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Dermatology > Skin Cancers > Flashcards

Skin Cancers Flashcards

1
Q

Which skin cancer has the nickname rodent ulcer?

A

BCC

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2
Q

Which skin cancers can metastasise?

A

SCC and melanoma

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3
Q

Name the 3 common skin cancers

A

Squamous cell carcinoma (SCC)
Basal cell carcinoma (BCC)
Malignant melanoma

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4
Q

Name the ABCDE criteria for pigmented skin lesions

A

A = asymmetry
B = irregular border
C = multiple colours
D = diameter >6mm
E = evolution (growing)

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5
Q

BCC risk factors

A

UV radiation
Ionising radiation
Immunosuppression
Chronic scarring and ulceration
Arsenic
Hereditary factors

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6
Q

SCC risk factors

A

UV radiation
Ionising radiation
Immunosuppression
Chronic scarring and ulceration
Wart virus
Hereditary factors

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7
Q

Malignant melanoma risk factors

A

UV radiation
Immunosuppression
Hereditary factors

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8
Q

List 3 hereditary factors causing skin cancer

A

Germline mutation eg. Familial melanoma
Acquired mutation eg. BRAF^V600E
Epigenetic eg. Arsenic toxicity

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9
Q

Malignant melanoma protective factors

A

Constitutional pigmentation
Immune system
DNA repair
Accurate control of cell division
Behaviour (avoiding UV rays, covering up, SPF)

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10
Q

SCC protective factors

A

Constitutional pigmentation
Immune system
DNA repair
Accurate control of cell division
Behaviour (avoiding UV rays, covering up, SPF)

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11
Q

BCC protective factors

A

Constitutional pigmentation
Immune system
DNA repair
Accurate control of cell division
Behaviour (avoiding UV rays, covering up, SPF)

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12
Q

What is a precursor for SCC?

A

Actinic keratosis
Bowen’s disease

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13
Q

Describe actinic keratosis

A

Sun-exposed sites (face, backs of hands, bald scalp)
Rough area of skin/raised, keratosis lesion
Usually multiple
Hard, spiky keratin our surface
Proliferations of cytologically aberrant epidermal keratinocytes
Pruritis, burning or stinging pain, bleeding and crusting

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14
Q

Describe Bowen’s disease

A

Superficial intraepidermal tumour
Slow radial expansion
Localised erythematous, scaly or crusted plaque
Not usually ulcerated, moist or thickened
Overlying scale or crust
Sun-exposed areas

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15
Q

Describe the carcinogenesis cycle

A

DNA lesion -> mutation -> gene -> cell phenotype -> clinal expansion -> pre-cancer or carcinoma

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16
Q

What type of UV exposure is a risk factor for SCC?

A

Flash fry (blistering burns)

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17
Q

What type of UV exposure is a risk factor for BCC?

A

Intermittent simmer (frequently tanning/burns)

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18
Q

Do SCCs or BCCs present later in life?

A

SCCs present later

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19
Q

General skin cancer risk factors

A

Skin type (eg. Red hair, blue eyes, pale,)
Sunburns (especially in childhood)
Outdoor exposure in occupation/hobbies
Living in sunny location
Immunosuppression (eg. Transplant)
Sunbeds/sunbathing
Family history
PMH skin cancer
Genetic disorders (eg. Albinism)

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20
Q

What are the types of albinism?

A

Type 1 = more severe, no melanin
Type 2 = some melanin
Occular albinism = normal, or slightly paler than normal for their ethnicity, skin and hair

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21
Q

Actinic keratosis risk factors

A

Older age
Male
Fair skin (easily burns and freckles)
Blonde/red hair and blue eyes
Cumulative UV radiation exposure
Immunosuppression
Prior AKs/other skin cancers

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22
Q

Arsenical keratosis clinical findings and cause

A

Associated with chronic arsenicism
Yellow keratosis paperless
Areas of constant pressure or repeated trauma
The bar and lateral borders of hands
Sides of fingers, dorsal fingers over joints

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23
Q

Bowen’s disease risk factors

A

UV exposure
Immunosuppression
Infection with Human Papillomagirus (HOV)
Chronic arsenicism

24
Q

Describe lentigo maligna

A

Subtype of melanoma in situ
Seen on chronically sun-exposed areas (eg. Cheeks, nose, neck, scalp, ears)

25
Q

Lentigo maligna clinical findings

A

Flat, slowly-enlarging brown freckle-like macule
Irregular shape and differing shades of brown and tan
Usually arising in background of photo damage,
ill-defined borders

26
Q

Where do BCCs originate?

A

Derived from non-keratinising cells from basal layer of epidermis

27
Q

Genetic causes of BCCs?

A

Gorlin’s syndrome (dental facts, palm pits)
Xeroderma pigmentosum

28
Q

Describe BCC clinically

A

Intermittent bleeding
May appear to heal
Pearly, translucency, ulceration, telangiectasia
Rolled edge
Slow-growing

29
Q

Describe Nodular BCC

A

Sun-exposed areas
Translucent Paul’s or nodule
Telangiectasia
Rolled border

30
Q

Describe pigmented BCC

A

Subtype of nodular BCC
Increased melanisation
Hyperpigmented, translucent Paul’s/nodule
May be eroded

31
Q

Describe superficial BCC

A

Commonly on trunk
Erythematous patch
May resemble eczema
Localised, red plaque
Scaly
Usually solitary or few
Slowly enlarge

32
Q

Describe infiltration BCC

A

Scar-like (lack of skin creases/indented)
Difficult to define edges of lesion
Shiny
Tenlangiectasia

33
Q

What cells cause SCC?

A

suprabasal epidermal keratinocytes

34
Q

SCC clinical findings

A

Flesh-coloured or erythematous
Hyperkeratotic, bleeding, oozing, crusting
Papule, nodule or plaque
May be pigmented or ulcerate
May have cutaneous horn
May be verrucous

35
Q

List 4 melanoma subtypes

A

Superficial spreading malignant melanoma (SSMM)
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma

36
Q

Describe seborrhoeic keratosis

A

Common benign lesion
Well-demarcated, stuck on appearance
Varied colours
Nodular or macular
Surface normally rough
No increases malignancy risk
Can bleed/ulcerate if traumatised

37
Q

Should you biopsy melanomas?

A

No

38
Q

Describe the Glasgow 7-point checklist for melanoma

A

Major features = change in size, irregular shape, irregular colour

Minor features = diameter >7mm, inflammation, oozing, change in sensitisation

39
Q

Dermoscopy melanoma findings

A

Pigment network = atypical irregular, variable and widened lines that end abruptly at periphery

Brown globules = correlate with pigmented nests of melanocytes in papillary dermis

Black dots = focal collections of melanocytes and clumps of melanin in stratum corneum

Blue-grey veil = represents regression in melanoma

40
Q

Describe cutaneous lymphoma

A

Consider in eczema which has not responded to topical steroids
Usually scaly, red rash
Less itchy than eczema
Not as thick as psoriasis
Progressive over decades

41
Q

Which cells are in the epidermis?

A

Keratinocytes
Melanocytes
Basal cells
Langerhans cells

42
Q

What is found in the dermis?

A

Capillaries
Fibroblasts
Lymphocytes
Macrophages
Mast cells
Granulocytes

43
Q

What is found in the subcutaneous tissue?

A

Collagen
Vessels
Elastic fibres
GAGs
Fibronectin

44
Q

When does an acquired naevus appear?

A

after birth

45
Q

When does a congenital naevus appear?

A

present at birth

46
Q

What are the 4 clinical types of acquired naevi?

A

junctional malanocytic neavus
compound melanocytic naevus
intradermal melanocytic naevus
rare naevi (eg. spitz, blue)

47
Q

What does a junctional naevus look like?

A

brown/black and flat
usually small

48
Q

What does a compound naevus look like?

A

pigmented papules
raised and palpable

49
Q

What does a dermal/intradermal naevus look like?

A

fawn or skin-coloured papules (raised)
can be hairy

50
Q

Describe congenital naevi

A

solitary
often relatively large
do not go through normal mole ageing process

51
Q

List the 4 main types of melanoma

A

lentigo maligna melanoma
superficial spreading malignant melanoma
acral lentiginous malignant melanoma (hands and feet)
nodular malignant melanoma

52
Q

Features of melanocytic lesions on dermoscopy

A

pigment network (regular, reticular pattern is good)
blue white veil
peripheral hypo/hyper-pigmentation
vascular structure
dots and globules (globular pattern)

53
Q

What is a marjolin ulcer?

A

SCC arising in a chronic site of inflammation, most commonly on an old burn scar or a venous ulcer
presents as new, persistent site of ulceration

54
Q

Which HPV types can cause HPV-associated SCC?

A

16 and 18

55
Q

Describe a keratoacanthoma

A

BCC or SCC like
nodule with central hard keratin or rolled edge
rapid growth
mimics histologically a SCC
good prognosis
normally excised as difficult to distinguish from SCC clinically

Dermatology (23 decks)

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