Skin Cancers Flashcards
What are the cells affected in non-melanoma skin cancer?
Basal cells
Squamous cells
Risk factors for non-melanoma?
UV radiation Photochemotherapy - PUVA Chemical carcinogens X-ray + thermal radiation HPV Familial cancer syndromes Immunosuppression
What are the characteristics of basal cell carcinoma?
Slowly growing
Locally invasive
Rarely metastasise
What is the appearance of basal cell carcinoma?
Nodular Pearly rolled edge Telangectasia Central ulceration Arborising vessels on dermoscopy
What are the 2 variables for appearance of basal cell carcinoma?
Pigmented
Morphoeic
What is the gold standard treatment for BCC?
Excision (curative if fully excised; will scar)
curettage in some circumstances
What is Mohs surgery?
Thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains
What are indications for Mohs surgery?
Site Size Subtype Poor clinical margin definition Recurrent Perineural or perivascular involvement
What is Vismodegib?
cancer treatment drug
What are indications for Vismodegib?
Locally advanced BCC not suitable for surgery or radiotherapy
Metastatic BCC
How does Vismodegib work?
Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
What effect does Vismodegib have?
Can shrink tumour and heal visible lesions in some; median progression free survival 9.5 months
Side effects of Vismodegib?
Hair loss, weight loss, altered taste
Muscle spasms, nausea, fatigue
What does squamous cell carcinoma derive from?
Keratinising squamous cells, usually on sun exposed sites
What does squamous cell carcinoma look like?
Fast growing, tender, scaly/crusted or fleshy growths
Can ulcerate
Can metastatise
Treatment of SCC?
Excision
+/- radiotherapy
Follow up of SCC patient after treatment if high risk - what would indicate a high risk patient?
Immunosuppressed >20mm diameter >4mm diameter Ear, nose, lip, eyelid Perineural invasion Poorly differentiated
What skin cancer is a variant of squamous cell carcinoma and erupts from hair follicles in sun damaged skin? How is it dealt with?
Keratocanthoma
Grows rapidly, may shrink after a few months and resolve
Surgical excision
Risk factor for melanoma skin cancer?
UV radiation
Genetic susceptibility (fair skin, red hair, blue eyes, tendency to burn)
Familial melanoma + melanoma susceptibility genes
What is the ABCDE rule for assessing melanoma?
Asymmetry Border Colour Diameter Evolution
7 point checklist for malignant melanoma?
MAJOR - change in size - change in shape - change in colour MINOR - diameter more than 5mm - inflammation - oozing/bleeding - mild itch or altered sensation
What tool is used to look at melanoma which has an improved clinical accuracy compared to unaided eye?
Dermoscope/dermatoscope
What are some subtypes of malignant melanoma?
Superficial Spreading Malignant Melanoma - often at site of existing mole; most common
Lentigo Maligna Melanoma
Nodular Melanoma
Acral Lentiginous Melanoma/Subungal Melanoma
Ocular Melanoma
Management plan for melanoma?
Urgent surgical excision Sentinel lymph node biopsy Chemo/immunotherapy Regular follow up Primary + secondary prevention
What 3 biologic drugs are used to treat metastatic melanoma?
Ipilimumab
Pembrolizumab
Vemurafenib and Dabrafenib
What is a cutaneous lymphoma a secondary cutaneous disease from?
From systemic/nodal involvement
What can cause cutaneous lymphoma as a primary disease?
Abnormal neoplastic proliferation of lymphocytes in the skin (cutaneous T cell (65%); cutaneous B cell (20%))
What are 2 the types of cutaneous T cell lymphoma?
Mycosis fungoides
Sezary syndrome
What is the most common cytotixic T cell lymphoma which accounts for ~50% of all primary cutaneous lymphomas?
Mycosis fungoides
Describe the appearance of the patch stage in MF
Flat, red, dry oval lesions
Usually covered sites
May slowly enlarge or spontaneously enlarge
May itch
What is the patch stage of MF difficult to differentiate from?
Eczema/psoriasis
Describe the appearance of the plaque stage in MF
Patches become thickened
Generally itch
Describe the tumour stage of MF
Large, irregular bumps which can ulcerate
Arise from existing plaques or in normal skin
More likely to have metastatic spread
Describe the metastatic stage of MF
Infiltration of neoplastic cells in lymph nodes, blood and solid organs
How is MF diagnosed?
Bloods for sezary cells
CT imaging + staging
What is Sezary Syndrome?
CTCL affecting skin of entire body
Features of Sezary?
Red Man Syndrome Skin thickened, scaly + red ITCHY Lymph node involvement Sezary cells (atypical T cells) in peripheral blood
What is the prognosis for Sezary?
Poor - median survival 2-4 yrs; opportunistic infection
List off some treatments for cutaneous lymphoma (dependent on stage)
- Topical steroids
- PUVA or UVB
- Localised radiotherapy
- Interferon
- Bexarotene
- 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 v small electrically charged particles
Delivers radiation primarily to superficial layers (epidermis + dermis)
Spares deeper tissues and organs
What are the 4 stages of extracorporeal photophoresis?
- Patients blood is drawn and leukocytes collected
- Collected white cells mixed with psoralen which makes the T-cells sensitive to UVA radiation
- Exposed to UVA radiation, damaging diseased cells
- Treated cells re-infused back to patient
Describe the occurrence of cutaneous metastases
Due to primary solid organ malignancy e.g. breast, colon, lung
or
Secondary to primary skin malignancy e.g. melanoma
Management of cutaneous metastases?
- Treat underlying malignancy
- Local excision
- Localised radiotherapy
- Symptomatic
