Skin Cancer Flashcards
What are risk factors for non-melanoma skin cancer?
UV radiation
Chemical carcinogens
Ionising radiation
HPV
Familial cancer syndromes (basal cell carcinoma when they are young suggests that they might have a familial cancer syndrome)
Immunosuppression
What are the pathogenic features of basal cell carcinoma?
Slowly growing
Locally invasive
Rarely metastasise
Describe the visual features of a basal cell carcinoma
(BCC is the most common type of cancer as well as the most common type of skin cancer)
Nodular:
–Pearly rolled edge
–Telangiectasia
–Central ulceration
–Arborising vessels on dermoscopy
What are these?
Pigmented
Morphoeic basal cell carcinomas
What is the treatment of BCC?
Excision
Courettage
Mohs surgery
Vismodegib (for locally advanced BCC that is not suitable for surgery or radiotherapy, metastatic basal cell carcinoma)
Side effects include hair loss, weight loss, altered taste, muscle spasms, nausea and fatigue
Describe the pathogenicity of squamous cell carcioma
Can metastasise
Faster growing, tender, scaly/crusted or fleshy growths
Can ulcerate
What do squamous cell carcinomas develop from?
Keratinising squamous cells
Usually on sun exposed sites
What is the treatment of small cell carcinoma?
Excision
With or without radiotherapy
Follow up is recquired for those who are considered high risk:
- Immunosuppressed
- Greater than 20 mm diameter
- Greater than 4 mm depth
- Ear, nose, lip, eyelid
- Perineural invasion
- Poorly differentiated
What skin cancer is a variant of squamous cell carinoma and erupts from hair follicles in sun damaged skin?
Keratocanthoma
Grows rapidly, may shrink after a few months and resolve
Surgical excision
What are the genetic risk factors for UV radiation?
UV radiation
Genetic susceptibility - fair skin, red hair, blue eyes and tendency to burn easily
Familial melanoma and melanoma susceptibility genes
What is the ABCDE rule for melanoma?
- Asymmetry
- Border - ill defined
- Colour - tends to vary
- Diameter - over 6mm is likely to be a melanoma
- Evolution - means the melanoma is changing
What is the 7 point checklist for malignant melanoma?
Major features:
Change in size
Change in shape
Change in colour
Minor features:
Diameter more than 5 mm
Inflammation
Oozing or bleeding
Mild itch or altered sensation
What visual aid can be used to help in the diagnosis of malignant melanoma?
Dermoscope
What are the different types of malignant melanoma?
Superficial Spreading Malignant Melanoma - often at the site of a preexisting mole - most common type and confined to the epidermis
Lentigo maligna melanoma - confined to the epidermis
Nodular
Acral lentiginous Melanoma
Ocular
What is the treatment for melanoma?
Urgent surgical incicsion
Sentinal lymph node biopsy
Chemotherapy/immnotherapy
Regualr follow up
Primary and secondary prevention
What are the biological agents for metastatic melanoma?
•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%
•Vemurafenib and Dabrafenib
–Blocks B-RAF protein
–Only useful if B-RAF mutation
–Median survival 10.5 months (7.8 months with standard chemotherapy)
Is cutaneous lymphoma primary or secondary?
Can be secondary (disease from systemic / nodal involvement)
Can also be primary - abnormal neoplastic proliferation of lymphocytes underneath the skin (cutaneous T cell lyphoma 65% and cutaneous B cell lymphoma 20%)
What are types of cutanous T cell lymphoma (a primary cause of lymphoma)?
Mycosis fungiodes
Sezary syndrome
What is the most common type of cytotoxic T cell lymphoma (accounts for around 50% of all primary cutaneous lymphomas)
Mycosis fungiodes
What are the features of mycosis fungiodes?
Patch - flat, red oval lesions
May spontaneously enlarge or spontaneously resolve
may itch
Hard to differentiate from eczema and psoriasis
Plaque - Patches become thickened - generally itch
Tumour - large irregular lumps which arise from existing plaques or in normal skin - can ulcerate - more likely to have metastatic spread
Metastatic - neoplastic cells in lymph nodes, bloods and solid organs
What is red man syndrome?
Sezary syndrome
Cytotoxic T cell lymphoma affecting the skin of the entire body
Skin thickened, scaly
ITCHY
Lymph nodes are involved and sezary cells are found are in the peripheral blood (atypical t cells)
Por prognosis - opportunistic infection
What is the treatment of cutaneous lymphoma?
–Topical steroids
–PUVA or UVB
–Localised radiotherapy
–Interferon
–Bexarotene (this is a retinoid)
–Low dose Methotrexate
–Chemotherapy
–Total skin electron beam therapy
- Extracorporeal photophoresis
- Bone marrow transplantation
What is total skin electron beam therapy?
•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
What is extracorporeal photophoresis?
•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
Where does cutaneous metastases arise from?
Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy
