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Z Year 2 BRS MSK > Skin Cancers 2 > Flashcards

Skin Cancers 2 Flashcards

1
Q

When is keratinocyte dysplasia/carcinoma common?

A
  • pale skin types

- solar induced UV damage

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2
Q

What are the stages of keratinocyte dysplasia?

A
  1. Actinic keratoses
  2. Bowen’s disease
  3. Squamous cell carcinoma
  4. aBasal cell carcinoma
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3
Q

What is actinic keratoses?

A

Dysplastic keratinocytes

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4
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ

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5
Q

What is squamous cell carcinoma?

A

Potential for metastasis/ death

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6
Q

What is basal cell carcinoma?

A
  • (Virtually) never metastasises

- Locally invasive

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7
Q

What is the pathogenesis of basal cell carcinoma?

A

UV radiation

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8
Q

What is the pathogenesis of basal cell carcinoma dependent on?

A

stroma produced by dermal fibroblasts

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9
Q

What happens in the stroma in basal cell carcinoma (BCC)?

A
  1. Cross talk between tumour cells and mesenchymal cells of stroma
  2. Receptors for PDGF are upregulated in Stroma
  3. but PDGF is upregulated in tumour cells
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10
Q

What is the activity of BCC like?

A

proteolytic activity e.g. metalloproteinases and collagenases – degrade pre-existing dermal tissue and facilitate spread of tumour cells

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11
Q

What genes loose function in BCC?

A
  1. Loss of function in chromosome 8q (PTCH gene)
    - Sonic Hedgehog-Patched signalling pathway
    / SHH signalling is required for growth of established BCCs
  2. p53 mutations are also important – majority are missense mutations that carry a UV signature
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12
Q

Why does squamous cell carcinoma develop?

A
  • UV radiation

- Genetic alterations

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13
Q

What genes make an impact in squamous cell carcinoma?

A
  1. P53
  2. CDKN2A
  3. NOTCH1 or NOTCH2 (Wnt / β-catenin signalling)
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14
Q

What are the process of squamous cell carcinoma development?

A
  1. Normal skin
  2. Epidermal p53 clone
  3. Squamous cell dysplasia
  4. Squamous cell carcinoma in situ
  5. Invasive squamous cell carcinoma
  6. Metastasis of squamous cell carcinoma
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15
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

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16
Q

How common is BCC compared to keratinocyte carcinomas?

A
  • BCC:SCC 4:1
  • Both commoner in pale skin types
  • Both more common in men vs women (2-3:1)
  • Median age at diagnosis of BCC is 68
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17
Q

What are the risk factors keratinocyte carcinomas?

A

•UV exposure
- PUVA
•Fair skin
•Genetic syndromes

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18
Q

What are the genetic syndromes that cause keratinocyte carcinomas?

A
  1. Xeroderma pigmentosum
  2. Oculocutaneous albinism
  3. Muir Torre syndrome
  4. Nevoid basal cell carcinoma syndrome*
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19
Q

What are the other risk factors of kertinocyte carcinomas?

A
  1. Nevus sebaceous
  2. Porokeratosis
    3, Organ transplantation (immunosuppressive drugs)
  3. Chronic non-healing wounds
  4. Ionising radiation
    - Airline pilots
  5. Occupational chemical exposures
    - Tar, polycyclic aromatic hydrocarbons,
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20
Q

What are atypical keratinocytes confined to?

A

epidermis

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21
Q

Where does actinic keratoses develop?

A

sun-damaged skin - usually head, neck, upper trunk and extremities

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22
Q

What does actinic keratoses look like?

A
  1. Erythematous macule or scale or both-> thick papules or hyperkeratosis or both
  2. Sometimes cutaneous horn
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23
Q

How do you distinguish actinic keratoses from SSC?

A

sometimes difficult – requiring biopsy

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24
Q

What is the risk of progression from actinic keratoses to SCC?

A

0.025–16% per year for any single lesion

25
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ

26
Q

What does Bowen’s disease look like?

A

Erythematous scaly patch or slightly elevated plaque

27
Q

When might Bowen’s disease arise?

A

de novo or from pre-existing AK

28
Q

What can Bowen’s disease resemble?

A
  • actinic keratoses
  • psoriasis
  • chronic eczema
29
Q

What is the treatment of actinic keratoses and Bowen’s disease?

A
  1. 5-fluorouracil cream
  2. Cryotherapy
  3. Imiquimod cream
  4. Photodynamic therapy
  5. Curettage and cautery
  6. Excision
30
Q

When might squamous cell carcinoma arise?

A

within background of sun-damaged skin

31
Q

When can squamous cell carcinoma look like?

A
  1. Erythematous to skin coloured
  2. Papule
  3. Plaque-like
  4. Exophytic
  5. Hyperkeratotic
  6. Ulceration
32
Q

What is the localisation of SCC?

A

Trunk and limbs > 2cm; Head / neck > 1cm; Periorificial zones

33
Q

What are the margins of SCC like?

A

Ill-defined

34
Q

How fast does SCC grow?

A

Rapidly growing

35
Q

When is SCC common?

A
  • Immunosuppressed patients

* Previous radiotherapy or site of chronic inflammation

36
Q

What is the histology like in SCC?

A
  1. Grade of differentiation: poorly differentiated
  2. Acantholytic, adenosquamous, demosplastic subtypes
  3. Tumour thickness - Clark level: >6mm, Clark IV, V
  4. Invasion beyond subcutaneous fat
  5. Perineural, lymphatic or vascular invasion
37
Q

What is keratocanthoma?

A

•Controversial entity

- Pseudo-malignancy vs variant of SCC

38
Q

What are the characteristics of keratoacanthoma?

A

Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core

39
Q

How does keratocanthoma resolve?

A

slowly over months to leave atrophic scar

40
Q

Where do keratocanthoma occur?

A
  • occur on head or neck / sun exposed areas

- Difficult to distinguish clinically and histologically from squamous cell carcinoma

41
Q

What are investigations of SCC?

A
  1. Often clinical diagnosis sufficient
  2. Diagnostic biopsy may be taken if diagnostic uncertainty
  3. Ultrasound of regional lymph nodes ± FNA if concerns regarding regional lymph node metastasis
42
Q

What is SCC treatment?

A
  • Examination of rest of skin and regional lymph nodes
  • Excision
  • Radiotherapy
  • Cemiplimab for metastatic SCC
43
Q

When do you use radiotherapy SCC?

A
  • Unresectable

- High risk features e.g. perineural invasion

44
Q

What is the secondary prevention of SCC?

A
  • Skin monitoring advice

- Sun protection advice

45
Q

When does BCC arise?

A

within sun damaged skin

46
Q

What are the main subtypes of BCC?

A
  1. Nodular
  2. Superficial
  3. Morpheic
  4. Infiltrative
  5. Basisquamous
  6. Micronodular
47
Q

How common is nodular BCC?

A
  • Most common subtype

- Accounts for approximately 50% of all Basal cell carcinomas

48
Q

How does nodular BCC present?

A

shiny, pearly papule or nodule

49
Q

What does superficial BCC look like?

A

Well-circumscribed, erythematous, macule / patch or thin papule /plaque

50
Q

What does BCC morphoeic look like?

A
  1. Slightly elevated or depressed area of induration
  2. Usually light-pink to white in colour
    - More aggressive behaviour
    - Extensive local destruction
51
Q

Is BCC mophoeic common?

A

less common

52
Q

What is basisquamous BCC like?

A

Histological features of both basal cell carcinoma and squamous cell carcinoma

53
Q

What is micronodular BCC like?

A
  1. Resembles nodular basal cell carcinoma clinically

2. More destructive behaviour – high rates of recurrence and subclinical spread

54
Q

What are the investigations for BCC?

A
  • Often clinical diagnosis sufficient

* Diagnostic biopsy may be taken

55
Q

What are the differential diagnosis of BCC?

A
  1. Squamous cell carcinoma
  2. Adnexal (sebaceous) carcinoma
  3. Merkel cell carcinoma
56
Q

What is the stages of treatment for BCC in Mohs?

A
  1. First thin layer removed
  2. Another thin layer removed
  3. Another thin layer removed
  4. Final layer of cancer removed
    - examine each one before taking another so no margin taken
57
Q

When is Mohs micrographic surgery used in BCC treatment?

A
  1. Recurrent basal cell carcinoma
  2. Aggressive subtype (morpheic / infiltrative / micronodular)
  3. Critical site (if nose/eye)
58
Q

What are the other option of BCC treatment?

A
  1. Topical therapy e.g. 5-Fluorouracil, Imiquimod
  2. Photodynamic therapy
  3. Curettage (as iceberg can still reccur with this)
  4. Radiotherapy
  5. Vismodegib - selectively inhibits abnormal signalling in Hedgehog (Hh) pathway
59
Q

What are some differential diagnsosi of SCC?

A
  1. BCC
  2. Viral wart
  3. Merkel cell carcinoma

Z Year 2 BRS MSK (18 decks)

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