Skin lesions and Skin cancer Flashcards
How do you describe a skin lesion?
Site Shape Size Colour Palpate - mobility, surface changes, temperature and consistency
What are seborrhoea keratoses and how do they present and what is the treatment?
(turtle shells) Benign, commonly referred Warty growths - "stuck on appearance" Patients often have multiple Generally left untreated, but if troublesome - cryotherapy and curettage.
What is Cryotherapy?
Liquid nitrogen
+ cheap and easy to perform on the day
- Can scar, failure and reoccurrence
How is seborrhoea linked to Leser-trelat?
Paraneoplastic phenomonenon
- abrupt onset of widespread seborrhoeic keratosis, particularly in young
Sis remain benign but may indicate underlying solid organ malignancy - GI adenocarcinoma
What are viral warts and how are they treated?
Due to Human papilloma virus
Rough hyperkeratotic surface
Difficult to treat - will clear when immunity developed to virus.
Cryotherapy or wart paints can stimulate immune system slightly
Can curette in severe cases.
What are cysts, how do they present and how do you treat them?
Encapsulated lesion containing fluid or semi-fluid material. Usually firm and fluctuant. Common.
Many different types:
Can rupture and cause inflammation of surrounded skin - may become secondary infected.
Treat with excision
If inflamed/infected - antibiotics, intralesional steroid, incision and drainage.
What are Dermatofibroma?
Benign fibrous nodule, often on limbs.
Firm nodule, tethered to skin but mobile over fat. Pale pink/brown. often paler in centre.
What is Lipoma?
Bening tumour consisting of fat cells
Common
smooth and rubbery subcutaneous mass
What is an Angioma?
Vascular lesion
Overgrowth of blood vessels in the skin due to proliferating endothelial cells.
Pregnancy and liver disease.
What is pyogenic Granuloma?
Vascular lesion rapidly enlarged red/raw growth, often at site of trauma. Common on head and hands Bleed easily Removed by curettage and cautery.
What are Actini Keratoses?
What is the treatment?
Pre-malignant lesion
Rough scaly patches on sun damaged skin
Low risk of transformation to SCC
Treatment = Cryotherapy, Curettage, Diclofenac gel, Imiquimod.
What is Bowen’s disease?
What is the treatment?
Squamous cell carcinoma in situ.
Full thickness dysplasia, entire contained within the epidermis, no metastatic potential.
Potential to become malignant (5%)
Irregular, scaly erythematous plaque.
Treatment = Cryotherapy, Curettage, photo-dynamic therapy, and Imiquimod
What is photo-dynamic therapy?
Photochemical reaction to selectively destroy cancer cells.
Topical photosensitising agent applied.
Red light applied.
What is Imiquimod?
Immune response modifier - stimulates cytokine release - inflammation and destruction of lesion.
+ useful where surgery not wanted, good cosmetic result.
- treatment is 6 weeks, significant inflammation.
What are the 2 non-melanoma skin cancers?
Basal cell cancer (70%) (146 to 788/100000)
Squamous cell cancer (38 to 250 / 100000)
What are the risk factors of non-melanoma skin cancer?
UV radiation Photochemotherapy - PUVA Chemical carcinogens X-ray and thermal radiation Human Papilloma virus Familial cancer syndromes Immunosuppression
What is Basal Cell carcinoma?
Slow growing Locally invasive Rarely metastasise Nodular: - pearly rolled edge - telangiectasia (thread like) - Central ulceration - absorbing vessels on dermoscopy - can be superficial, pigmented, or morphoeic
Treatment of BCCs
Surgery
- Excision is gold standard
- Curettage in some circumstances
- Mohs surgery
What is Mohs surgery?
Removal layer by layer. Indications: site size subtype poor clinical margin definition recurrent perineurial or perivascular involvement
What is Vismodegib and when is it used?
What are the side affects?
drug for invasive BCC
Indications:
Locally advanced BCC not suitable for surgery or radiotherapy
metastatic BCC
Selectively inhibits abnormal signalling in the hedgehog pathway (molecular driver)
Can shrink tumour and heal visible lesions in some
Median progression free survival 9.5 months
- side affects = Hair loss, weight loss, altered taste, muscle spasm, nausea, fatigue.
What is squamous cell carcinoma and how does it present?
Derived from keratinising squamous cells Usually on sun exposed sites Can metastasise Faster growing, tender, scaly/crusted or fleshy growths Can ulcerate.
Treatment for SCC
Excision +/- radiotherapy Follow up if high risk: immunosuppressed >20 mm diameter >4mm depth Perineurial invasion ear, nose, lip, eyelid
What is Keratoacanthoma?
Variant of SCC
Erupts from hair follicles in sun damaged skin
Grows rapidly, may shrink after a few months and resolve
Surgical excision.
Risk factors for melanoma skin cancer?
UV radiation
Genetic susceptibility - fair skin, red hair, blue eyes and tendency to burn easily
Familial melanoma and melanoma susceptibility genes.
What is the ABCDE rule of cancer lesions?
Asymmetry Border Colour Diameter Evolution
What is the 7 point checklist for cancer lesions?
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.
What are the different sub types of malignant melanomas?
Superficial spreading malignant melanoma
Lentigo maligna melanoma
Nodular melanoma
Aural lentiginous melanoma/ subungal melanoma
Ocular melanoma
What is the treatment for malignant melanoma?
Urgent surgical excision - subtype - breslow thickness Wide local excision sentinel lymph node biopsy Chemo/ immunotherapy Regular follow up Primary and secondary prevention
Metastatic Melanoma drugs
Monoclonal antibodies
ipilimumab
Vemurafenib and Dabrafenib (only Braf)
Pembrolizumab
What is cutaneous lymphoma?
Secondary cutaneous disease from systemic/nodal involvement
Primary cutaneous disease - abnormal neoplastic proliferation of lymphocytes in the skin.
- cutaneous T cell lymphoma (65%)
- cutaneous B cell lymphoma (20%)
What is Mycosis fungicides?
What are the stages of MF?
Most common CTCL and accounts for around 50% of all primary cutaneous lymphommas.
Stages:
Patch - flat, red, dry oval lesions, usually covered sites, itch, difficult to differentiate between eczema and psoriasis.
Plaque - patches become thickened, generally itch
What is sezary syndrome?
“red man syndrome”
CTCL affecting skin of entire body - skin thick and scaly and red and itchy.
Lymph node involvement
Treatment of cutaneous lymphoma
Dependent on stage:
- topical steroids
- PUVA or UVB
- Localised radiotherapy
- Interferon
- Bexarotene
- low does methotrexate
- Chemotherapy
- Total skin electron beam therapy (type of radio)
What is cutaneous Metastases?
How is it treated?
Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy - most common in breast, colon and lung.
treat underlying malignancy, local excision, localised radiotherapy, symptomatic.
