Skin cancers Flashcards
Learn about these nasty skin tumours
1
Q
What is the epidemiology of non melanoma skin cancer?
A
- Basal cell cancer & Squamous cell cancer
- Incidence has increased in the last 30-40 years
- Northern europe 3-4 times less than Australia
- BCCs account for 70% of NMSCs.
- BCCs incidence from 146 to 788/100000
- SCCs 38 to 250/100000
2
Q
What are the risk factors of non melanoma skin cancer?
A
- UV radiation
- Photochemotherapy (PUVA)
- Chemical carcinogens
- X-ray and thermal radiation
- Human papilloma virus
- Familial cancer syndromes
- Immunosuppression
3
Q
Describe basal cell carcinoma (including the different types)
A
- Slow growing
- Locally invasive
- Rarely metastasise
Nodular
- Pearly rolled edge
- Telangiectasia
- Central ulceration
- Arborising vessels on dermoscopy
Superficial
Pigmented
Merphoeic
4
Q
What is the treatment of basal cell carcinoma?
A
- Excision is gold standard
* Ellipse, with rim of unaffected skin
* Curative if fully excised
* Will scar - Curettage in some circumstances
- Mohs surgery
- Vismodegib
5
Q
What are the indications of Mohs surgery?
A
- Site
- Size
- Subtype
- Poor clinical margin definition
- Recurrent
- Perineural or perivascular involvement
6
Q
Explain Vismodegib
A
- 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 shrink tumors 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
7
Q
Explain squamous cell carcinoma
A
- Derived from keratinising squamous cells
- Usually on sun exposed sites
- Can metastasise
- Faster growing, tender, scaly/crusted or fleshy growths
- Can ulcerate
8
Q
What is the treatment of squamous cell carcinoma?
A
- Excision
- +/- Radiotherapy
Follow up if high risk
- Immunosuppressed
- > 20mm diameter
- > 4mm depth
- Ear, nose, lip, eyelid
- Perineural invasion
- Poorly differentiated
9
Q
Explain keratoacanthoma
A
- Variant of squamous cell carcinoma
- Erupts from hair follicles in sun damaged skin
- Grows rapidly, may shrink after a few months and resolve
- Surgical excision
10
Q
What is the epidemiology of melanoma skin cancer?
A
- 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
11
Q
What are the risk factors of melanoma skin cancer?
A
- UV Radiation
- Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily
- Familial melanoma and melanoma susceptibility genes
12
Q
What is the ABCDE rule?
A
- Asymmetry
- Border
- Colour
- Diameter
- Evolution
13
Q
What is the seven point checklist?
A
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
14
Q
What is the treatment of melanoma skin cancer?
A
- Urgent surgical excision
* Subtype
* Breslow thickness - Wide local excision
- Sentinel lymph node biopsy
- Chemotherapy/immunotherapy
- Regular follow up
- Primary and Secondary Prevention
- drugs
15
Q
What drugs are used to treat metastatic melanoma?
A
Ipilimumab - Inhibits CTLA-4 molecule - One year survival 47-51% (double those not on treatment) Pembrolizumab - Blocks activity of PD-1 - 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)
