Skin Cancers Flashcards
What is BCC?
- A slow growing, locally invasive malignant tumour of the epidermal keratinocytes
- Normally in older individuals
- Rarely metastasises
- Most common malignant skin tumour
What are the risk factors for BCC?
- Excessive sun exposure
- Hx of frequent sunburn in childhood
- Type 1 skin type (fair skin, red hair, blue eyes)
- Increasing age
- Male sex
- Immunosuppression
- Prev. Hx. of skin cancer
What is the clinical presentation of BCC?
- Nodular (= most common type)
- Slow growing
- Small, skin-coloured papule or nodule
- Pearly-rolled edge
- Telangiectasia
- Central ulceration
- Arborising vessels on Dermoscopy
What is the management of BCC?
- Surgical excision (= gold standard)
- Curettage
- Topical treatment (if superficial + low-risk)
- > Imiquimod
- Moh’s Micrographic Surgery (for high-risk, recurrent tumours)
- Chemo
- > Vismodegib
What is Vismodegib used for?
- Chemo
- for locally-advanced BCC not suitable for surgery or radiotherapy
- Metastatic BCC
What is SCC?
- Locally invasive malignant tumour of the epidermal keratinocytes
- Potential to metastasise
- In-situ = Bowen’s disease
What are the risk factors for SCC?
- Excessive UV (sun) exposure
- HPV (genital SCC)
- Smoking (lip SCC)
- Outdoor occupation
- Caucasian ethnicity
- Increasing age
What is the Clinical Presentation of SCC?
- Usually on sun-exposed sites
- Faster growing (than BCC)
- Tender
- Scaly/crusted (keratotic)
- Fleshy growths
- Can ulcerate
What is the Management of SCC?
- Surgical excision
- +/- RT (large + non-resectable nodes)
- Follow-up if high-risk
What are the risk factors for high-risk SCC lesions?
- Immunosuppressed
- > 20mm diameter
- > 4mm depth
- Ear, nose, lip, eyelid
- Perineural invasion
- Poorly differentiated -> tends to metastasise!
What is Keratocanthoma?
- Varient of SCC
- Erupts from hair follicles in sun damaged skin
- Grows rapidly -> may shrink after a few months and resolve
- Surgical excision (tends to resolve itself by the time surgery-time comes)
What is Malignant Melanoma?
- Malignant tumour of the Epidermal Melanocytes
- Potential to Metastasise
What are the risk factors for Malignant Melanoma?
- Excessive UV (sun) exposure
- Type 1 skin type (fair skin, red hair, blue eyes)
- Hx. of multiple or atypical moles
- PMH or FH of Melanoma
How can you identify between a normal mole and melanoma?
- “ABCDE” symptoms*
- Asymmetrical – melanomas usually have 2 very different halves and are an irregular shape
- Border – melanomas usually have a notched or ragged border
- Colours – melanomas will usually be a mix of 2 or more colours
- Diameter – most melanomas are usually >6mm in diameter
- Evolution: enlargement or elevation – a mole that changes size over time is more likely to be a melanoma
Which instrument would you use to identify a suspicious mole?
- Dermatoscope
What are the different types of Melanoma?
- Superficial Spreading Malignant Melanoma
- Lentigo Maligna Melanoma
- Nodular Melanoma
- Acral Lentiginous Melanoma/Subungal Melanoma
- Ocular Melanoma
What is the management of Malignant Melanoma?
- Depends on stage and Breslow thickness*
- Surgical excision (= definitive treatment)
Metastasis or adjuvant therapy:
- Immunotherapy
- Chemo
- Regular follow-up
- Primary and secondary prevention
What is Breslow Thickness?
- Measures the depth of the Melanoma from the surface of the skin, down to the deepest part of the tumour
- Helps determine the stage of the cance
- > guides treatment and determines prognosis
What is the general prognosis of Malignant Melanoma?
90% of people diagnosed with Melanoma in England and Wales survived 10 years or more
What are the 2 most common Cutaneous Lymphomas?
- Mycosis Fungoides
- Sezary syndrome
(both are sub-types of Cutaneous T Cell lymphoma → CTCLs make up 65% of all Cutaneous Lymphomas)
What is the most common CTCL?
Mycosis Fungoides
What are the identifying features of Mycosis Fungoides?
- Patch (difficult to differentiate from eczema/psoriasis) -> Plaques -> Tumour (large, irregular, can ulcerate) -> Metastases (LNs, blood, solid organs)
- Work up includes bloods for sezary cells, and CT imaging for staging
What are the identifying features of Sezary syndrome?
- “Red Man syndrome” -> >80% BSA
- CTCL affecting the entire body:
- > skin thickened, scaly and red
- > vv itchy
- LN involvement
- Sezary cells in peripheral blood
- > atypical T cells
- Poor prognosis
- > median survival 2-4yrs
- > opportunistic infection
- Treatment = Extracorporeal Photophoresis
