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Stage 3 > Dermatology: Skin cancer > Flashcards

Dermatology: Skin cancer Flashcards

1
Q

Which is the commonest skin cancer

A

Basal cell carcinoma (BCC)

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2
Q

What does nodular basal cell carcinoma look like?

A

Pearly nodule with rolled telangiectatic edge on the face or sun exposed site ± central ulcer

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3
Q

Does BCC metastasise?

A

Very rare

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4
Q

What happens if BCC is left untreated?

A

Slowly causes local destruction

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5
Q

How does superficial BCC look?

A

Red scaly plaques with raised smooth edge, often on the trunk or shoulders

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6
Q

What causes BCC?

A

1) UV exposure
2) Immunosuppression

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7
Q

What is the first line treatment for BCC?

A

Excision

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8
Q

What are other options for treating BCC?

A

Cryotherapy, curettage, radiotherapy, photodynamic therapy

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9
Q

What can be used to treat superficial BCC lesions at low-risk sites?

A

Topical imiquimod or fluorouracil

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10
Q

What is the second most common skin cancer?

A

Squamous cell cancer (SCC)

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11
Q

How does squamous cell skin cancer present?

A

Persistently ulcerated or crusted firm, irregular lesion often on sun-exposed sites

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12
Q

What are the risks if squamous cell skin cancer is left untreated?

A

It is locally invasive and may metastasise

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13
Q

What factors increase the risk of squamous cell cancer metastasising?

A

1) Site = lip, ear or non-sun exposed site
2) > 2cm diameter
3) Poor histological differentiation
4) Immunosuppression

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14
Q

What is squamous cell cancer related to?

A

Chronic inflammation e.g. leg ulcers, HPV (e.g. genital area or periungual)

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15
Q

How do you treat squamous cell cancer?

A

Local complete excision

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16
Q

What are two types of premalignant skin tumours that can progress to squamous cell cancer?

A

1) Actinic (solar) keratoses
2) Bowen disease

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17
Q

How does actinic (solar) keratoses present?

A

Premalignant crumbly, yellow-white scaly crusts on sun-exposed skin from dysplastic intraepidermal proliferation of atypical keratinocytes

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18
Q

What is the prevalence of actinic (solar) keratoses in the UK?

A

23% in > 60 years

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19
Q

What is the prognosis of actinic (solar) keratoses?

A

1) May regress or recur
2) Progression to squamous cell cancer risk is < 1% per year (risk increases over time and with larger numbers of lesions)

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20
Q

How does Bowen disease present?

A

Well-defined, slowly-enlarging red scaly plaque with a flat edge (asymptomatic)

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21
Q

What does Bowen disease look like on histology?

A

Full-thickness dysplasia/carcinoma in situ

22
Q

What is the prognosis of Bowen disease?

A

3-5% progress to SCC but the risk of metastases from the SCC is high

23
Q

What are the causes of Bowen disease?

A

1) UV exposure
2) Radiation
3) Immunosuppression
4) Arsenic
5) HPV infection - anogenital disease

24
Q

What is another name for Bowen disease?

A

Squamous cell cancer in situ

25
Q

Which cancers can cause skin metastases?

A

Breast, stomach and colon, lung, genitourinary system, non-Hodgkin’s lymphoma, leukaemia

26
Q

How do skin metastases present?

A

Firm, intradermal or subcutaneous nodules of varying colour

27
Q

What is Mycosis fungoides?

A

The commonest cutaneous T cell lymphoma

28
Q

How does mycosis fungoides present?

A

Progresses from well-defined itchy, red, scaly patches and plaques to red-brown infiltrated plaques and ulcerating tumours

29
Q

What is Paget disease of the nipple?

A

An itchy, red, scaly or crusted nipple from direct extension of intraductal adenocarcinoma

30
Q

What is Sezary syndrome?

A

Leukaemic form of cutaneous T cell lymphoma characterised by erythroderma, lymphadenopathy and malignant circulating CD4 positive T cells (Sezary cells)

31
Q

What is the epidemiology of malignant melanoma?

A

1) 5th commonest cancer in the UK
2) ⅓ occur in < 50 years
3) Accounts for 75% of deaths associated with skin cancer
4) Most arise de novo, not in pre-existing melanocytic naevi

32
Q

What are risk factors for malignant melanoma?

A

1) UV exposure
2) Sunburn
3) Fair complexion
4) Many (> 50) melanocytic or dysplastic naevi
5) Family history
6) Previous melanoma
7) Old age

33
Q

What are the ABCDEF criteria to identify suspicious pigmented lesions that could be malignant melanoma?

A

1) Asymmetry - in the outline of the lesion
2) Border irregularity/blurring
3) Colour variation - shades of black, brown, blue or pink
4) Diameter > 6mm (cannot be covered by end of pencil)
5) Evolution - all changing moles are suspect
6) Funny looking mole

34
Q

What is the ugly duckling sign?

A

A mole that stands out or is different from others - better than ABCDE criteria for identifying nodular melanoma

35
Q

What are the features of nodular melanoma?

A

1) Nodular, Firm and Growing
2) Can be symmetrical, have regular borders and be uniform in colour

36
Q

What is the first line management for any pigmented lesion you are concerned about?

A

Refer urgently 2ww

37
Q

How is prognosis of malignant melanoma determined?

A

Breslow thickness

38
Q

What improves mortality in malignant melanoma?

A

If the tumour is removed when it is thin

39
Q

What are the three types of melanoma?

A

1) Superficial spreading melanoma (70%)
2) Nodular melanoma (15%)
3) Acral lentiginous melanoma (10%)
4) Lentigo maligna melanoma (5%) - arises within a lentigo maligna

40
Q

How does superficial spreading melanoma present?

A

1) Slowly enlarging pigmented lesion with colour variation and an irregular border
2) Initially growth is in the radial plane, where the lesion remains thin, but this may be followed by vertical invasion
3) Common on the trunks of men or legs of women

41
Q

What is the most aggressive type of melanoma?

A

Nodular melanoma

42
Q

How does nodular melanoma present?

A

1) No radial growth phase
2) Lesions grow rapidly, invade deeply and metastasise early
3) Often darkly pigmented but may be amelanotic in 5%

43
Q

What is the most common type of melanoma in black and Asian skin?

A

Acral lentiginous melanoma

44
Q

How does Acral lentiginous melanoma present?

A

1) Occurs on the palms, soles and subungual areas
2) Refer urgently any new pigmented line in a nail or growing under a nail esp. if Hutchinson’s nail sign

45
Q

Which melanoma occurs under the nailbed (subungual)?

A

Acral lentiginous melanoma

46
Q

What is Hutchinson’s nail sign?

A

Pigmented line extends from the nailbed to the nail fold

47
Q

What is the only curative treatment for malignant melanoma?

A

Surgery

48
Q

How is malignant melanoma surgically managed?

A

Wider excision margin biopsy is taken (up to 3cm) to ensure complete removal (± sentinel lymph node biopsy)

49
Q

How is malignant melanoma diagnosed?

A

Excision biopsy (2mm margin of normal skin around lesion + cuff of s/c fat) - allows for histological diagnosis and measurement of tumour depth (Breslow thickness)

50
Q

What is indication for excision biopsy?

A

Any unusual, growing or changing pigmented lesion

51
Q

How is metastatic melanoma treated?

A

Surgery + adjuvant therapy ± palliative (melanoma not responsive to radiotherapy)

52
Q

What are the three types of benign melanocytic naevi (mole)?

A

1) Congenital melanocytic naevi (usually > 1cm) - present at birth or early neonatal period, increased risk for malignant change if > 20cm
2) Acquired melanocytic naevi - present in childhood or young adults (disappear in old age)
3) Halo naevi - common in adolescence, white halo develops around benign melanocytic naevus

Stage 3 (61 decks)

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