Skin cancers Flashcards Preview

Dermatology > Skin cancers > Flashcards

Flashcards in Skin cancers Deck (25)
Loading flashcards...
1
Q

What is the epidemiology of non melanoma skin cancer?

A
  • Basal cell cancer & Squamous cell cancer
  • Incidence has increased in the last 30-40 years
  • Northern europe 3-4 times less than Australia
  • BCCs account for 70% of NMSCs.
  • BCCs incidence from 146 to 788/100000
  • SCCs 38 to 250/100000
2
Q

What are the risk factors of non melanoma skin cancer?

A
  • UV radiation
  • Photochemotherapy (PUVA)
  • Chemical carcinogens
  • X-ray and thermal radiation
  • Human papilloma virus
  • Familial cancer syndromes
  • Immunosuppression
3
Q

Describe basal cell carcinoma (including the different types)

A
  • Slow growing
  • Locally invasive
  • Rarely metastasise

Nodular

  • Pearly rolled edge
  • Telangiectasia
  • Central ulceration
  • Arborising vessels on dermoscopy

Superficial

Pigmented

Merphoeic

4
Q

What is the treatment of basal cell carcinoma?

A
  • Excision is gold standard
    * Ellipse, with rim of unaffected skin
    * Curative if fully excised
    * Will scar
  • Curettage in some circumstances
  • Mohs surgery
  • Vismodegib
5
Q

What are the indications of Mohs surgery?

A
  • Site
  • Size
  • Subtype
  • Poor clinical margin definition
  • Recurrent
  • Perineural or perivascular involvement
6
Q

Explain Vismodegib

A
  • Indications
    * Locally advanced BCC not suitable for surgery or radiotherapy
    * Metastatic BCC
  • Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
  • Can shrink tumors and heal visible lesions in some
  • Median progression free survival 9.5 months
  • Side Effects
    * Hair loss, weight loss, altered taste
    * Muscle spasms, nausea, fatigue
7
Q

Explain squamous cell carcinoma

A
  • Derived from keratinising squamous cells
  • Usually on sun exposed sites
  • Can metastasise
  • Faster growing, tender, scaly/crusted or fleshy growths
  • Can ulcerate
8
Q

What is the treatment of squamous cell carcinoma?

A
  • Excision
  • +/- Radiotherapy

Follow up if high risk

  • Immunosuppressed
  • > 20mm diameter
  • > 4mm depth
  • Ear, nose, lip, eyelid
  • Perineural invasion
  • Poorly differentiated
9
Q

Explain keratoacanthoma

A
  • Variant of squamous cell carcinoma
  • Erupts from hair follicles in sun damaged skin
  • Grows rapidly, may shrink after a few months and resolve
  • Surgical excision
10
Q

What is the epidemiology of melanoma skin cancer?

A
  • The incidence of malignant melanoma has increased by 360% since the 1970s in the UK
  • About 10 to 40 per 100000 per annum
  • Mortality is about 1.9 per 100000 per annum
11
Q

What are the risk factors of melanoma skin cancer?

A
  • UV Radiation
  • Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily
  • Familial melanoma and melanoma susceptibility genes
12
Q

What is the ABCDE rule?

A
  • Asymmetry
  • Border
  • Colour
  • Diameter
  • Evolution
13
Q

What is the seven point checklist?

A
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
14
Q

What is the treatment of melanoma skin cancer?

A
  • Urgent surgical excision
    * Subtype
    * Breslow thickness
  • Wide local excision
  • Sentinel lymph node biopsy
  • Chemotherapy/immunotherapy
  • Regular follow up
  • Primary and Secondary Prevention
  • drugs
15
Q

What drugs are used to treat metastatic melanoma?

A
Ipilimumab
- Inhibits CTLA-4 molecule
- One year survival 47-51% (double those not on treatment)
Pembrolizumab
- Blocks activity of PD-1
- One year survival 68-74%
Vemurafenib and Dabrafenib
- Blocks B-RAF protein
- Only useful if B-RAF mutation
- Median survival 10.5 months (7.8 months with standard chemotherapy)
16
Q

Describe secondary cutaneous lymphoma

A

Secondary cutaneous disease from systemic/nodal involvement

17
Q

Describe primary cutaneous lymphoma

A

Primary cutaneous disease – abnormal neoplastic proliferation of lymphocytes in the skin
- Cutaneous T Cell lymphoma (65%)
* Mycosis fungoides
* MF variants
* Sezary syndrome
* CD30+ lymphoproliferative disorders
* Subcutaneous panniculitis like T cell lymphoma
* Cutaneous CD4+ lymphoma
* Extranodal NK/T cell lymphoma
Cutaneous B Cell lymphoma (20%)
* Cutaneous follicle centre lymphoma
* Cutaneous marginal zone lymphoma
* Cutaneous diffuse large B Cell lymphoma

18
Q

Explain mycosis fungoides

A
  • Most common CTCL & accounts for around 50% of all primary cutaneous lymphomas
  • Incidence 6 per 1 million population
  • Cause unknown
  • More common in older patients and more common in men than women
  • Indolent course
19
Q

What are the stages of mycosis fungoides

A
  • Tumour
    * Large irregular lumps, can ulcerate
    * Arise from existing plaques or in normal skin
    * More likely to have metastatic spread
  • Metastatic
    * Infiltration of neoplastic cells in lymph nodes, blood and solid organs
  • Work up includes bloods for sezary cells and CT imaging for staging
20
Q

What is sezary syndrome?

A
  • “Red Man Syndrome”
  • CTCL affecting skin of entire body
    * Skin thickened, scaly and red
    * Itchy++
  • Lymph node involvement
  • Sezary cells in peripheral blood
    * Atypical T cells
  • Poor prognosis
    * Median survival 2-4 years
    * Opportunistic infection
21
Q

What is the treatment of cutaneous lymphoma?

A
  • Dependant on stage
  • Topical steroids
  • PUVA or UVB
  • Localised radiotherapy
  • Interferon
  • Bexarotene
  • Low dose Methotrexate
  • Chemotherapy
  • Total skin electron beam therapy
  • Extracorporeal photopheresis
  • Bone marrow transplantation
22
Q

What is total skin electron beam therapy?

A
  • 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
23
Q

Explain extracorporeal photopheresis

A
  • Step 1: patients blood is drawn and leukocytes collected
  • Step 2: collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation
  • Step 3: exposed to UVA radiation, damaging diseased cells
  • Step 4: treated cells re-infused back to patient
24
Q

Explain cutaneous metastases

A
  • Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy
    * Most commonly breast, colon and lung
25
Q

What is the management of cutaneous metastases?

A
  • Treat the underlying malignancy
  • Local excision
  • Localised radiotherapy
  • Symptomatic