Skin Cancers Flashcards by Sophia Boyce

What are the cells affected in non-melanoma skin cancer?

Basal cells

Squamous cells

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Risk factors for non-melanoma?

UV radiation 
Photochemotherapy - PUVA
Chemical carcinogens
X-ray + thermal radiation 
HPV
Familial cancer syndromes 
Immunosuppression

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What are the characteristics of basal cell carcinoma?

Slowly growing
Locally invasive
Rarely metastasise

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What is the appearance of basal cell carcinoma?

Nodular
Pearly rolled edge
Telangectasia
Central ulceration 
Arborising vessels on dermoscopy

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What are the 2 variables for appearance of basal cell carcinoma?

Pigmented

Morphoeic

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What is the gold standard treatment for BCC?

Excision (curative if fully excised; will scar)

curettage in some circumstances

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What is Mohs surgery?

Thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains

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What are indications for Mohs surgery?

Site
Size
Subtype
Poor clinical margin definition 
Recurrent
Perineural or perivascular involvement

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What is Vismodegib?

cancer treatment drug

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What are indications for Vismodegib?

Locally advanced BCC not suitable for surgery or radiotherapy
Metastatic BCC

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How does Vismodegib work?

Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)

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What effect does Vismodegib have?

Can shrink tumour and heal visible lesions in some; median progression free survival 9.5 months

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Side effects of Vismodegib?

Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

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What does squamous cell carcinoma derive from?

Keratinising squamous cells, usually on sun exposed sites

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What does squamous cell carcinoma look like?

Fast growing, tender, scaly/crusted or fleshy growths
Can ulcerate
Can metastatise

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Treatment of SCC?

Excision

+/- radiotherapy

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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

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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?

1. Patients blood is drawn and leukocytes collected 2. Collected white cells mixed with psoralen which makes the T-cells sensitive to UVA radiation 3. Exposed to UVA radiation, damaging diseased cells 4. 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