Skin Cancers Flashcards

1
Q

Skin Cancers (2)

A
Malignant Melanoma (MM)  
Nonmelanoma skin cancers (NMSC)
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2
Q

Primary prevention for skin cancers

A

Reduce exposure to sunlight, avoid sun tanning

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3
Q

Secondary prevention for skin cancers

A

1) Educate pts on skin changes and skin cancer
2) Total body skin exam
3) Importance of communicating with dermatologist for early dx and tx
4) Attend free community yearly skin assessment by dermatologists

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4
Q

Tertiary prevention for skin cancer

A
Sunscreen 
Retinoids
Antioxidants 
Beta carotene 
Vitamin C, E 
Dietary modifications 
Complementary therapies 
Reduction of immunosuppressive burden (discuss changes to regimen after transplant)
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5
Q

Nonmelanoma Skin Cancers (2)

A

Basal Cell skin cancer

Squamous Cell skin cancer

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6
Q

Basal cell skin cancer =

A

Malignant transformation of non-keratinizing cells in basal layer of epidermis

Locally invasive, rarely metastasizes

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7
Q

Squamous cell skin cancer =

A

Malignant transformation of keratinocytes arising in epidermis on skin or mucous membranes

Spreads rapidly within dermis and invades other tissues

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8
Q

Most common type of skin cancer in US

A

Basal Cell Skin Cancer

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9
Q

Risk factors for Non Melanoma Skin Cancers

A
  • UV (natural or artificial)
  • Light hair, Eye color (burn easily, difficult to tan)
  • North European ancestry
  • Arsenic (wells, insecticides, medical)
  • Lesions (actinic keratosis)
  • Radiation
  • Chronic inflammatory skin conditions
  • Complications of burns, scars, tattoos
  • Cigarette, pipe smoking
  • Genetics (xeroderma pigmentosum, bazex-dupre-christol syndrome, p53 mutations, basal cell nevus syndrome)
  • Fam hx of NMSC in first degree relative
  • Immunosupression (transplants)
  • Infections (HPV)
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10
Q

NMSC Treatment (6)

A

1) Topical Chemotherapy
2) Photodynamic Therapy (PDT)
3) Surgical Intervention
4) Laser Treatment
5) Radiation Therapy
6) Systemic Therapies

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11
Q

NMSC Topical Chemotherapy and RT

A

Imiquimod
Fluorouracil

Intensity modulated RT
Adjuvant RT

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12
Q

NMSC Photodynamic Therapy and Laser Treatment

A

Red light photodynamic therapy

CO2 laser for BCC

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13
Q

NMSC Surgical Intervention

A
  • Cryosurgery: freeze temp to destroy tissue
  • Curettage and electrodessication: use of heat to cut tissue
  • Excision with postop margin assessment
  • Mohs surgery (thin slices until clear margins)
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14
Q

NMSC Systemic Therapies

A

Capecitabine and Cisplatin for metastatic SCC

Intralesional interferon investigational

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15
Q

Prognosis of BCC

A
  • Does not really metastasize

- Timely diagnosis and tx is key

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16
Q

Subtypes of SCC (3)

A

1) Primary tumor
2) Secondary skin cancer, second cancers
3) Transplant recipients

17
Q

Primary cutaneous SCC prognosis

A
  • Five year cure rate of 90%

- 2-5% mets to regional nodes, lung, liver, brain, bone

18
Q

Organ donar recipients SCC Prognosis

A
  • likely to have more aggressive cutaneous SCC manifestation with prognosis of developing mets in 5-8% of pts
19
Q

Secondary skin CA, second cancers SCC

A

History of NMSC has 50% increase risk at five years to develop second NMSC

NMSC increases risk of second cancers = lung, colon, breast

20
Q

Malignant Melanoma incidence

A

1% of all skin cancers

21
Q

Malignant Melanoma Risk Factors

A

1) UV
- hx of blistering, peeling sunburn, tanning beds <35 yrs
2) Skin Phenotype
- Fitzpatrick skin photo type I-II
3) Melanocytic Nevi
- Adults w >100 typical appearing nevi
- Children w>50 typical appearing nevi
4) Fam Hx of Melanoma
5) Personal Hx of melanoma, nmsc, actinic keratosis
6) Genetics
- Mutations: CDKN2A
- P16, p14, p53
- RAS signaling (BRAF mutations)
- Overexpression of MITF with ectopic expression of BRAF
- Mutated or amplified KIT TKI
- Mutations in MC1R
- Xeroderma pigmentosum
- Carriers of BRCA2

22
Q

Malignant Melanoma =

A

Aggressive neoplastic process of melanocytes

Metastasis, morbidity, and mortality highest compared w NMSCs

23
Q

Prognosis of Malignant Melanoma determined by?

A

Thickness of primary tumor (Breslow scale)
Ulceration
Mitotic rate
Presence and extent of metastatic disease

24
Q

Subtypes of Malignant Melanoma

A

(in order of frequency)

Superficial spreading melanoma 
Nodular melanoma 
Lentigo maligna melanoma 
Acral lentigous melanoma 
Amelanotic melanoma
25
Q

Malignant Melanoma Tx

1) Surgical
2) RT: rarely the primary mode of therapy
3) Systemic Agents: Immunotherapy, Targeted, Chemo
4) Vaccines

A

1) Wide excision, Sentinel lymph node biopsy, laser ablation
2) Adjuvant combined w surgery, palliation of sx
3) Immunotherapy (interferon, interleukin, ipilimumab, pembrolizumab, nivolumab
Targeted (vemurafenib, dabrafenib, trametinib, cobimetinib - Kinase inhibitors)
Chemo (melphalan, dacarbazine, temozolomide, paclitaxel w/wo carboplatin
4) Bacillus Calmette Guerin