Skin Cancer Flashcards
(66 cards)
1
Q
What are the non-melanoma skin cancers?
A
Basal cell cancer
Squamous cell cancer
2
Q
Risk factors for non-melanoma skin cancer
A
UV radiation Photochemotherapy Chemical carcinogens X ray and thermal radiation HPV Familial cancer syndromes Immunosuppression
3
Q
Features of BCC
A
Slow growing
Locally invasive
Rarely metastasise
4
Q
What does a BCC look like?
A
Nodular Pearly rolled edge Telangiectasia Central ulceration Arborizing vessels on dermoscopy
5
Q
Treatment of BCC
A
Surgical excision Curettage Cryotherapy Topical cream - imiquimod - fuorouracil Radiotherapy Vismodegib (advanced BCC)
6
Q
When is vismodegib used?
A
Locally advanced BCC not sutiable for surgery or radiotherapy
Metastatic BCC
7
Q
SEs of vismodegib
A
Hair loss Weight loss Altered taste Muscle spasms Nausea Fatigue
8
Q
Features of SCC
A
Usually on sun exposed sites
Can metastasise
Fast growing
9
Q
Presentation of SCC
A
Tender
Scaly/crusted or fleshy growths
Can ulcerate
10
Q
What are SCC derived from?
A
Keratinising squamous cells
11
Q
Treatment of SCC
A
Excision
+/- radiotherapy
12
Q
What is a keratoacanthoma?
A
Variant of SCC
13
Q
Features of keratoacanthoma
A
Erupts from hair follicles on sun damaged skin
Grows rapidly
May shrink after a few months and resolve
14
Q
Treatment of keratoacanthoma
A
Surgical excision
15
Q
Risk factors for melanoma
A
UV radiation Genetics - fair skin - red hair - blue eyes - tendency to burn easily Familial melanoma and melanoma susceptibility genes
16
Q
What is the ABCDE rule of melanoma?
A
Asymmetry Border Colour Diameter Evolution
17
Q
What is the 7 point checklist for melanoma?
A
Major features - change in size - change in shape - change in colour Minor features - diameter > 6mm - inflammation - oozing or bleeding - mild itch or altered sensation
18
Q
What is the biologic progression of melanoma?
A
Benign nerves Dysplastic nerves Rapid growth phase Vertical growth phase Metastatic melanoma
19
Q
Types of melanoma
A
Superficial spreading malignant melanoma Lentigo maligna melanoma Nodular melanoma Acral Lentiginous melanoma/subungual melanoma Ocular melanoma
20
Q
Treatment of melanoma
A
Urgent surgical excision Wide local excision Sentinel lymph node biopsy Chemo / immunotherapy Regular follow up 1 and 2 prevention
21
Q
Treatment of metastatic melanoma
A
Ipilimumab
Pembrolizumab
Vemurafenib and Dabrafenib
22
Q
Causes of cutaneous metastases
A
Can be secondary to primary skin malignancy such as melanoma
Due to primary solid organ malignancy
23
Q
Most common causes of cutaneous metastases
A
Breast
Colon
Lung
24
Q
Treatment of cutaneous metastases
A
Treat underlying malignancy
Local excision
Localised radiotherapy
Symptomatic
25
Causes of cutaneous lymphoma
Secondary disease from systemic / nodal involvement
| Primary disease from abnormal neoplastic proliferation of lymphocytes in the skin
26
What is mycosis fungoides?
Most common form of cutaneous T cell lymphoma
27
Cause of mycosis fungoides
Unknown
28
Who gets mycosis fungiodes?
Older > young
| M > F
29
Stages of mycosis fungiodes
```
Patch
- flat, red, dry oval lesions
- usually covered sites
- may slowly enlarge or spontaneously resolve
- may itch
Plaque
- patches become thickened
- generally itch
Tumour
- large irregular lumps
- can ulcerate
- arises from existing plaques or normal skin
- more likely to have metastatic spread
Metastatic spread
- infiltration of neoplastic cells in lymph nodes, blood and solid organs
```
30
Investigations for mycosis fungiodes
Blood - sezary cells
| CT
31
What is sezary syndrome?
Red man syndrome
| CTCL affecting skin of the entire body
32
Presentation of sezary syndrome
Entire body affected
Skin thickened, scaly and re
Very itchy
Lymph node involvement
33
In sezary syndrome, what is found in the blood? What are these?
Sezary cells
| These are atypical T cells
34
Prognosis for sezary syndrome
Poor
| Median survival 2-4 years
35
Treatment of cutaneous lymphoma
```
Depends on stage
Topical steroids
PUVA or UVB
Localised radiotherapy
Interferon
Bexarotene
Low dose methotrexate
Chemo
Total skin electron beam therapy
Extracorporeal photophoresis
Bone marrow transplant
```
36
What is cutaneous lymphoma?
A subtype of NHL that starts in the skin
37
What is total skin electron beam therapy?
Type of radiotherapy consisting of very small electrically charged particles
Delivers radiation primarily to superficial layers i.e. epidermis and dermis
Spares deeper tissues and organs
38
What is extracorporeal photophoresis?
Leucocytes collected from blood
Collected white cells mixed with psoralen which makes the T cells sensitive to UVA radiation
Exposed to UVA radiation, damaging diseased cells
Treated cells reinfused back to patient
39
Another name of BCC
Rodent ulcers
40
What is the most common type of cancer in the western world?
BCC
41
Definition of bowens disease
Intraepidermal SCC
42
Who is bowens disease common in?
Elderly
| Females
43
What is the chance of bowens disease causing invasive skin cancer?
3%
44
Presentation of bowens disease
Red scaley patches
| Sun exposed areas such as lower limbs
45
Management options of bowens disease
Topical 5-fluorouracil or imiquimod
Cryotherapy
Excision
46
What is leukoplakia?
Pre malignant condition which presents as white, hard spots on the mucous membranes of the mouth
47
Who is leukoplakia more common in?
Smokers
48
What is leukoplakia a diagnosis of?
Exclusion
49
What else should be considered as differentials of leukoplakia?
Candidiasis
| Lichen planus
50
What can leukoplakia transform into and in what % of people?
SCC
| 1%
51
What is a lipoma?
Common, benign tumour of adipocytes
52
Pathology of lipoma
Generally found in subcutaneous tissues
| May rarely also occur in deeper adipose tissue
53
How common is lipoma transformation to liposarcoma?
Very rare
54
Who are lipomas most commonly seen in?
Middle aged adults
55
Presentations of lipoma
Lump
- smooth
- mobile
- painless
56
Management of lipoma
May be observed
| If diagnosis uncertain or surrounding structures compressed then may be removed
57
What are the features that would suggest sarcomatous change of a lipoma?
Size > 5cm
Increasing size
Pain
Deep anatomical location
58
Most aggressive type of melanoma
Nodular
59
What are the margins of excision malignant melanoma related to?
Breslow thickness
60
What are the Breslow thickness excision margins?
```
Lesions 0 - 1mm thick
- 1cm
Lesions 1 - 2mm thick
- 1 - 2cm (depending upon site and pathological features
Lesions 2 - 4mm thick
- 2 - 3 cm (depending on site and pathological features)
Lesions >4 mm thick
- 3cm
```
61
What is the single most important factor in determining prognosis of patients with malignant melanoma?
Invasion of depth of a tumour (Breslow depth)
62
Prognosis of malignant melanoma related to the Breslow thickness
< 1mm - 5 year survival 95 - 100%
1 - 2 mm - 80 - 96%
2.1 - 4mm - 60 - 75%
>4mm - 50%
63
Risk factors for SCC of skin
Excessive exposure to sunlight / psoralen UVA therapy
Actinic keratoses
Bowens disease
Immunosuppression
Smoking
Long standing leg ulcers (marjolins ulcer)
Genetic conditions e.g. xeroderma pigmentosum
64
Is metastases common or rare in SCC?
Rare, 2 - 5%
65
Gold standard management for morpheoic BCC
Mohs Micrographic surgery
66
Explain mohs micrographic surgery
Microscopic examination of excised tissues DURING the surgery
Useful in tumours with poorly defined edges / cosmetic areas as it ensures the whole tumour has been excised while minimising the removal of healthy tissue
