Skin Cancers Flashcards
(22 cards)
What are the broad different types of skin cancer?
Non-melanoma skin cancers (BCC, SCC)
Melanoma skin cancer
Cutaneous Lymphoma
What are the different types of non-melanoma skin cancers and which is most common?
Basal cell carcinoma (70% of non-melanomas)
Squamous cell carcinoma
What are the risk factors for non-melanoma cancers?
UV radiation Photochemotherapy (PUVA) Chemical carcinogens Ionising radiation HPV Familial cancer syndromes Immunosuppression
What are the features/symptoms/signs of BCC?
Slow growing
Locally invasive
Rarely metastasise
Nodular
- pearly rolled edge
- telangiectasia
- central ulceration
- arborising vessels on dermoscopy
- pigmented or morphoeic
How is BCC treated?
Surgery - excision is gold standard
Curative if fully excised
Mohs surgery
Vismodegib - indicated in locally advanced BCC not suitable for surgery/radiotherapy, or metastatic BCC
- median progression free survival 9.5months
What are the features/symptoms/signs of SCC? Any particular variants?
Usually on sun-exposed sites Faster growing, tender, scaly/crusted or fleshy growths Can ulcerate Can metastasise Derived from keratinising squamous cells
Keratoacanthoma
- SCC variant
- erupts from hair follicles in sun-damaged skin
- grows rapidly, but may shrink after a few months and resolve
How is SCC treated?
Excision +/- radiotherapy
Follow-up if high risk
Concern in immunosuppressed, if >20mm in diameter or 4mm in depth, on ear/nose/lip/eyelid, perineural invasion, poorly differentiated
Surgical excision for keratoacanthoma
What are the risk factors for melanoma skin cancers?
UV radiation
Genetic susceptibility - fair skin, red hair, blue eyes, burn tendency
Familial melanoma and melanoma susceptibility genes
How is melanoma assessed?
ABCDE
- asymmetry, border, colour, diameter, evolution
Major features - change in size, shape, colour
Minor features - diameter >5mm, inflammation, oozing/bleeding, mild itch, altered sensation
Dermoscopy can be used
Sentinel node biopsy
What are the different types of melanoma?
Superficial spreading malignant melanoma Lentigo maligna melanoma Nodular melanoma Acral lentiginous melanoma/subungal melanoma Ocular melanoma
How is melanoma treated?
Urgent surgical excision - depends on subtype, Breslow thickness Wide local excision Chemo/immunotherapy Regular follow-up Primary/secondary prevention
What are the biologic treatments for metastatic melanoma?
Ipilimumab - CTLA-4
Pembrolizumab - PD-1 receptor
Vemufarenib/Dabrafenib - BRAF
What is cutaneous lymphoma?
Secondary cutaneous disease from systemic/nodal involvement OR
Primary cutaneous disease of abnormal neoplastic proliferation of lymphocytes in cells
What are the different types of primary cutaneous lymphoma and which is more common?
Cutaneous T Cell lymphoma - 65%
Cutaneous B Cell lymphoma - 20%
What are the different subtypes of cutaneous T cell lymphoma and which are the most important?
Mycosis Fungoides + variants Sezary syndrome CD30+ immunoproliferative disorders Subcutaneous panniculitis-like T cell lymphoma Cutaneous CD4+ lymphoma Extranodal NK/T cell lymphoma
What is mycosis fungoides and its appearance?
Most common CTCL - accounts for 50% of primary lymphomas
Patch - flat, red, dry, oval lesions, usually on covered sites - may resolve or progress
Can become plaques - thickened, itchy patches
Can become tumour - large irregular lumps that may ulcerate - more likely to have metastatic spread
What investigations are done for mycosis fungoides?
Bloods for sezary cells
CT for staging
What are the signs/symptoms of sezary syndrome?
Red-man syndrome
CTCL affecting entire skin of body
- skin thickened, scaly, red, very itchy
Sezary cells in blood
Atypical T cells
Lymph node involvement
What are the treatments for mycosis fungoides/sezary syndrome?
Topical steroids PUVA/UVB Localised radiotherapy Interferon Bexarotene Low dose methotrexate Chemotherapy Total skin electron beam therapy Extracorporeal photophoresis Bone marrow transplant
What is total skin electron beam therapy?
Type of radiotherapy
Delivers radiation primarily to superficial layers e.g. epidermis and dermis, sparing deeper organs/tissues
How does extracorporeal photophoresis work?
- Patients blood drawn and leucocytes collected
- Collected white cells mixed with psoralen which makes the T cells sensitive to UVA
- UVA exposure, damaging diseased cells
- Treated cells re-infused back to patient
How are cutaneous metastases managed? What are the common origins?
Treat underlying malignancy
Local excision
Localised radiotherapy
Symptomatic treatments
Can be secondary to primary skin malignancy such as melanoma, or due to primary solid organ malignany (commonly breast, colon, lung)
