Skin Cancer Flashcards
(26 cards)
What cells cause basal cell and squamous cell carcinomas in the skin?
BCC- basal cells
SCC- keratinocytes
What are the risk factors of non-melanoma skin cancers?
UV radiation High sun exposure before age 5 Photochemotherapy Chemical carcinogens X-ray and thermal radiation HPV Familial cancer syndromes Immunosuppression
What are the characteristics of a basal cell carcinoma?
Slow growing
Rarely metastasise
Locally invasive
Nodular- pearly rolled edge, telengiectasia, central ulceration with arboring vessels on dermoscopy
What are the different kinds of nodes that can be present in basal cell carcinoma?
Superficial
Pigmented
Morphoeic
How are basal cell carcinomas treated?
Excision is gold standard- take an ellipse with a rim of unaffected skin
Curettage useful in some cases
Mohs surgery (with pathologist) helpful if morphoeic lesion or if cosmetically sensitive site
Vismodegib
When is vismodegib indicated?
In basal cell carcinomas that are locally advanced and not suitable for surgery or radiotherapy or in metastatic BCC (v rare)
What are the side effects of vismodegib?
Hair loss Altered taste Weight loss Muscle spasms Nausea Fatigue
What are the characteristics of squamous cell carcinoma?
Faster growing
Tender
Scaly/crusted or fleshy growths
Can metastasise
In what population are squamous cell carcinomas more common than basal cell carcinomas?
In the immunosuppressed
How are squamous cell carcinomas treated?
Excision with potential adjuvant radiotherapy
What criteria would indicate need for follow up appointments after treating squamous cell carcinomas and how long would you follow up for?
Follow up for three years if:
- Immunosuppressed
- > 20mm diameter
- > 4mm depth
- Lesion was on ear, nose, lip or eyelid
- Perineural invasion
- Poorly differentiated tumour
What is a keratoacanthoma?
A varient of squamous cell carcinoma that erupts from hair follicles in sun damaged skin
What are the risk factors for melanoma?
UV radiation
Genetic susceptibility (fair skin, red hair, blue eyes, tendency to burn easily)
Familial melanoma
What characteristics should you check when examining a potential melanoma?
Asymmetry Borders Colour Diameter Evolution
What are the features of a melanoma lesion?
Change in shape Change in size Change in colour Diameter >5mm Inflammation Oozing or bleeding Mild itch or altered sensation
What are the possible different presentations of melanoma and which has the highest risk of metastases?
Superficial spreading malignant melanoma Lentigo malignant melanoma Nodular melanoma (highest risk) Acral lentigous melanoma Subungal melanoma Ocular melanoma
What criteria is most useful in staging melanomas?
Breslow depth and ulceration
How is melanoma treated?
Urgent surgical excision- wide local excision with sentinel node biopsy
Give adjuvant chemotherapy/immunotherapy if metastatic disease queried
What medications can be given to treat melanoma if surgery is contraindicated?
Ipilumab
Pembrozilumab
Vemurafenib and dabrafenib (only if B-RAF mutated)
Where does melanoma most commonly metastasise?
Liver
Brain
Bone
What is cutaneous lymphoma?
Secondary cutaneous disease from systemic/nodal involvement. Can be T or B cell lymphoma
What is mycosis fungoides and who is most at risk?
The most common cutaneous T cell lymphoma
Most commonly affects older populations
M>F
What are the stages of mycosis fungoides?
Patches present
Patches become plaques
Tumour develops
Tumour metastasises
What are the characteristics of Sezary syndrome?
Cutaneous T cell lymphoma affecting the skin of the entire body
Skin is thickened, scaly, itchy and red
Lymph node involvement
Sezary cells (atypical T cells) in peripheral blood
Poor prognosis
