Skin Cancers Flashcards
(25 cards)
Categories of skin cancer?
Non-melanoma skin cancer
Cutaneous lymphoma
Cutaneous metastases
Epidemiology of non-melanoma skin cancers?
Basal cell and squamous cell cancers
Incidence increased
BCCs about 70% of non-melanoma
Risk factors for non-melanoma skin cancer?
UV radiation Photochemotherapy Chemical carcinogens X-ray and thermal radiation HPV Familial cancer syndromes Immunosuppression
Basal Cell Carcinoma (BCC)?
Slow growing Locally invasive Rarely metastasise Nodular - rolled edge and central ulceration May be pigmented
First line treatment of BCC?
Excision is gold standard
Curative if fully excised
Will scar
If surgery is not an option for BCC?
Vismodegib
Selectively inhibits abnormal signaling in hedgehog pathway
Side effects: hair loss, weight loss, altered taste, muscle spasms, nausea, fatigue
Squamous Cell Carcinoma (SCC)?
Derived from keratinising squamous cells Usually due to sun exposure Can metastasise Faster growing Can be tender, scaly or fleshy Can ulcerate
Treatment of SSC?
Excision
+/- radiotherapy
Follow up if high risk
Keratoacanthoma?
Variant of squamous cell carcinoma
Erupts from hair follicles in sun damaged skin
Grows rapidly, may resolve
Surgical excision
Epidemiology of Melanoma skin cancers?
Increased about 360% since the 70s
About 10-40 per 100,000 in the UK
Risk factors for melanoma skin cancers?
UV radiation
Genetic susceptibility: fair skin, red hair, blue eyes, easy burner
Familial melanoma and susceptibility genes
ABCDE rule?
Asymmetry Border Colour Diameter Evolution
7 point checklist?
Major - Change in size - Change in shape - Change in colour Minor - Diameter more than 5mm - Inflammation - Oozing or bleeding - Mild itch or altered sensation
Types of melanoma?
Superficial spreading malignant melanoma Lentigo maligna melanoma Nodular melanoma Acral lentiginous melanoma Subungual melanoma Ocular melanoma
Treatment of melanoma?
Check subtype and breslow thickness Urgent, wide local excision Sentinel node biopsy Chemo/immunotherapy Regular follow up
Drugs for metastatic melanoma?
Ipilimumab
Pembrolizumab
Vemurafenib and dabrafenib
Two types of cutaneous lymphoma?
Cutaneous T cell lymphoma (65%)
Cutaneous B cell lymphoma (20%)
Two subtypes of T cell lymphoma?
Mycosis fungoides
Sezary syndrome
Mycosis fungoides?
Most common CTCL
About 50% of all primary cutaneous lymphomas
Cause unknown
More common in men and the elderly
Stages of mycosis fungoides?
Patch - flat, red, dry lesions
Plaque - pathces become thickened
Tumour - larger, can ulcerate
Metastatic - infilatration of neoplastic cells
Sézary syndrome?
"Red man" syndrome CTCL affecting entire body Lymph node involvement Sézary cells in peripheral blood Poor prognosis
Treatment of cutaneous lymphoma?
Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose methotrexate Chemotherapy Total skin electron beam therapy Extracorporeal photopheresis Bone marrow transplantation
What happens in extracorporeal photopheresis?
1) Blood is drawn and leukocytes collected
2) Cells mixed with psoralen which makes T Cells sensitive to UVA
3) Exposed to UVA, damaging diseased cells
4) Treated cells re-infused back to patient
Cutaneous metastases?
Can be secondary to primary skin malignancy or due to primary solid organ malignancy (most commonly breast, colon and lung)
