mean?

A

You cannot tan

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30
Q

What is solar lentigines?

A

Sun induced permanent freckles

31
Q

What do sunburn and solar lentigines mean?

A

UVB damage

32
Q

What is solar ageing?

A

Skin ageing

33
Q

What is solar ageing associated with?

A

penetration by UVA effecting elastin fibres and collagen

34
Q

What is sunburn caused by?

A

a protective measure where keratinocytes are badly UV-damaged and undergo apoptosis

35
Q

How much does childhood sunburn increase your chances of melanoma?

A

4 fold

36
Q

How is chronic UV exposure immunosuppressive?

A

Dendritic cells lose abilities to present antigens
T cells switch from helper to suppressor (Tregs dominate)
Keratinocytes and dendritic cells secrete immunosuppressive cytokines

37
Q

How does immunosuppression increase cancer risk?

A

Remove immune surveillance

38
Q

In transplant patients, how much is SCC risk increased?

A

100-200 fold

39
Q

In transplant patients, how much is BCC and melanoma risk increased?

A

5-10 fold

40
Q

How are bone marrow transplant patients effected in terms of SCC?

A

It is more aggressive, more metastatic and do not tend to respond to treatment

41
Q

What pathway tends to be effected in BCC?

A

Hedgehog signalling, involving PTCH

42
Q

How many people tend to develop inactivating mutations in PTCH?

A

90%

43
Q

Apart from PTCH, what other mutation occurs in BCC and how often does this occur?

A

Activating mutation in SMO

10%

44
Q

What drug inhibits the hedgehog pathway?

A

Vismodegib

45
Q

What is the side effects of Vismodegib?

A

Effects the dermal capillaries on the tongue and effects peoples taste buds and makes them unable to eat

46
Q

What percentage of melanomas have a Braf mutation?

A

50%

47
Q

What is the critical transcription factor in melanoma?

A

MITF

48
Q

What does vemurafenib target?

A

BRAF V600E

49
Q

Name a anti-CTLA-4 drug

A

Ipilimumab

50
Q

Name a anti-PD-1 drug

A

Pembrolizumab

51
Q

Why is anti-PD-1 typically used by itself?

A

Patients cannot tolerate the dose in combination

52
Q

What did whole genome sequencing of SCC show?

A

They have large number of copy number changes

53
Q

What is a sign of SCC development?

A

Actinic keratoses

54
Q

What is chronic sun exposure associated with?

A

Increase clone size

55
Q

What is the issue with p53 mutations and continued sun exposure in SCC?

A

If you have a p53 mutation in the beginning then you will not get apoptosis, however, further skin exposure can cause the p53 mutations to expand without the need for other mutation

56
Q

what gene is most highly mutated in cSCC?

A

NOTCH

57
Q

How many cSCCs have NOTCH1 and/or NOTCH2 mutations?

A

82%

58
Q

What is NOTCH?

A

A tumour suppressor and oncogene depending on the conext

59
Q

What cancers is NOTCH an oncogene in?

A

T-acute lymphoblastic leukaemia
Chronic lymphoblastic leukaemia
B-cell malignancies

60
Q

What cancers is NOTCH a tumour suppressor in?

A

Head and neck SCC

61
Q

What is FAT1?

A

A negative regulator of Wnt/beta-catenin

62
Q

What is signature 32 associated with?

A

Immunosuppression

63
Q

What increases signature 32?

A

Azathioprine (immunosuppressive drug)

64
Q

How does azathioprine induce cancer?

A

It is metabolised -> incorporated into DNA -> produces ROS when exposed to UVA -> damages DNA -> decreased nucleotide excision repair -> increase mutagenesis

65
Q

What is DNA 6-TG?

A

a UVA photosensitiser

66
Q

If a patient has to receive azathioprine, what should they also do?

A

Photoprotect

67
Q

What is the primary prevention against skin cancer?

A

Photoprotection

Diet and drug

68
Q

What is the secondary prevention against skin cancer?

A

Surgery if it might be invasive SCC
Lesion directed destructive treatments
Topical agents e.g. 5-FU and Imiquimod
Photodynamic therapy

69
Q

Give an example of a lesion directed destructive treatment

A

Cryotherapy

70
Q

What is the issue with photodynamic therapy?

A

It is typically not well tolerated

71
Q

What does Imiqumod do?

A

Increases the immune system to remove the tumour

72
Q

What are retinoids used for?

A

helps to differentiate the skin and prevents early lesions from developing?

73
Q

Why do retinoids have to be used at low doses?

A

If you take a patient off them, e.g. due to side effects, the lesions rebound so better to use at low doses for life than higher doses and rebound occur

Cancer Pharmacology (13 decks)

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