Skin cancer overview & epidemiology Flashcards
What are the two categories of skin cancer?
Non-melanoma skin cancer (BCC & SCC) and melanoma skin cancer
What cells do the three types of skin cancer arise form?
Melanocytes, basal cells & suprabasal cells
List the types of skin cancer from most to least serious
Melanoma > SCC > BCC
Which category of skin cancer has the highest incidence?
NMSC
Which factors have contributed to the rise of skin cancer in Scotland?
Increase in sunbed use, increase in number of people going on sunny holidays, increased diagnosis
Which cancer is the fastest increasing cancer in Scotland?
Melanoma
Patients often develop multiple skin cancers. T/F
True
How do BCCs typically present?
- Translucent/pearly, slow-growing lump with telangiectasia or non-healing ulcer (rodent ulcer).
- Often painless.
- Superficial BCC presents as a scaly plaque.
- Morphoeic BCC is infiltrative.
How do SSCs typically present?
- Warty/crusted growth or non-healing ulcer.
- Tend to arise on sun-damaged skin and are fast(er) growing.
- May be painful and/or bleed
BCCs grow slow but spread throughout the body fast. T/F
False - locally invasive but they don’t tend to spread
There is generally a high surgical morbidity with skin cancer but a lower mortality. T/F
True - generally
Malignant melanoma is responsible for the majority of skin cancer deaths. T/F
True
What is the most common cancer affecting 15-24 year olds?
Malignant melanoma
What is the distribution of melanoma between the sexes?
More woman get melanoma but more men die of melanoma
Melanoma spreads at an early stage. T/F
True
Describe the ABCDE approach to melanoma
A - asymmetry B - border C - colour D - diameter E - evolution
What is the ugly duckling sign?
When a person has multiple moles/skin markings and one stands out as “uglier” than the rest. This ugly duckling is typically cancerous
Over which age do BCCs tend to arise?
> 40
Where do BCCs tend to present?
Central facial ulcers
Which type of BCC can be topically treated?
Superficial BCCs
BCCs are never pigmented. T/F
False
What is the difference between well differentiated and poorly differentiated SSCs in terms of risk?
Well differentiated - low risk
Poorly differentiated - high risk
What is the general risk that a SSC will metastasise?
5% (significantly worsens prognosis)
What the the precursor lesions to SSC?
Bowens, actinic keratosis
What is a keratoacanthoma?
A self-resolving tumour of the skin follicles often confused with SSC and removed (hard to distinguish so this is for the best)
How does keratoacanthoma present?
Rapidly growing, symmetrical, scaly, dome-shaped nodule surrounded by erythema
What are actinic keratosis?
Scaly, erythematous lesions. AK present in multiples.
What is bowens disease?
Well demarcarcated scaly, erythematous plaques
What is a cutaneous horn?
Benign keratinous skin tumours appearing like horns
The ears, lips and scalp are high risk sites for skin cancer. T/F
True
50% of people who develop a NMSC will go on to develop a further skin cancer within 5 years. T/F
True
Chronic ulcers/wounds may go on to become SSCs. T/F
True
What are the risk factors for skin cancer?
Sun exposure, genetics, smoking, immunosuppression, HPV infection, chronic ulceration, skin type, occupation, age
What are the sun exposure patterns for the various skin cancers?
SSC - chronic, cumulative UV exposure
BCC - intermittent, intense sunburn episodes
Melanoma - intermittent, intense sunburn episodes
What are the most common sites for SCC?
Head, neck, hands, forearms (i.e exposed body sites)
Sunburn in childhood is a particular risk factor for skin cancer. T/F
True
What is xeroderma pigmentosum? What is the relationship between this and skin cancer?
A genetic (defect in nucleotide excision repair) photosensitivity condition also associated with neurological degeneration. Skin cancers develop more commonly on sun exposed sites
What is the average age of onset of skin cancer in patients with xeroderma pigmentosum?
8 y/o
Name some genetic conditions which are associated with an increased risk of skin cancer?
Xeroderma pigmentosum, oculocutaneous albinism & naevoid basal cell carcinoma (gorlin’s) syndome, recessive dystrophic epidermolysis bullosa, hereditary type VII collagen deficiency
What is Gorlin’s syndrome? What are the features of this syndrome?
Autosomal dominant familial cancer syndrome. Early onset/multiple BCC, palmar pits, jaw cysts, ectopic calcification falx
Which immunosuppressed group are a high risk for skin cancer?
Transplant patients
How can skin cancer be prevented?
Behavioural changes, clothing, suncream & regular self surveillance
