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Dermatology SB > Cancer > Flashcards

Cancer Flashcards

1
Q

what are the hallmarks of cancer

A 
resisting cell death
sustaining proliferative signalling
evading growth suppressors
activating invasion and metastasis
enabling replicative immortality 
inducing angiogenesis
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2
Q

what is a major carinogen related to skin cancer

A

ultraviolet radiation (UVR)

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3
Q

what effects does UV have

A

damages DNA and causes mutations

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4
Q

which UV light is more dangerous

A

UVB

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5
Q

which UV light is more prevalent

A

UVA

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6
Q

what is the UV signature mutation

A

pyrimidine dimer

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7
Q

what is the principle carcinogen of UV

A

UVB 290-320nm

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8
Q

how does the different UV lights cause damage

A

UVB causes direct DNA damage

UVA causes indirect oxidative damage

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9
Q

UVR is immunosuppressive - true or false

A

true

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10
Q

why has there been an increase in non-melanoma skin cancer

A

cheap air travel
sun seeking behaviour
ageing population

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11
Q

what are cutaneous precursors for SCC

A

actinic keratoses

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12
Q

what are risk factors for skin cancer

A 
sunlight 
sunburn in childhood
sun exposure 
genetic susceptibility
chemicals
age 
immunosuppression
HPV
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13
Q

who are skin type 1

A

Very fair skin/redheads/blondes

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14
Q

what is different about those with skin type 1

A

Pheomelanin instead of eumelanin
Pheomelanin absorbs UV less efficiently
Unable to “tan” in a protective way

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15
Q

what are signs that you cannot tan

A 
freckles
solar lentigines (freckles across the shoulders)
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16
Q

what can increase melanoma risk by 4-fold

A

childhood sunburn

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17
Q
  • genetic disease
  • defect in enzyme
  • causes increased photosensitivity
A

Xeroderma Pigmentosum

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18
Q

what skin cancers are suffers of Xeroderma Pigmentosum susceptible to

A 
AKs
BCC
SCC
Melanoma
Fibrosarcoma
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19
Q

what is Oculocutaneous albinism

A

form of albinism involving the eyes, skin and hair

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20
Q

what are the major features of Gorlin’s syndrome/Naevoid basal cell carcinoma

A

early onset/multiple BCCs
palmar pits
jaw cysts
skeletal abnormality

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21
Q

what is Gorlin’s syndrome due to

A

germline mutation in PTCH gene - leads to hedgehog signalling

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22
Q

molecular drivers of BCC

A

Genetically homogenous tumour; aberrant hedgehog signalling, involvement PTCH

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23
Q

what mutations are common early on in skin cancer

A

TP52 mutations

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24
Q

what is a hereditary type IV collagen deficiency

A

Recessive Dystrophic Epidermolysis Nullosa

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25
Q

examples of phytotoxic drugs

A 
Voriconazole
Thiazide diuretics 
NSAIDs
Anti-TNF
Azathioprine
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26
Q

what are precancerous skin conditions

A

actinic keratoses

viral warts

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27
Q

what skin cancer does HPV associate with

A

SCC

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28
Q

what is the treatment for premalignant structures

A

cryotherapy
surgery
topical agents
photodynamic therapy

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29
Q

what is the most common cancer in 15-24 year olds

A

melanoma

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30
Q

what does melanoma survival depends on

A

tumour depth

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31
Q

thin melanomas have the worst prognosis - t or f

A

false
thin melanomas are cured
the deeper the tumour the worst the prognosis

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32
Q

what is the rule for melanomas

A 
A – Asymmetry
B – Border (regular or irregular)
C – Colour (darker, unsafer)
D – Diameter (increasing in size?)
E – Evolution (has it changed)
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33
Q

melanoma sign

A

ugly duckling sign

34
Q

what is the typical history of Basal cell carcinoma

A 
slow growing lump or non-healing ulcer
painless
well defined border
pearly/translucent
visible blood vessels
central ulceration 
can by locally invasive but rarely metastasise
35
Q

typical history of SSC

A

hyperkeratonic (crusted) lump or ulcer
fleshy
grow relatively fast
can be painful or bleed

36
Q

what is the general rule for the borders of SSC

A

majority - well differentiated low risk SCC

minority - poorly differentiated high risk SCC

37
Q

what are precursor lesions for SSC

A

actinic keratoses and Bowen’s disease (erythematous plaque)

38
Q

what are cutaneous horns

A

hard conical projections from the skin, made of compact keratin
arise from benign, premalignant or malignant skin lesions (commonly SSC)

39
Q

where are high risk sites for SSC

A

the ear, lip and scalp

40
Q

where do SSC’s metastasise to

A

Lymph nodes and Bone

41
Q

what type of immunosuppressed patients often get skin cancers

A

people receiving organ transplants

42
Q

what is RDEB

A

Recessive dystrophic epidermolysis bullosa
presents with severe blistering
Blisters heal but with scarring and deformity causing limited movement as fingers and toes may be fused together

43
Q

where are melanocytes derived from

A

Neural Crest

44
Q

what determines the balance of pigment in skin and hair

A

MC1R - Melanocortin 1 receptor gene

45
Q

what causes red hair

A

phaeomelanin

46
Q

what causes any hair colour bar red

A

eumelanin

47
Q

what does MC1R do

A

turns phaeomelanin into eumelanin

48
Q

what does a defective MC1R cause

A

One defective copy of MC1R causes freckling

Two defective copies-red hair and freckles

49
Q

what is the correct name for liver spots

A

actinic lentigines

50
Q

where do you get AL and why

A

face, forearms and dorsal hands

related to UV exposure

51
Q

correct name for baby born with mole

A

congenital melanocytic naevi

52
Q

what is the pathology of usual type acquired naevi

A

During infancy the melanocytes : keratinocyte ratio breaks down at a number of cutaneous sites
Allows formation of simple naevi

53
Q

what are the 3 stages of naevus development

A 
Junctional naevus (childhood)
Compound naevus (early adulthood)
Intradermal naevus (adulthoos)
54
Q

what are the characteristics of dysplastic naevi

A

Generally >6mm diameter
Variegated pigment
Border asymmetry

55
Q

what are halo naevi

A

peripheral halo of depigmentation. inflammatory regression and are overrun by lymphocytes

56
Q

what are blue naevi

A

entirely dermal and consist of pigment rich dendritic spindle cells

57
Q

when is a melanoma suspected

A 
Ulceration
Development of satellite nodules
Bleeding
Irregular pigmentation
Change in shape
New pigmented lesions develops in adulthood
58
Q

what are the 4 types of malignant melanoma

A

superficial spreading (commonest)
Acral/mucosal lentiginous
Lentigo maligna
Nodular

59
Q

what are characteristics of SSM, A/MLM and LMM

A

grow as macules or with dermal micro invasion

invade the dermis forming an expansile mass with mitosis

60
Q

what melanomas can metastasis

A

in vertical growing phase

61
Q

NM characteristics

A

a nodule of VGP tumour

has metastatic potential from beginning

62
Q

what are adverse prognostic indicators for melanomas

A

tumour depth

ulceration

63
Q

what are ulcers called

A

suffix b

64
Q

what areas do melanomas commonly metastasis to

A

local dermal lymphatics
regional lymph nodes
blood spread - to any where

65
Q

melanoma treatment

A

primary excision with clear margins
sentinel node biopsy - if positive then regional lymphadenectomy
if cancer far along - chemo, radio

66
Q

what is the medical term for freckles

A

ephilides

67
Q

characteristics of SSM

A

young-middle-aged adults
Usually trunk of men or legs of women
Usually macule with irregular border and colour which may have been increasing in size for years (slow horizontal growth phase) before developing a nodule (rapid vertical growth phase)

68
Q

characteristics of NM

A 
any body site
Usually in older patients
Blue-black or red-skin-coloured nodule 
may be ulcerated or bleeding
developed rapidly over preceding months
Aggressive growth pattern (vertical from outset)
69
Q

what are seborrheic keratoses

A

harmless warty spot that appears during adult life as a common sign of skin agin
stuck on appearance
regular border

70
Q

what can Eruptive appearance of many seborrheic keratoses may indicate

A

internal malignancy

Leser-Trelat Sign

71
Q

what are the 3 types of BCC

A

nodular
superficial
infiltrative (most important as it may infiltrate tissues widely)

72
Q

where are viral precursors often dysplastic

A

genital lesions

73
Q

what are viral genital lesions associated with

A

HPV type 16

74
Q

how to dermtofibroma appear

A

firm to touch

often increased pigment around rim

75
Q

what are topical treatments for skin cancer

A

5% imiquimod cream

76
Q

how does a snip excision work

A

1 - grasp lesion with skin hook

2 - cut across base of lesion

77
Q

advantages of snip excision

A

minimally invasive procedure

78
Q

what the surgical options for getting out a skin cancer

A

snip excision
shave excision
punch biopsy
elliptical excision

79
Q

what are the advantages and disadvantages of punch biopsy

A

adv - quick, good wound edges

disadv - difficult to judge depth round holes do not always heal well, pathology sample may be too small

80
Q

what is the ratio for margin of normal skin in elliptical excision

A

3mm length to 1mm height

need relaxed skin tension lines

Dermatology SB (11 decks)

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