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MD2 Surgery and Anaesthesia > Pathology of Skin Tumours > Flashcards

Pathology of Skin Tumours Flashcards

1
Q

What sort of biopsy is performed on potentially invasive lesions?

A

Excisional - curative as well

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2
Q

What are the histological findings of solar keratoses?

A

Thicker
- Can also be thinner > atrophic
Hyper-keratotic
Slightly larger basal cells

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3
Q

How is solar keratosis usually diagnosed?

A

Clinically

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4
Q

What are the treatment options for solar keratosis?

A 
Cryotherapy
Topical; eg:
- 5-fluoruracil
- Imiquinod
Excision biopsy if
- Concerned about invasion
- Not recurrent
Shave biopsy
- Not helpful for therapy if extensive
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5
Q

What is a possible side effect of imiquinod?

A

Irritating > redness and burning

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6
Q

What information should be included in the pathology report for a skin excision?

A 
Location
Duration of lesion
PHx of skin lesion
Size
Clinical description
Indication for biopsy
Previous treatment
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7
Q

What are the histological abnormalities of SCCs?

A

Nests

Keratin pearls

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8
Q

What are the risk factors for SCC?

A 
Lifetime UV exposure
Solar keratoses
Fair skin
Burn scars
Chronic ulcers
Renal/any transplant
Road workers > exposure to tar
Tobacco
Arsenic
Betel leaf chewing
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9
Q

What are the bad prognostic features of SCC of skin?

A

Late presentation
Relatively thick lesion
- >6 mm depth
Large size

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10
Q

What is the excision margin for SCC of skin?

A

4 mm

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11
Q

What is the most frequent form of skin cancer?

A

BCC

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12
Q

Where do BCCs commonly occur?

A 
Sun exposed skin, esp
- Head
- Neck and trunk
- Older adults
May be multiple
Slow growing
Metastasis rare
Can be locally aggressive
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13
Q

What are different types of BCCs?

A

Nodular
Superficial
Morhoeic
Basosquamous

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14
Q

What are the risk factors for BCCs?

A 
Fair skin
Blue eyes
Immunosuppression
Basal cell naevus syndrome
XP = genetic syndrome
Radiation
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15
Q

What are the bad features of BCCs?

A

Morphoeic type - infiltrative
Basosquamous type
Perineural invasion
Incomplete excision

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16
Q

What is the treatment for BCCs?

A 
Excision = best
If can't excise
- Imiquinod
- Efudex
Cryotherapy - if must
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17
Q

When do benign melanocytic naevi develop?

A

Some congenital

Most acquired during childhood

18
Q

What is the most common melanocytic tumour?

A

Benign melanocytic naevi

19
Q

Do benign melanocytic naevi involve mucous membranes?

A

Sometimes

20
Q

What are the macroscopic features of benign melanocytic naevi?

A

Small size
Circumscription
Symmetry

21
Q

Do benign melanocytic naevi need to be excised?

A 
No
May be for
- Cosmetic reasons
- Changing
- Bleeding
- Concern about melanoma
22
Q

What are the histological features of benign melanocytic naevi?

A

Small nuclei
Melanocytes decrease in size towards base of dermal component
Absence of mitotic activity

23
Q

When are naevi a risk factor for melanoma?

A

Large numbers

24
Q

What is the risk of dysplastic naevi becoming melanoma?

A

Of single lesion transforming = low

Multiple lesions = increased risk

25
Q

What are familial dysplastic naevi syndromes?

A

Dysplastic naevus syndrome

Familial atypical multiple mole-melanoma syndrome

26
Q

What are the features of naevi in familial dysplastic naevi syndromes?

A

Multiple naevi with unusualy features

Increased risk of development of melanoma

27
Q

What are some pigmented lesions, other than naevi?

A 
Freckles
Lentigines
Pigmented keratoses
Basal cell and sometimes squamous cell carcinomas
Vascular lesions
- Haemangioma
- Haematoma
- Others
Dermatofibroma
Malignant melanoma
28
Q

How do you differentiate between freckles and lentigines?

A

Freckles darken with sun exposure

Lentigines don’t darken with sun exposure

29
Q

What does ABCDE stand for when identifying potentially malignant lesions?

A 
A = asymmetry
B = borders - irregular
C = colour
D = diameter
E = evolving
30
Q

For a possibly malignant lesion, what sort of biopsy should be performed?

A

Excision biopsy

31
Q

What is the excision margin for a melanoma?

A

Up to 10 mm

32
Q

Other than the skin, where else can melanoma occur?

A 
Oral cavity
Lip
Conjunctiva
Choroid
Oesophagus
Leptomeninges
Cervix
Vagina
Vulva
Anus
33
Q

Do melanomas arise in normal skin, or an existing naevus?

A

Most arise in normal skin

34
Q

What are the histological features of melanoma?

A 
Atypical junctional proliferation
Dermal invasion by atypical melanocytes
- Not mature
- Large, eosinophilic cytoplasm
- Contain melanin
- Large irregular nuclei
- Prominent nucleoli
- Frequent mitoses
35
Q

What is melanoma in-situ?

A

Malignant melanoma along dermo-epidermal junction
May show pagetoid epidermal spread
Don’t invade dermis
= Clark level 1 melanoma

36
Q

What is a red flag for a possibly malignant lesion?

A

Nail lesions that don’t grow out

37
Q

What are the key tumour related prognostic factors in melanoma?

A

TNM stage

Breslow thickness

38
Q

What are host related prognostic factors in melanoma?

A 
Age
Gender
Site
In stage IV disease
- Raised serum LDH
- Poor performance status
39
Q

What is the relationship between Breslow thickness and risk of mortality in melanoma?

A

The higher the Breslow thickness, the higher the risk of mortality

40
Q

Is a sentinel node biopsy performed in melanoma?

A

In some cases, yes

41
Q

How is metastatic melanoma treated?

A

Surgically

Experimental chemotherapy and immunotherapy

MD2 Surgery and Anaesthesia (31 decks)

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