Skin Cancer Flashcards
Skin Cancer Types
- Non-melanoma and melanoma skin cancer
- Cutaneous lymphoma
- Cutaneous metastases
2 types of
Cutaneous lymphoma
Mycosis fungoides
Sezary Syndrome
Skin Cancer Epidemiology
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
Skin Cancer Risk Factors
UV radiation Photochemotherapy (PUVA) Chemical carcinogens Ionising radiation Human papilloma virus Familial cancer syndromes Immunosuppression
Basal Cell Carcinoma
Growth & Appearance
Slow growing
Locally invasive
Rarely metastasise
Nodular Pearly rolled edge Telangiectasia Central ulceration Arborising vessels on dermoscopy
Basal Cell Carcinoma Types
Superficial
Pigmented
Morphoeic
Basal Cell Carcinoma Treatment:
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
Mohs Surgery & Indications
- 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
BCC - Vismodegib
Indications, what is it, side effects?, Prognosis following treatment?
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
Squamous Cell Carcinoma
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
Treatment of SCC
& follow up indications:
Excision
+/- Radiotherapy
Follow up if high risk Immunosuppressed >20mm diameter >4mm depth Ear, nose, lip, eyelid Perineural invasion Poorly differentiated
Keratoacanthoma - SCC
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
Melanoma Skin Cancer
Epidemiology
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
Melanoma Skin Cancer Risk Factors
UV Radiation
Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily
Familial melanoma and melanoma susceptibility genes
Melanoma Skin Cancer ABCDE rule
Asymmetry Border Colour Diameter Evolution
7 Point Checklist
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
Investigations for Melanoma
Dermoscopy
Dermoscopy - Melanoma
‘dermoscope’ or ‘dermatoscope’
Improved clinical accuracy compared to unaided eye
Biological growth transitions of melanoma
- benign nevus
- dysplastic nevus
- rapid growth phase
- vertical growth phase
- Metastatic Melanoma
Melanoma Types:
- Superficial Spreading Malignant Melanoma
- Nodular Melanoma
- Acral Lentiginous Melanoma/Subungal Melanoma
- Ocular Melanoma
Melanoma Treatment
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
Metastatic Melanoma and Adjuvent Therapy
Pembrolizumab
Nivolumab
Vemurafenib and Dabrafenib
Trametinib
Used in combination with Dabrafenib
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
Cutaneous Lymphoma
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%)
Cutaneous T Cell lymphoma (65%)
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
