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2ND YEAR SYSTEMS: Dermatology > Skin cancer > Flashcards

Skin cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

Name 2 types of non-melanoma skin cancer

A

Basal cell cancer

Squamous cell cancer

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2
Q

Risk factors for Skin cancer (7)

A

UV radiation

Photochemotherapy (PUVA) - UV treatment used for severe skin diseases

Chemical carcinogens

Ionising radiation

Human papilloma virus

Familial cancer syndromes

Immunosuppression

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3
Q

Describe Basal cell carcinoma features

A

Slow growing
Locally invasive - rarely metastasise

Nodular - pearly rolled edge (well defined)
Central ulceration
Spider veins around it

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4
Q

Surgery for Basal cell carcinoma

A

Excision is gold standard
- Ellipse (scar runs with existing skin creases etc)

Curative if fully excised but will leave a scar

If it’s superficial can used Imiquimod cream

If deeper - curettage (scrapes skin) in some circumstances

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5
Q

What is Mohs surgery?

A

A precise surgical technique used to treat skin cancer.

Thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains

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6
Q

What is Vismodegib? When is it used? How does it work?

A

A cancer treatment drug for locally advanced BCC.

Used if cancer lesion is not suitable for surgery or radiotherapy. Or if there’s metastases.

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

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7
Q

Side effects of Vismedegib BCC cancer drug

A 
Hair loss
Weight loss
Altered taste
Muscle spasms
Nausea
Fatigue
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8
Q

Squamous cell carcinoma features

A

Derived from keratinising squamous cells

Usually on sun exposed sites

Can metastasise and ulcerate

Faster growing, tender, scaly/crusted or fleshy growths

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9
Q

Treatment of squamous cell carcinoma

A

Excision
+/- Radiotherapy

Follow up if high risk lesion

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10
Q

What factors make an SCC lesion high risk

A 
Immunosuppressed
>20mm diameter
>4mm depth
Ear, nose, lip, eyelid
Perineural invasion
Poorly differentiated
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11
Q

What is Keratoacanthoma?

A

A variant of SCC

A skin lesion that erupts from hair follicles in sun-damaged skin, rather like a little volcano.

Grows rapidly, may shrink after a few months and resolve

Surgical excision

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12
Q

Melanoma skin cancer epidemiology

A

The incidence of malignant melanoma has increased by 360% since the 1970s in the UK

About 10 to 40 per 100,000 per annum

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13
Q

Risk factors of melanoma

A

UV radiation

Genetics - fair skin, red hair, blue eyes and tendency to burn easily

Familial melanoma + melanoma susceptibility genes

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14
Q

What is the ABCDE rule for moles/lesions (things you should check for)

A 
Asymmetry
Border
Colour
Diameter
Evolution
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15
Q

7 pint checklist recommended by NICE for skin lesions

A

Major features (2 points):
Change in size
Change in shape
Change in colour

Minor features (1 point):
Diameter more than 5 mm
Inflammation
Oozing or bleeding
Mild itch or altered sensation

All suspicious pigmented skin lesions scoring 3 points or more should be referred urgently.

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16
Q

As melanoma progresses what happens?

A

In the benign stages only the epidermis is affected. As it progresses the lesion moves into deeper layers of the skin

17
Q

Name some variations of melanoma

A

Lentigo Maligna Melanoma

Acral Lentiginous Melanoma/Subungal Melanoma

Nodular Melanoma

Ocular melanoma (eye)

18
Q

Where are Acral Lentiginous Melanoma/Subungal Melanoma lesions founds?

A

On palms, soles or under nail

19
Q

Treatment of melanoma

A

Urgent surgical excision

Sentinel lymph node biopsy (first ones into which a tumour drains)

Do immunotherapy for metastasis or adjuvant therapy

Never really do chemo or Radiotherapy

20
Q

What is Clark’s levels?

A

A staging system, which describes the level of anatomical invasion of the melanoma in the ski

21
Q

What is Breslow thickness?

A

Measures from the top of the granular layer of the epidermis (or, if the surface is ulcerated, from the base of the ulcer) to the deepest invasive cell across the broad base of the tumour (dermal/subcutaneous).

Basically how far into the skin the lesion has penetrated

22
Q

Adjuvant therapy used in metastatic melanoma

A

Ipilimumab

Pembrolizumab - in those with complete surgical resection of lymph node/metastatic disease

Nivolumab - those with complete surgical resection of lymph node/metastatic disease. Sometimes used in combo with ipilimumab

Vemurafenib

Trametinib

23
Q

What is secondary Cutaneous disease?

A

Secondary cutaneous disease from systemic/nodal involvement

24
Q

What is primary Cutaneous disease?

A

Abnormal neoplastic proliferation of lymphocytes in the skin

Cutaneous T Cell lymphoma (65%)

Cutaneous B Cell lymphoma (20%)

25
Q

2 broad classifications of Cutaneous lymphoma?

A

Secondary cutaneous disease

Primary cutaneous disease

26
Q

What is Cutaneous T Cell lymphoma?

Name a common form and an aggressive form of this disease.

A

A rare type of non-Hodgkin lymphoma that affects the skin.

Most common form = Mycosis fungoides

Aggressive form = sezary syndrome

27
Q

What is Cutaneous B Cell lymphoma

A

A rare type of cancer that begins in the WBCs and attacks the skin.

Affects lymphocytes (B cells)

28
Q

3 common types of cutaneous b cell lymphoma

A

Cutaneous follicle centre lymphoma

Cutaneous marginal zone lymphoma

Cutaneous diffuse large B Cell lymphoma

29
Q

Stages of Mycosis Fungoides (type of T cell lymphoma)

A
  1. Patch - Flat, red, dry oval lesions

Usually covered sites
May slowly enlarge or spontaneously resolve

May itch

Difficult to differentiate from eczema/psoriasis

  1. Plaque - Patches may become thickened - quite itchy
  2. Tumour - Large irregular lumps, can ulcerate. Arise from existing plaques or in normal skin. More likely to have metastatic spread.
  3. Metastatic - infiltration of neoplastic cells in LN’s, blood and solid organs.
30
Q

Sezary syndrome features

A

Red Man Syndrome

T cell lymphoma - affects skin of entire body. Thickened skin, scaly and red. Very itchy.

LN involvement

Sezary cells in peripheral blood - atypical T cells

Poor prognosis - average 2-4 years. Opportunistic infection.

31
Q

Treatment of cutaneous lymphoma is dependent on what?

A

Stage of disease

32
Q

What are some options for treatment of cutaneous lymphoma

A

Topical steroids

PUVA or UVB

Localised radiotherapy

Interferon

Bexarotene

Low dose Methotrexate

Chemotherapy

Total skin electron beam therapy - type of radiotherapy. Delivers radiation primarily to superficial layers i.e. Epidermis and Dermis

Extracorporeal photophoresis

Bone marrow transplantation

33
Q

Extracorporeal photophoresis steps

A

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

34
Q

Most common organs causing Cutaneous metastases

A

Breast
colon
lung

2ND YEAR SYSTEMS: Dermatology (11 decks)

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