skin Cancer Flashcards
Differential diagnosis of BCC/SQCC (perez)
Senile keratosis
Keratoacanthoma
Melanoma
Non pigmented nevi
Cutaneous horn
Psoriasis
Lymphoma
Soft tissue sarcoma
Hemangiosarcoma
MCC
Adnexal carcinoma of skin
Premalignant condition of skin
Remember by the mnemonic: BDS PHLR
B= bowens disease
D= dysplatic naevi
S= solar actinic keratosis
P= papilloma
H= hyperkeratosis
R= radiodermatitis
Xeroderma pigmentosum
Marjolin ulcer
Etiology of skin cancer
Actinic exposure/UV exposure
Ionizing radiation
Scar: burn scar
Immune disorder: solid organ transplant patient, discoid lupus erythematosus
Chemicals:
- arsenics
- psoralen and ultraviolet light
-nitrates
-tars oils, paraffins
Hereditary disorder:
- xeroderma pigmentosum
-basal cell nevus syndrome
-albinism
-congenital epidermolysis bullosa
Type of basal cell carcinoma
Classic nodular (60%)
Superficial 15%
Morphoeic BCC
Infiltrative
Other:
- micronodular
-pigmented
-cystic
-fibroepithelioma of pinkus
Type of sq cell carcinoma of skin
Clear cell
Spindle cell (sarcomatoid)
SCC with single cell infiltrates
De novo
Verrucous
Lympho epithelioma like
Factors for high risk of multiple primary in skin cancer
Organ transplant recepients
Immunusuppression by lymphoma, CLL, drug induced or HIV
Genetic syndromes like: Examples include xeroderma pigmentosum, generalized eruptive keratoacanthoma of Grzybowski, Rothmund-Thomson syndrome, dyskeratosis congenita, epidermodysplasia verruciformis, recessive dystrophic epidermolysis bullosa, severe generalized junctional epidermolysis bullosa, KID syndrome (keratitis, ichthyosis, deafness), and Ferguson-Smith disea
Low risk factors in squamous cell carcinoma: NCCN
Location/size: trunk, extremities , (</2cm)
Clinical extent: well defined
Primary
No immunosupression
No history of priar RT
No rapidly growing tumor
No neurologic symptoms
In pathology:
Well or moderately differentiated
Depth <2 cmm thick and no invasion beyond subcutaneous fat
No perineural involvement
No lymphatic or vascular involvement
High risk factors for squamous cell skin cancer: nccn
Location/size: trunk, extermities, >2cm to </4cm
Head and neck, hands, feet, pretibia and anogenital
Clinical extent: poorly defined
Recurrent
Immunosuppression +ve
Site of prior RT or chronic inflammatory process +ve
Rapidly growing tumor
Neurologic symptoms
Acantholytic, adenosquamous, subtypes
Depth 2-6 mm
Perineural involvement and lymphatic or vasuclar invasion positive.
Very high risk for sq cell skin cancer nccn
Size >4cm
Poorl differentiation
Desmoplastic SCC
>6 mm or invasion beyond subcutaneous fat
Tumor cells within the nerve sheath of a nerve lying deeper than the dermis or measuring >/ 0./1 mm
Lymphatic and vascular involvement positive
Radiotherapy dose for sq cell carcinoma
Doses
• RT dose for lesions of 2 cm or less of the ear/nose/eyelid/canthi is 200 cGy/fx to 60-64 Gy or 250
cGy/fx to 50 Gy.
• Lesions of 2-5 cm, the dose is 200 cGy/fx to 60-70 Gy or 300 cGy/fx to 45 Gy; for lesions of 5 cm or
more, the dose is 200 cGy/fx to 66-70 Gy.
• Post-op adjuvant radiation dose is 200 cGy/fx to 60 Gy or 250 cGy/fx to 50 Gy.
Adjuvant RT indication in sq cell skin cancer
-Gross perineural invasion
-multifocal histologic nerve invasion
- ≥6cm tumor diameter
- recurrent tumors
- high risk for regional or distant metastasis
- close surgical margin where further surgery cannot be performed
- desmoplastic or infiltrative tumors in immunosuppressive patients
(From EB)
- positive margin
- extensive PNI
- involvement of large caliber nerve (>/0.1mm)
What should we see in histologic findings of sq cell skin cancer post surgery
Elements reported by the physician reporting the histologic findings:
-Margin status (whether or not tumor is present at margins)
-Well, moderate, or poor differentiation
-Depth of invasion (either Breslow depth [in mm] measured from granular layer of adjacent normal epidermis to the base of the tumor OR
-tissue plane of deepest invasion eg, dermis, fat, fascia, muscle, perichondrium/periosteum, cartilage bone, other)
-Perineural invasion defined as tumor cells within the nerve sheath of a nerve deep to dermis or with a caliber 0.1 mm or larger Lymphovascular invasion
-High-risk histology eg, desmoplasia, adenomatous, sarcomatous, or spindle cell
-Low-risk histology (optional) eg, verrucous, keratoacanthomatous
Surgical margin in case of skin cancer surgery
For low risk
BCC: 2-4mm
SCC: 4-6 mm
localised high risk
BCC: 4-10 mm
SCC >/ 10mm
Relative RT contraindication for skin cancer
Post radiation recurrence
Area prone to repeated trauma such as bony prominence, poor blood supply,
High occupational sun exposure
Exposed cartilage
Gorlins syndrome
CD4 count <200
RT contraindicated in
Xeroderma pigmentosum
Basal cell nevus
Scleroderma
