Skin Cancer (non-melanomas)

What are the 4 main functions of the skin?

1. Protection 2. Regulates body temperature 3. Synthesizes important chemicals and hormones 4. Sophisticated Sense Organ

What are the 5 effects of aging that have to do with the skin?

1. Reduced Blood Flow 2. Thinner Skin (bruises easier, skin tears) 3. Loosened Structure (loss of collagen, flabby) 4. Decreased Activity of the glands (sweat, oil glands) 5. Decrease in Melanin (cannot tan as easily)

What areas would be preferred for Excision and why?

1. Scalp 2. Forehead 3. Distal Extremities -Because there is not as much tissue in these areas (you can pretty much feel your bone)

What are the six etiologies associated with BCC?

1. Sun exposure 2. Geographic location 3. Ionizing Radiation (long latency period) 4. Chemical Factors 5. Immuno-Suppressed Patients (HIV) 6. Basal Cell Nevi Syndrome

What is the Mohs' Microscopic Surgery used for? (4)

1. Tissue Preservation 2. Areas of high risk for recurrence 3. Where the extent of the disease is unkown 4. Aggressive tumor histology

What are the 4 etiologies associated with Squamous Cell Carcinoma?

1. Total Accumulated Dose of Sun Exposure 2. Exposure 3. Immunosuppressed Patients 4. Scars or Chronic Inflammatory Conditions

What are the three advantages of laser treatment?

1. Usually blood free surgery 2. Reduced post operative pain 3. Faster healing than conventional surgery

Name the 5 functions of the skin.

1. protection 2. temperature 3. waste removal 4. sensory 5. vitamin D production

If you have excessive exposure to the sun, you increase your risk of having Squamous Cell Carcinoma by what ?

3-5.5 times

Explain how basal cell carcinomas grow.

Basal Cell Carcinomas typically have a slow growth rate, they can remain unchanged for years. If left untreated, they can become fatal. BCC's grow radially (grow outward), but they must have a good blood supply to do this--the further away they grow, they loose blood supply and then it can become necrotic(black & dead).

How do Lasers work in the treatment of non-melanomas?

Beam of intense light destorys tissue.

What is the Pacinian Sensory Receptor responsible for?

Deeper, detects deep pressure (pinching)

What area is missing: Curettage & Electrodesication is not recommended for lesions on the: - Eyelid - Nose - Temple - Scalp - Lips - ??????

Ears

Basal Cell Carcinomas occur in what types of skin?

Occurs predominantly on the skin exposed to UV radiation

What are the two professions that typically get Squamous Cell Carcinoma?

Radiologists Dentists

What would you look for when trying to detect Squamous Cell Carcinoma?

Scaly raised lesions or non-healing scab

What are the complications of Cryosurgery?

Scarring, Swelling, Blistering

When Squamous Cell Carcinoma occurs on the mucosal surfaces and is left untreated, what does it have the potential to do?

Spread to Regional Nodes & Distant Sites

What is the 2nd most common skin cancer?

Squamous Cell Carcinoma

Hypodermis is what type of tissue?

Subcutaneous, type of connective tissue

What etiology is the main cause of BCC?

Sun Exposure --Sun or UV

What happens during a Mohs' Microscopic Surgery?

The tumor is removed one layer at a time and is typically examined by a pathologist right on the spot. Once they see that the layer contains no cancer cells, they will stop the surgery.

True False: If you do not have the electrodesication done after curettage, it will decrease the scarring.

True

True or False: Basal Cell Carcinomas rarely develop in darker skinned people. But if does happen to develop it is normally found on the hands & feet (generally H&N area).

True

True or False: Electrons and superficial treatment are excellent options.

True

True or False: Incidence increases with age when looking at Squamous Cell Carcinoma.

True

True or False: Lasers are also used to treat early BCC and insitu SCC.

True

True or False: Sweat and sebaceous gland tumors can metastasize to nodes/distant sites.

True

True or False: The Epidermis is avascular.

True

True or False: Brachytherapy has no major advantages over EBT (electron beam therapy).

True

True or False: Sun exposure associated with BCC etiology is considered cumulative.

True

True or False: Basal Cell Carcinoma is the most common type of skin cancer.

True: Accounts for ~75% of all non-melanoma cancers.

What is Photodynamic Therapy for treatment of non-melanomas?

Use of visible light and photosensitizer

Explain how electrodesication works.

You do not have to do this with curettage, but it is an option. After curettage, they can send electric waves around the site and it will kill any cells that might not have been removed during the curettage.

Basal Cell Carcinoma arises in what type of cells?

basal cells of the epidermis

Why are Lymphoma & Leukemia patients at a higher risk for Squamous Cell Carcinoma?

because they recieve TBI

Non-Melanoma Staging: Tx-?

cannot be assessed

Why are electrons not the best treatment method used for Radiation Therapy?

electrons have a very fast fall off, spare skin better

If you have BCC and it is an ulcerated lesion, this most often will appear in what 4 areas of the body?

face hands ears arms

What type of skin tone increases your risk for skin cancers?

fair skin with poor tanning ability

90% of skin cancers could be prevented, how?

if exposure to sun's rays were eliminated

For cases of systemic disease involving the bone, chemotherapy is used how...

in conjunction with RT & for used for several weeks

What is Chemotherapy used for?

locally aggressive or metastatic disease

A patient has Basal Cell Nevi Syndrome--what does that consist of?

lots of moles

Excision is only good for providing what?

specimen for clinical examination

What are the two Sensory Receptors?

1. Messiner's 2. Pacinian

What are the two common Chemotherapy topical agents used for non-melanomas?

1. Nitrogen Mustard (really bad for skin) 2. 5 FU (MOST COMMON)

What are the three main doses used for non-melanoma skin cancers?

- 45-50 Gy (250 per fraction) - 55-60 Gy (200 per fraction) - 6 or 9 e- to Dmax (may bolus to bring doses up to skin level)

Skin diseases of the sweat and sebaceous glands are what histology and how do they grow?

- Adenocarcinomas - slow growing

When simulating skin lesions for RT treatment, what is the process? What special equipment is needed?

- Applicator Cone - Special Equipment-->lead shields, bolus

What are the chemicals associated with the etiology of BCC?

- Arsenic - Topically applied nitrogen mustard

When is Radiation Therapy used for non-melanoma skin cancers?

- BCC & SCC where cosmetic results are important - In areas of extensive disease and affected nodes

What are the four disadvantages of Brachytherapy?

- Cost - Trauma - Length of Hospital Stay - Risks of Anesthesia

What are all of the complications from Radiation Therapy for non-melanoma skin cancers?

- Erythema - Pigmentation - Dry Desquamation - Moist Desquamation - Temporary Hair Loss (area treated) - Decreased function of sweat or sebaceous glands - Late Reactions

What types of immunosuppressed patients experience higher risk for Squamous Cell Carcinoma?

- HIV - Lymphoma & Leukemia Patients

To prevent Squamous Cell Carcinoma, what are the main lifestyle changes or practices you should do...

- Minimize exposure to the sun - Use sunscreens (> or =15 SPF) - Wear Protective Clothing - Avoid Tanning Booths!

What are the three types of Brachytherapy used for non-melanoma skin cancers?

- Temporary Implants - Superficial Treatment - Even permanent implants

For the skin disease of the sweat and sebaceous glands, what is the treatment of choice? Why not RT?

- Treatment of choice: Surgical Removal - Tumors are most often radioresistant

Where are the common areas of occurence for Squamous Cell Carcinoma?

- nose - lip - cheek - temple - nail bed - trunk - extremities - genitals

What layer is the Stratum Corneum? Where is it? What does it do? What type of cancer is typically found in this layer?

- outermost layer - skin surface - dead flakey skin cells that fall off - BCC

What are the three general layers of the skin?

1. Hypodermis 2. Dermis 3. Epidermis (outermost layer)

What are three examples of exposure when looking at etiology of Squamous Cell Carcinoma?

1. Ionizing Radiation 2. Arsenic 3. Hydrocarbons from coal tar exposure (petroleum)

What are the two things your tumor has to be inorder to recieve curettage & electrodesication for your treatment?

1. 1cm or smaller 2. well defined borders

What are the three main types of skin cancer?

1. Basal Cell Carcinoma 2. Squamous Cell Carcinoma 3. Melanoma

What are the 8 ways you can treat BCC & SCC (non-melanomas)?

1. Curettage & Electrodesiccation 2. Mohs' Micrographic Surgery 3. Excision 4. Cryosurgery 5. Lasers 6. Chemotherapy 7. Photodynamic Therapy 8. Radiation Therapy

What are the five main categories used to compare advantages and disadvantages of the Radiation Therapy treatments (Kv, Mv, e-, or orthovoltage)?

1. Field Sizes 2. Depth of maximum dose d-max 3. Deep tissue dose 4. Differential bone absorption 5. Cosmesis and control rates

Of the three main types of skin cancer, which one is rarely metastatic? Why?

Basal Cell Carcinoma, because it is closer to the surface of the skin. <1% typically

What type of permanent implants in Brachytherapy have shown good curative and cosmetic results?

AU 198

What does the hypodermis do? & Name the 2 main functions.

Act as a foundation 1. Padding 2. Shape (the body)

What makes up the hypodermis? (composition)

Adipose Tissue (aka fat)

Explain the process of Photodynamic Therapy.

An agent called HPD (hematopreforin?) is injected into the body, absorbed, and selectively retained in the cancer cells. Light from a laser is directed on the tumor area and this causes a reaction within the cells containing the HPD and destroys the cells.

What is the muscle layer that attaches to the hair follicle and is responsible for goose bumps when you're cold?

Arrector Pili

Explain what Mycosis Fungoides is?

Associated with T-cell Lymphocytes and it is a rare chronic lymphatic skin disease

Compare the cure rates of Excision to Mohs' Microscopic Surgery.

Cure rates for Excision are inferior to Mohs' Microscopic Surgery.

What treatment is the most common method of treatment for the non-melanomas?

Curettage & Electrodesication

Non-Melanoma Staging: T4-?

Extension to bone, muscle, cartilage

True or False: Radiation Therapy is not effective in the treatment of non-melanoma skin cancers.

False- Radiation therapy is VERY effective in the treatment of non-melanoma skin cancers.

True or False: Mohs' Microscopic Surgery obtains the lowest cure rate and was developed by Dr. Frederick Mohs' in 1936.

False: Mohs' Microscopic Surgery obtains the HIGHEST cure rate and was developed by Dr. Frederick Mohs' in 1936.

True or False: Early detection and treatment will not help to cure your skin cancer.

False: Be aware of skin changes, early detection and treatment is essential for a cure.

True or False: Squamous Cell Carcinoma is a disease of the younger generation, usually between the ages of 20-40.

False: Squamous Cell Carcinoma is a disease of the OLDER generation, usually b/w 68-70 years or older. (few before 40)

True or false: Skin is considered a small organ, measuring only 5-12 square feet and weighing only about 2 lbs.

False: The skin is the largest organ, measuring about 17-20 square feet and 10-12 pounds.

What are the two reasons why BCC is becoming a disease of the younger generation?

Fashion & Lifestyle (clothing doesn't cover as much, tanning beds, etc)

Non-Melanoma Staging: T2-?

Greater than 2cm but less than 5cm

Non-Melanoma Staging: T3-?

Greater than 5cm

Non-Melanoma Staging: Tis -?

Insitu (pre-cancerous, very early)

Explain how Cryosurgery works.

It is the use of liquid nitrogen or carbon dioxide at very low temperatures (-50C) on the lesion.

Squamous Cell Carcinoma arises in what cells? & What layer of skin?

Keratinizing Cells of Epidermis

For all five categories used to compare the advantages and disadvantages what is the best treatment method used for Radiation Therapy? - Kv - Mv - e- - Orthovoltage

Kv is best- it has more pentration

Non-Melanoma Staging: T1-?

Less than or equal to 2cm in dimension

MV treatment is used when?

MV treatment rarely used unless tumors are infiltrating into other tissues or in areas of reccurence.

What are all of the possibilities for the appearance of a BCC?

May be... - Flesh colored, pink, or pearly gray - Presence of Melanin (darker colored) - Small red scaly growth (like psoriasis) - Ulcerated lesion - Solitary or Multiple lesions

What is the Messiner's Sensory Receptor responsible for?

More superficial, light touch sensation (brushing)

Non-Melanoma Staging: T0-?

No evidence

What is the main disadvantage of Photodynamic Therapy?

the patient must be protected from all bright light while the HPD levels remain in the body. (~3-6 weeks following Tx)

What is the melanin in your skin responsible for?

the pigment (color)

How does the skin remove waste?!

through the sweat glands, by sweating

True or False: The Epidermis is the layer of skin that flakes off in everyday activity.

true

True or False: Skin cancer is the most common type of malignancy.

true

Tanning is the body's response to _____.

ultraviolet damage

For the average person, what percentage does the skin weigh compared to their body weight?

~15% of their body weight