7.6 - Skin cancer tutorial Flashcards
Which of the following is false regarding melanoma?
A. It can arise in eyes
B. Red hair is a risk factor
C. Pre-existing nevi are a risk factor
D. Causes >75% of skin cancer deaths
C (>50% of melanomas arise without a pre-existing nevus. Atypical nevi and >100 nevi are considered a risk factor)
Which of the following statements is true?
A. Acral lentiginous melanoma is more common in darker skin types
B. Melanoma incidence is decreasing
C. Superficial spreading melanoma is most common variant in pale skin types
D. Nodular melanoma has a rapid radial growth phase
C (not A as it affects all skin types equally)
Which of the following is true regarding melanoma detection?
A. ABCDE rule is helpful for early detection of nodular melanoma
B. The advent of dermoscopy has rendered history-taking obsolete in MM screening
C. Melanoma and basal cell carcinoma may appear grossly similar
D. The ‘black swan’ rule may facilitate detection of melanoma
C (with D, the ‘black swan’ rule does not actually exist. It is the ‘ugly duckling’ sign instead - a mole that does not resemble other nevi, that may indicate a melanoma)
Which of the following investigations of melanoma is correct?
A. Suspected melanoma should undergo punch biopsy
B. Confirmed melanoma should undergo sentinel lymph node biopsy
C. BRAF mutation status can inform prognosis and treatment decisions
D. LDH is relevant in haematological malignancy but not helpful in melanoma
C (A - suspected melanomas should undergo complete excision for diagnose, B - sentinel LN offered for pT1b+, D - LDH major prognostic factor in metastatic melanoma)
Which of the following is true regarding keratinocyte carcinoma/dysplasia?
A. Actinic keratoses typically evolve into squamous cell carcinoma
B. Basal cell carcinoma is more likely than squamous cell carcinoma to metastasise
C. Squamous cell carcinoma is three times more common than basal cell carcinoma
D. Keratinocyte carcinomas are more common in men than women
D
Which of the following is false about basal cell carcinoma?
A. Nodular BCC appears as a ‘pearly’ plaque
B. Morpheic BCC resembles a scar
C. Morpheic, micronodular and infiltrative BCC are aggressive subtypes
D. BCC never metastasises, and thus treatment is usually desirable rather than essential
D - untreated BCCs may become highly destructive to local structures and if left untreated and if left untreated over many years, may eventually becoming metastatic
Which of the following is true regarding basal cell carcinoma management?
A. Diagnostic biopsies are always required prior to definitive treatment
B. Topical treatments should always be offered
C. Mohs micrographic surgery has replaced traditional excision in surgical management
D. Vismodegib may be used for unresectable BCC
D (A - diagnostic biopsies not required if clinical features suffice for diagnosis, B - topical treatments only suitable for superficial low-risk BCCs, C - Mohs micrographic for aggressive subtypes, critical sites and recurrent BCC)
Which of the following is correct regarding cutaneous squamous cell carcinoma?
A. Typical appearance virtually always allows clinical diagnosis
B. May be difficult to distinguish from keratoacanthoma
C. Cemiplimab represents an alternative to surgical treatment
D. Rapid growth is a paradoxically positive prognostic feature
B (A - clinical appearances may vary substantially, C - for unresectable/metastatic SCC, D - rapid growth is a poor prognostic feature)
Which of the following statements is false regarding Merkel cell carcinoma?
A. It arises from cancerous Merkel cells
B. Polyomavirus plays an aetiological role
C. It demonstrates more aggressive behaviour than melanoma
D. Surgery, radiation and anti-PD1 checkpoint inhibitors are used in treatment
A (shares structural and immunohistochemical features with neuroectodermally derived cells, including Merkel cells)
Which of the following is not a treatment option for actinic keratoses?
A. Cryotherapy
B. Topical 5-Fluorouracil
C. Imiquimod
D. Radiation therapy
D - radiation therapy may be used in treatment of BCC, SCC, MCC but not actinic keratoses
Which of the following represent (relative) low-risk features in squamous cell carcinoma?
A. Periorificial zones
B. Acantholysis on histology
C. Immunosuppression
D. Absence of perineural invasion
D
