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Flashcards in Skin cancer Deck (61)
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1

What are the two forms of non-melanoma skin cancer?

• Basal cell cancer & Squamous cell cancer

2

What are some risk factors for non-melanoma skin cancer?

• UV radiation
• Photochemotherapy
• Chemical carcinogens
• X-ray and thermal radiation
• Human papilloma virus
• Familial cancer syndromes
• Immunosuppression

3

Describe morphoeic BCC

Morphoeic – infiltrative group of BCC; flat whitish plaque with pearly edge with central regression (pit)

4

Describe basal cell carcinoma

• Slow growing superficial lesions
• Locally invasive
• Rarely metastasise
• Nodular
– Pearly rolled edge
– Telangiectasia
– Central ulceration
– Arborising vessels on dermoscopy

5

How is BCC treated?

Excision is gold standard
– Ellipse, with rim of unaffected skin
– Curative if fully excised
– Will scar
– Curettage in some circumstances

6

Describe Mohs surgery?

Microscopically controlled surgery used to treat common types of skin cancer – forms hole like wound which can be stitched up

7

When is Mohs surgery indicated?

– Site
– Size
– Subtype
– Poor clinical margin definition
– Recurrent
– Perineural or perivascular involvement

8

When is Vismodegib indicated?

– Locally advanced BCC not suitable for surgery or radiotherapy
– Metastatic BCC

9

What is indicated if locally advanced BCC is not suitable for treatment or in metastatic BCC?

Vismodegib

10

What is Vismodegib?

• Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
• Can shrink tumour and heal visible lesions in some
• Median progression free survival 9.5 months

11

What are the side effects of vismodegib?

• Side Effects
– Hair loss, weight loss, altered taste
– Muscle spasms, nausea, fatigue

12

From what do squamous cell carcinomas derive from?

• Derived from keratinising squamous cells
• Usually on sun exposed sites

13

Describe squamous cell carcinomas

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

14

Which non-melanoma skin cancer is associated with ulceration?

SCC

15

Which non-melanoma skin cancer is usually faster growing?

SCC

16

How is SCC treated?

• Excision +/- Radiotherapy

17

When is SCC high risk?

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

18

Name a variant of SCC

Keratoacanthoma

19

Describe Keratoacanthoma

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

20

How is Keratocanthoma treated?

Surgical excision

21

What are some risk factors for melanoma?

UV Radiation

Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily

Familial melanoma and melanoma susceptibility genes

22

Describe the ABCDE approach in identifying melanoma

• Asymmetry – melanomas are asymmetrical

• Border – edges are uneven, crusty or notched in melanoma

• Colour – variety of colours, especially white or blue, are bad signs

• Diameter – melanomas are usually wider in diameter than a pencil eraser

• Evolution – danger if it has changed in size, colour or begins to bleed/scab

23

Describe the 7 point checklist in melanoma detection

Major features
o Change in size/new lesion
o Change in shape
o Change in colour
Minor features
o Diameter more than 5 mm
o Inflammation
o Oozing or bleeding
o Mild itch or altered sensation

Suspect melanoma if 1 or more major sign or if 3 or 4 minor signs alone

24

What 2 systems are used for melanoma identification

ABCDE approach
7 point checklist

25

What is used to examine the skin?

'Dermoscope’ or ‘dermatoscope’

26

Describe the biologic progression of melanoma and the different types of melanoma associated with each stage

Benign then neoplastic

Rapid growth phase – superficial spreading melanoma

Vertical growth phase – nodular melanoma

Mestatsatic melanoma – has reached underlying blood stream

27

Describe superficial spreading melanoma

Superficial spreading melanoma is a form of melanoma in which the malignant cells tend to stay within the tissue of origin, the epidermis, in an 'in-situ' phase for a prolonged period (months to decades). At first, superficial spreading melanoma grows horizontally on the skin surface – this is known as the radial growth phase.

28

Describe lentigo maligna melanoma

Lentigo maligna is an early form of melanoma in which the malignant cells are confined to the tissue of origin, the epidermis, hence it is often reported as 'in situ' melanoma

29

Describe nodular melanoma

Nodular melanomas are a faster-developing type of melanoma that can quickly grow downwards into the deeper layers of skin if not removed. Nodular melanomas usually appear as a changing lump on the skin which might be black to red in colour.

30

Describe acral lentiginous melanoma

Acral lentiginous melanoma is a form of skin cancer that appears on the palms of the hands, the soles of the feet, or under the nails.