Skin Cancer Flashcards
What are the non-melanoma skin cancers?
Basal cell cancer
Squamous cell cancer
Risk factors for non-melanoma skin cancer
UV radiation Photochemotherapy Chemical carcinogens X ray and thermal radiation HPV Familial cancer syndromes Immunosuppression
Features of BCC
Slow growing
Locally invasive
Rarely metastasise
What does a BCC look like?
Nodular Pearly rolled edge Telangiectasia Central ulceration Arborizing vessels on dermoscopy
Treatment of BCC
Surgical excision Curettage Cryotherapy Topical cream - imiquimod - fuorouracil Radiotherapy Vismodegib (advanced BCC)
When is vismodegib used?
Locally advanced BCC not sutiable for surgery or radiotherapy
Metastatic BCC
SEs of vismodegib
Hair loss Weight loss Altered taste Muscle spasms Nausea Fatigue
Features of SCC
Usually on sun exposed sites
Can metastasise
Fast growing
Presentation of SCC
Tender
Scaly/crusted or fleshy growths
Can ulcerate
What are SCC derived from?
Keratinising squamous cells
Treatment of SCC
Excision
+/- radiotherapy
What is a keratoacanthoma?
Variant of SCC
Features of keratoacanthoma
Erupts from hair follicles on sun damaged skin
Grows rapidly
May shrink after a few months and resolve
Treatment of keratoacanthoma
Surgical excision
Risk factors for melanoma
UV radiation Genetics - fair skin - red hair - blue eyes - tendency to burn easily Familial melanoma and melanoma susceptibility genes
What is the ABCDE rule of melanoma?
Asymmetry Border Colour Diameter Evolution
What is the 7 point checklist for melanoma?
Major features - change in size - change in shape - change in colour Minor features - diameter > 6mm - inflammation - oozing or bleeding - mild itch or altered sensation
What is the biologic progression of melanoma?
Benign nerves Dysplastic nerves Rapid growth phase Vertical growth phase Metastatic melanoma
Types of melanoma
Superficial spreading malignant melanoma Lentigo maligna melanoma Nodular melanoma Acral Lentiginous melanoma/subungual melanoma Ocular melanoma
Treatment of melanoma
Urgent surgical excision Wide local excision Sentinel lymph node biopsy Chemo / immunotherapy Regular follow up 1 and 2 prevention
Treatment of metastatic melanoma
Ipilimumab
Pembrolizumab
Vemurafenib and Dabrafenib
Causes of cutaneous metastases
Can be secondary to primary skin malignancy such as melanoma
Due to primary solid organ malignancy
Most common causes of cutaneous metastases
Breast
Colon
Lung
Treatment of cutaneous metastases
Treat underlying malignancy
Local excision
Localised radiotherapy
Symptomatic
Causes of cutaneous lymphoma
Secondary disease from systemic / nodal involvement
Primary disease from abnormal neoplastic proliferation of lymphocytes in the skin
What is mycosis fungoides?
Most common form of cutaneous T cell lymphoma
Cause of mycosis fungoides
Unknown
Who gets mycosis fungiodes?
Older > young
M > F
Stages of mycosis fungiodes
Patch - flat, red, dry oval lesions - usually covered sites - may slowly enlarge or spontaneously resolve - may itch Plaque - patches become thickened - generally itch Tumour - large irregular lumps - can ulcerate - arises from existing plaques or normal skin - more likely to have metastatic spread Metastatic spread - infiltration of neoplastic cells in lymph nodes, blood and solid organs
Investigations for mycosis fungiodes
Blood - sezary cells
CT
What is sezary syndrome?
Red man syndrome
CTCL affecting skin of the entire body
Presentation of sezary syndrome
Entire body affected
Skin thickened, scaly and re
Very itchy
Lymph node involvement
In sezary syndrome, what is found in the blood? What are these?
Sezary cells
These are atypical T cells
Prognosis for sezary syndrome
Poor
Median survival 2-4 years
Treatment of cutaneous lymphoma
Depends on stage Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose methotrexate Chemo Total skin electron beam therapy Extracorporeal photophoresis Bone marrow transplant
What is cutaneous lymphoma?
A subtype of NHL that starts in the skin
What is total skin electron beam therapy?
Type of radiotherapy consisting of very small electrically charged particles
Delivers radiation primarily to superficial layers i.e. epidermis and dermis
Spares deeper tissues and organs
What is extracorporeal photophoresis?
Leucocytes collected from blood
Collected white cells mixed with psoralen which makes the T cells sensitive to UVA radiation
Exposed to UVA radiation, damaging diseased cells
Treated cells reinfused back to patient
Another name of BCC
Rodent ulcers
What is the most common type of cancer in the western world?
BCC
Definition of bowens disease
Intraepidermal SCC
Who is bowens disease common in?
Elderly
Females
What is the chance of bowens disease causing invasive skin cancer?
3%
Presentation of bowens disease
Red scaley patches
Sun exposed areas such as lower limbs
Management options of bowens disease
Topical 5-fluorouracil or imiquimod
Cryotherapy
Excision
What is leukoplakia?
Pre malignant condition which presents as white, hard spots on the mucous membranes of the mouth
Who is leukoplakia more common in?
Smokers
What is leukoplakia a diagnosis of?
Exclusion
What else should be considered as differentials of leukoplakia?
Candidiasis
Lichen planus
What can leukoplakia transform into and in what % of people?
SCC
1%
What is a lipoma?
Common, benign tumour of adipocytes
Pathology of lipoma
Generally found in subcutaneous tissues
May rarely also occur in deeper adipose tissue
How common is lipoma transformation to liposarcoma?
Very rare
Who are lipomas most commonly seen in?
Middle aged adults
Presentations of lipoma
Lump
- smooth
- mobile
- painless
Management of lipoma
May be observed
If diagnosis uncertain or surrounding structures compressed then may be removed
What are the features that would suggest sarcomatous change of a lipoma?
Size > 5cm
Increasing size
Pain
Deep anatomical location
Most aggressive type of melanoma
Nodular
What are the margins of excision malignant melanoma related to?
Breslow thickness
What are the Breslow thickness excision margins?
Lesions 0 - 1mm thick - 1cm Lesions 1 - 2mm thick - 1 - 2cm (depending upon site and pathological features Lesions 2 - 4mm thick - 2 - 3 cm (depending on site and pathological features) Lesions >4 mm thick - 3cm
What is the single most important factor in determining prognosis of patients with malignant melanoma?
Invasion of depth of a tumour (Breslow depth)
Prognosis of malignant melanoma related to the Breslow thickness
< 1mm - 5 year survival 95 - 100%
1 - 2 mm - 80 - 96%
2.1 - 4mm - 60 - 75%
>4mm - 50%
Risk factors for SCC of skin
Excessive exposure to sunlight / psoralen UVA therapy
Actinic keratoses
Bowens disease
Immunosuppression
Smoking
Long standing leg ulcers (marjolins ulcer)
Genetic conditions e.g. xeroderma pigmentosum
Is metastases common or rare in SCC?
Rare, 2 - 5%
Gold standard management for morpheoic BCC
Mohs Micrographic surgery
Explain mohs micrographic surgery
Microscopic examination of excised tissues DURING the surgery
Useful in tumours with poorly defined edges / cosmetic areas as it ensures the whole tumour has been excised while minimising the removal of healthy tissue
