Episode.19 - Mr. Bump’s Guide to Navigating Skin Tumours (David Killick)

John introduces the podcast and the co-hosts for this conversation; the guest on this episode is RCVS Specialist in Veterinary Oncology, David Killick.

Chapter 1 – Little Miss Diagnosis

David's Background:

2.14 - David began in general practice in 2003 and later specialized in medical oncology at the University of Liverpool, earning a PhD at the RVC in London. He is now the professor of veterinary oncology at the University of Liverpool.

Malignant vs. Benign:

3.19 - Benign growths stay localized, mostly causing no problems during a pet's lifetime, while malignant growths can invade nearby tissues and spread.

4.49 - Approximately 40-50% of skin growths in dogs are malignant.

Investigate All Lumps

5.30 - Investigate All Lumps: Investigating all skin lumps is essential, even if no immediate action is taken. Initial investigation involves history-taking and examination, looking for signs like attachment to underlying structures or enlarged lymph nodes.

Biopsy Importance

8.05 - Diagnostic biopsy samples, including fine needle aspiration (FNA), are invaluable in veterinary medicine. FNA is minimally invasive, providing initial insights in 80-90% of cases. It may not offer a precise diagnosis but guides further steps.

David suggests fine needle aspiration as a cost-effective initial diagnostic tool, emphasizing its utility in informed decision-making. Other options include incisional and excisional biopsies, each with its own considerations regarding risks and benefits.

By prioritizing fine needle aspiration, veterinarians can efficiently navigate the path toward accurate diagnoses and appropriate treatment plans.

Factors Influencing Animal Skin Tumours

11.05 - Sue inquires about factors influencing susceptibility to skin tumours in animals, such as age, breed, and sex. David discusses breed-related associations with specific diseases in veterinary oncology, citing mast cell tumours in bulldogs, boxers, and retrievers. He mentions melanomas more common in Scotties and Schnauzers and highlights characteristics like rapid growth and tissue attachment raising malignancy concerns.

Identifying Common Benign Lumps Visually

13.18 - John seeks insights into visually identifying common benign lumps. David notes some, like skin tags, papillomas, and sebaceous adenomas, can be recognized by appearance. Skin tags are outgrowths, papillomas breed-specific, and sebaceous adenomas common in aging Cocker Spaniels. David advises monitoring, measuring, and fine needle aspiration for accurate identification.

Understanding Pigmented Tumours in Dogs, Especially Melanomas

16.33 - Sue asks about pigmented tumours in dogs, melanomas specifically. David explains not all pigmented tumours are melanomas. Dark or black lesions suggest melanomas, including malignant melanoma and benign melanocytoma. Skin melanomas may require removal if melanocytes are detected, with digital and oral melanomas requiring active management.

Identifying Melanocytes in Fine Needle Aspirations

18.00 - Sue questions melanocyte identification in fine needle aspirations. David notes pigmented tumours are usually melanomas, with characteristic black granules in cells. He mentions amelanotic melanomas' rare occurrence, especially in oral cases.

Chapter 2 – Introducing Mr Mast Cell

Insight into Mast Cell Tumours

18.52 - John seeks insight into mast cell tumours (MCTs). David explains their origin from mast cells, which release histamine and cause itchiness and redness. MCTs may periodically change size upon palpation. They are common in dogs, especially specific breeds, potentially requiring multiple management due to recurrence.

Using Fine Needle Aspirations (FNAs) for Diagnosis and the Role of Veterinary Nurses

22.10 - John inquires about using fine needle aspirations (FNAs) for diagnosis and the role of veterinary nurses in interpreting samples. He wonders if preliminary assessments in practice are acceptable due to budget constraints and potential risks. David encourages practitioners, including vets and nurses, to develop cytology skills, which are enjoyable and relatively easy to learn. He suggests self-examining slides in their lab, writing reports, and seeking feedback for skill improvement. David notes that mast cell tumours are an excellent starting point for cytology learning as they often feature distinctive "fried egg-like" cells with blue to purplish granules. However, expert consultation is crucial for tumours with unusual characteristics or more aggressive features.

The Necessity of Biopsies for Tumour Grading After FNAs

25.15 - Sue questions the necessity of biopsies after fine needle aspirates (FNAs) for tumour grading. David notes FNA's value in general practice and good correlation with histological grade. He emphasizes combining clinical tools and considering staging, especially for higher-grade tumours. For less aggressive cases, FNA of the draining lymph node may rule out lymph node involvement before surgery. David discusses grading schemes, including the pattern grading scheme and Kiupel system.

Chapter 3 – Mr and Mrs Outcome

Treatment Options for Mast Cell Tumours

29.55 - John inquires about mast cell tumour treatments and whether they're managed in primary vet settings or by specialists. David explains treatment involves addressing the local tumour through surgery or radiation therapy, with staging for potential metastasis. Medical therapies like chemotherapy or growth factor inhibitors are considered if metastasis is found. Emerging therapies like Tigilanol tiglate and Electro Chemotherapy are mentioned, particularly for challenging cases.

Prognosis of Mast Cell Tumours

35.52 - John inquires about mast cell tumour prognosis. David explains that low and intermediate-grade tumours have a generally favourable prognosis with surgery, even if some cells remain at the margins. However, high-grade tumours, especially if they've spread, often require ongoing medical therapy and monitoring, with potential recurrence.

Key Points on Dealing with Dog Lumps and Seeking Specialist Guidance

37.54 - Sue summarizes key points: Urges not to ignore lumps on dogs, as up to 50% can be malignant. Recommends consulting specialists like David instead of relying on online sources for accurate guidance and evolving treatment options. David appreciates the summary, emphasizing the dynamic nature of oncology and the limitations of online information.

https://www.liverpool.ac.uk/sath/about-us/

43.44: John wraps the pod with another daft questions.