Skin Cancers

Question 1

Skin Cancers (2)

Answer 1

Malignant Melanoma (MM)  
Nonmelanoma skin cancers (NMSC)

Question 2

Primary prevention for skin cancers

Answer 2

Reduce exposure to sunlight, avoid sun tanning

Question 3

Secondary prevention for skin cancers

Answer 3

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

Question 4

Tertiary prevention for skin cancer

Answer 4

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

Question 5

Nonmelanoma Skin Cancers (2)

Answer 5

Basal Cell skin cancer

Squamous Cell skin cancer

Question 6

Basal cell skin cancer =

Answer 6

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

Locally invasive, rarely metastasizes

Question 7

Squamous cell skin cancer =

Answer 7

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

Spreads rapidly within dermis and invades other tissues

Question 8

Most common type of skin cancer in US

Answer 8

Basal Cell Skin Cancer

Question 9

Risk factors for Non Melanoma Skin Cancers

Answer 9

• 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)

Question 10

NMSC Treatment (6)

Answer 10

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

Question 11

NMSC Topical Chemotherapy and RT

Answer 11

Imiquimod
Fluorouracil

Intensity modulated RT
Adjuvant RT

Question 12

NMSC Photodynamic Therapy and Laser Treatment

Answer 12

Red light photodynamic therapy

CO2 laser for BCC

Question 13

NMSC Surgical Intervention

Answer 13

• 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)

Question 14

NMSC Systemic Therapies

Answer 14

Capecitabine and Cisplatin for metastatic SCC

Intralesional interferon investigational

Question 15

Prognosis of BCC

Answer 15

• Does not really metastasize

- Timely diagnosis and tx is key

Question 16

Subtypes of SCC (3)

Answer 16

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

Question 17

Primary cutaneous SCC prognosis

Answer 17

• Five year cure rate of 90%

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

Question 18

Organ donar recipients SCC Prognosis

Answer 18

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

Question 19

Secondary skin CA, second cancers SCC

Answer 19

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

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

Question 20

Malignant Melanoma incidence

Answer 20

1% of all skin cancers

Question 21

Malignant Melanoma Risk Factors

Answer 21

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

Question 22

Malignant Melanoma =

Answer 22

Aggressive neoplastic process of melanocytes

Metastasis, morbidity, and mortality highest compared w NMSCs

Question 23

Prognosis of Malignant Melanoma determined by?

Answer 23

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

Question 24

Subtypes of Malignant Melanoma

Answer 24

(in order of frequency)

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

Question 25

Malignant Melanoma Tx

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

Answer 25

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