skin cancer

Question 1

whatare the risk factors for non- melanoma skin cacer?

Answer 1

UV radiation
Photochemotherapy - PUVA
Chemical carcinogens
X-ray and thermal radiation
Human papilloma virus
Familial cancer syndromes
Immunosuppression

Question 2

what are characteristics of basal cell carcinoma?

Answer 2

Slow growing
Locally invasive
Rarely metastasise

Question 3

what are the signs of basal cell carcinoma?

Answer 3

Pearly rolled edge
Telangiectasia
Central ulceration
Arborising vessels on dermoscopy

Question 4

what is the surgery treatment of basal cell carcinoma?

Answer 4

Excision is gold standard
Ellipse, with rim of unaffected skin
Curative if fully excised
Will scar

Curettage in some circumstances

Question 5

what are the indications of Mohs surgery?

Answer 5

Site
Size
Subtype
Poor clinical margin definition
Recurrent
Perineural or perivascular involvement

Question 6

what are the indications for Vismodegib

Answer 6

Locally advanced BCC not suitable for surgery or radiotherapy
Metastatic BCC

Question 7

what is the action of Vismodegib

Answer 7

Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
Can shrinks tumour and heal visible lesions in some

Question 8

what are the side effects of vismodegib?

Answer 8

Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

Question 9

what is squamous cell carcinoma?

Answer 9

Derived from keratinising squamous cells

Usually on sun exposed sites

Question 10

what are characteristics of squamous cell carcinomas

Answer 10

Can metastasise
Faster growing, tender, scaly/crusted or fleshy growths
Can ulcerate

Question 11

what is the treatment of squamous cell carcinomas?

Answer 11

Excision

+/- Radiotherapy

Question 12

what is Keratoacanthoma

Answer 12

Varient of squamous cell carcinoma

Erupts from hair follicles in sun damaged skin

Question 13

what are characteristics of Keratoacanthoma

Answer 13

Grows rapidly, may shrink after a few months and resolve

Question 14

what is the treatment of Keratoacanthoma

Answer 14

Surgical excision

Question 15

what are risk factors for melanoma skin cancer?

Answer 15

UV Radiation
Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily
Familial melanoma and melanoma susceptibility genes

Question 16

what is the ABCDE rule?

Answer 16

Asymmetry
Border
Colour
Diameter
Evolution

Question 17

what is the 7 point checklist?

Answer 17

Change in size
Change in shape
Change in colour

Diameter more than 5 mm
Inflammation
Oozing or bleeding
Mild itch or altered sensation

Question 18

what is the treatment of melanoma skin cancer?

Answer 18

Urgent surgical excision

Wide local excision
Sentinel lymph node biopsy

Chemotherapy/immunotherapy
Regular follow up

Question 19

what are some immunotherapies for metastatic melanoma?

Answer 19

Ipilimumab
Pembrolizumab
Vemurafenib and Dabrafenib

Question 20

what is cutaneous lymphoma?

Answer 20

Secondary cutaneous disease from systemic/nodal involvement

Primary cutaneous disease – abnormal neoplastic proliferation of lymphocytes in the skin
Cutaneous T Cell lymphoma (65%)
Cutaneous B Cell lymphoma (20%)

Question 21

what are the types of cutaneous lymphomas?

Answer 21

Cutaneous T Cell lymphoma (65%)- Mycosis fungoides

cutaneous B cell lymphoma

Question 22

what is the most common cutaneous T cell lymphoma ?

Answer 22

Mycosis Fungoides

Question 23

what are the stages of Mycosis Fungoides

Answer 23

Patch
Flat, red, dry oval lesions
Usually covered sites
May slowly enlarge of spontaneously resolve
May itch

Plaque
Patches become thickened
Generally itch

Tumour
Large irregular lumps, can ulcerate
Arise from existing plaques or in normal skin
More likely to have metastatic spread

Metastatic
Infiltration of neoplastic cells in lymph nodes, blood and solid organs

Question 24

what is Sezary Syndrome

Answer 24

“Red Man Syndrome”
CTCL affecting skin of entire body
Skin thickened, scaly and red
Itchy++
Lymph node involvement

Question 25

what are the sezary cells in peripheral blood?

Answer 25

Atypical T cells

Question 26

what is the treatment of cutaneous lymphoma?

Answer 26

Dependant on stage ``` Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose Methotrexate Chemotherapy Total skin electron beam therapy ```

Question 27

what is Total skin electron beam therapy

Answer 27

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

Question 28

what is the treatment of cutaneous lymphoma?

Answer 28

``` Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose Methotrexate Chemotherapy Total skin electron beam therapy Extracorporeal photophoresis ```

Question 29

what are the steps for Extracorporeal photophoresis

Answer 29

Step 1 Patients blood is drawn and leucocytes collected Step 2 Collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation Step 3 Exposed to UVA radiation, damaging diseased cells Step 4 Treated cells re-infused back to patient

Question 30

what is the treatment of cutaneous lymphoma

Answer 30

``` Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose Methotrexate Chemotherapy Total skin electron beam therapy Extracorporeal photophoresis Bone marrow transplantation ```

Question 31

what is cutaneous metastases?

Answer 31

Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy Most commonly breast, colon and lung

Question 32

what is the management for cutaneous metastases?

Answer 32

Treat the underlying malignancy Local excision Localised radiotherapy Symptomatic