Skin cancer Flashcards
Name 2 types of non-melanoma skin cancer
Basal cell cancer
Squamous cell cancer
Risk factors for Skin cancer (7)
UV radiation
Photochemotherapy (PUVA) - UV treatment used for severe skin diseases
Chemical carcinogens
Ionising radiation
Human papilloma virus
Familial cancer syndromes
Immunosuppression
Describe Basal cell carcinoma features
Slow growing
Locally invasive - rarely metastasise
Nodular - pearly rolled edge (well defined)
Central ulceration
Spider veins around it
Surgery for Basal cell carcinoma
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
What is Mohs surgery?
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
What is Vismodegib? When is it used? How does it work?
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.
Side effects of Vismedegib BCC cancer drug
Hair loss Weight loss Altered taste Muscle spasms Nausea Fatigue
Squamous cell carcinoma features
Derived from keratinising squamous cells
Usually on sun exposed sites
Can metastasise and ulcerate
Faster growing, tender, scaly/crusted or fleshy growths
Treatment of squamous cell carcinoma
Excision
+/- Radiotherapy
Follow up if high risk lesion
What factors make an SCC lesion high risk
Immunosuppressed >20mm diameter >4mm depth Ear, nose, lip, eyelid Perineural invasion Poorly differentiated
What is Keratoacanthoma?
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
Melanoma skin cancer epidemiology
The incidence of malignant melanoma has increased by 360% since the 1970s in the UK
About 10 to 40 per 100,000 per annum
Risk factors of melanoma
UV radiation
Genetics - fair skin, red hair, blue eyes and tendency to burn easily
Familial melanoma + melanoma susceptibility genes
What is the ABCDE rule for moles/lesions (things you should check for)
Asymmetry Border Colour Diameter Evolution
7 pint checklist recommended by NICE for skin lesions
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.
As melanoma progresses what happens?
In the benign stages only the epidermis is affected. As it progresses the lesion moves into deeper layers of the skin
Name some variations of melanoma
Lentigo Maligna Melanoma
Acral Lentiginous Melanoma/Subungal Melanoma
Nodular Melanoma
Ocular melanoma (eye)
Where are Acral Lentiginous Melanoma/Subungal Melanoma lesions founds?
On palms, soles or under nail
Treatment of melanoma
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
What is Clark’s levels?
A staging system, which describes the level of anatomical invasion of the melanoma in the ski
What is Breslow thickness?
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
Adjuvant therapy used in metastatic melanoma
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
What is secondary Cutaneous disease?
Secondary cutaneous disease from systemic/nodal involvement
What is primary Cutaneous disease?
Abnormal neoplastic proliferation of lymphocytes in the skin
Cutaneous T Cell lymphoma (65%)
Cutaneous B Cell lymphoma (20%)
