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1A Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

Skin Cancer Types

A
  1. Non-melanoma and melanoma skin cancer
  2. Cutaneous lymphoma
  3. Cutaneous metastases
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2
Q

2 types of

Cutaneous lymphoma

A

Mycosis fungoides

Sezary Syndrome

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3
Q

Skin Cancer Epidemiology

A

Basal cell cancer & Squamous cell cancer
Incidence has increased in the last 30-40 years
131,000 cases in the UK each year
Underestimate
BCCs account for 70% of NMSCs.
BCCs incidence from 146 to 788/100000
SCCs 38 to 250/100000

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4
Q

Skin Cancer Risk Factors

A 
UV radiation
Photochemotherapy (PUVA)
Chemical carcinogens
Ionising radiation
Human papilloma virus
Familial cancer syndromes
Immunosuppression
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5
Q

Basal Cell Carcinoma

Growth & Appearance

A

Slow growing
Locally invasive
Rarely metastasise

Nodular
Pearly rolled edge
Telangiectasia
Central ulceration
Arborising vessels on dermoscopy
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6
Q

Basal Cell Carcinoma Types

A

Superficial
Pigmented
Morphoeic

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7
Q

Basal Cell Carcinoma Treatment:

A

Excision is gold standard

Ellipse, with rim of unaffected skin

Curative if fully excised
Will leave a scar

Curettage in some circumstances

Imiquimod if superficial

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8
Q

Mohs Surgery & Indications

A
  1. First thin layer removed - repeated another two times and then the final layer of cancer is then removed.
Indications
Site
Size
Subtype
Poor clinical margin definition
Recurrent
Perineural or perivascular involvement
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9
Q

BCC - Vismodegib

Indications, what is it, side effects?, Prognosis following treatment?

A

Indications
Locally advanced BCC not suitable for surgery or radiotherapy
Metastatic BCC
Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
Can shrinks tumour and heal visible lesions in some
Median progression free survival 9.5 months
Side Effects
Hair loss, weight loss, altered taste
Muscle spasms, nausea, fatigue

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10
Q

Squamous Cell Carcinoma

A

Derived from keratinising squamous cells
Usually on sun exposed sites
Can metastasise, up to 16% depending on study
Faster growing, tender, scaly/crusted or fleshy growths
Can ulcerate

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11
Q

Treatment of SCC

& follow up indications:

A

Excision
+/- Radiotherapy

Follow up if high risk
Immunosuppressed
>20mm diameter
>4mm depth
Ear, nose, lip, eyelid
Perineural invasion
Poorly differentiated
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12
Q

Keratoacanthoma - SCC

A

Varient of squamous cell carcinoma
Erupts from hair follicles in sun damaged skin
Grows rapidly, may shrink after a few months and resolve
Surgical excision

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13
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 100000 per annum
Mortality is about 1.9 per 100000 per annum

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14
Q

Melanoma Skin Cancer Risk Factors

A

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

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15
Q

Melanoma Skin Cancer ABCDE rule

A 
Asymmetry
Border
Colour
Diameter
Evolution
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16
Q

7 Point Checklist

A 
Major features
1. Change in size
2. Change in shape
3. Change in colour
Minor features
4. Diameter more than 5 mm
5. Inflammation
6. Oozing or bleeding
7. Mild itch or altered sensation
17
Q

Investigations for Melanoma

A

Dermoscopy

18
Q

Dermoscopy - Melanoma

A

‘dermoscope’ or ‘dermatoscope’

Improved clinical accuracy compared to unaided eye

19
Q

Biological growth transitions of melanoma

A
  1. benign nevus
  2. dysplastic nevus
  3. rapid growth phase
  4. vertical growth phase
  5. Metastatic Melanoma
20
Q

Melanoma Types:

A
  1. Superficial Spreading Malignant Melanoma
  2. Nodular Melanoma
  3. Acral Lentiginous Melanoma/Subungal Melanoma
  4. Ocular Melanoma
21
Q

Melanoma Treatment

A

Urgent surgical excision
Subtype
Breslow thickness

Wide local excision
Sentinel lymph node biopsy

Chemotherapy – almost never
Radiotherapy - rarely
Immunotherapy – metastasis or adjuvent therapy

Regular follow up

Primary and Secondary Prevention

22
Q

Metastatic Melanoma and Adjuvent Therapy

Pembrolizumab

Nivolumab

Vemurafenib and Dabrafenib

Trametinib
Used in combination with Dabrafenib

A

Ipilimumab

  • Inhibits CTLA-4 molecule
  • One year survival 47-51% (double those not on treatment)

Pembrolizumab

  • Targets PD-1 receptor on tumour cell
  • One year survival 68-74% in metastatic disease
  • Adjuvent therapy in those with complete surgical resection of lymph node/metastatic disease
Nivolumab (also PD-1 antibody)
Single agent (one year survival 72.9%) or in combination with Ipilimumab in metastatic disease.
Adjuvent therapy in those with complete surgical resection of lymph node/metastatic disease

Vemurafenib and Dabrafenib
Blocks B-RAF protein
Only useful if B-RAF mutation
Median survival 10.5 months (7.8 months with standard chemotherapy)

Trametinib
Used in combination with Dabrafenib
Reduced toxicity
Increased response
MEK inhibitor
In those with B-RAF mutation the MEK pathway is hyperactive resulting in uncontrolled growth of melanocytes
23
Q

Cutaneous Lymphoma

A

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%)

24
Q

Cutaneous T Cell lymphoma (65%)

A

Cutaneous T Cell lymphoma (65%)

Mycosis fungoides *** 
MF varients
Sezary syndrome *** 
CD30+ lymphoproliferative disorders
Subcutaneous panniculitis like T cell lymphoma
Cutaneous CD4+ lymphoma
Extranodal NK/T cell lymphoma
25
Q

Cutaneous B Cell lymphoma (20%)

A

Cutaneous B Cell lymphoma (20%)

Cutaneous follicle centre lymphoma
Cutaneous marginal zone lymphoma
Cutaneous diffuse large B Cell lymphoma

26
Q

Most common Cutaneous T-Cell Lymphoma:

A

Mycosis Fungoides

27
Q

CTCL: Mycosis Fungoides

A

Most common CTCL & accounts for around 50% of all primary cutaneous lymphomas
Incidence 6 per 1 million population
Cause unknown
More common in older patients and more common in men than women
Indolent course

28
Q

Stages of: Mycosis Fungoides (CTCL)

A

Patch
Flat, red, dry oval lesions
Usually covered sites
May slowly enlarge of spontaneously resolve
May itch
Difficult to differentiate from eczema/psoriasis

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

Work up includes bloods for * sezary cells * and CT imaging for staging

29
Q

Mycosis Fungoides (CTCL) –> Sezary Syndrome

A

“Red Man Syndrome”

CTCL affecting skin of entire body

Skin thickened, scaly and red
Itchy++
Lymph node involvement
Sezary cells in peripheral blood
Atypical T cells

Poor prognosis
Median survival 2-4 years
Opportunistic infection

30
Q

Treatment of cutaneous lymphoma drugs:

A 
Dependant on stage 
Topical steroids
PUVA or UVB
Localised radiotherapy
Interferon
Bexarotene
Low dose Methotrexate
Chemotherapy
Total skin electron beam therapy
Bone marrow transplantation
31
Q

Treatment of cutaneous lymphoma:

Total skin electron beam therapy

A

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

32
Q

Treatment of cutaneous lymphoma:

Extracorporeal photophoresis

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

33
Q

Cutaneous metastases

A

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

34
Q

Cutaneous metastases Management

A

Treat the underlying malignancy
Local excision
Localised radiotherapy
Symptomatic

1A Dermatology (9 decks)

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