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Dermatology: Key Information > Melanoma > Flashcards

Melanoma Flashcards

1
Q

what are the two types of melanoma

A
  1. melanoma

2. non-melanoma

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2
Q

what does malignant melanoma arise from?

A

arises from melanocytes

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3
Q

genetics of malignant melanoma

A

CDKN2A (tumour suppressor) and CDK4 (oncogene, cell cycle with Rb)

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4
Q

four types of malignant melanoma

A
  1. superficial spreading
  2. acral/mucosal lentiginous
  3. lentigo maligna
  4. nodular
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5
Q

sites for superficial spreading melanoma

A

trunk and limbs

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6
Q

sites for lentigo maligna melanoma

A

sun damaged areas, commonly face, neck, scalp

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7
Q

describe nodular melanoma

A
  • commonest cancer
  • slow growing nodule
  • pearly
  • telangiectasia
  • excellent prognosis
  • surgical excision
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8
Q

how does SSM, A/MLM and LMM grow?

A
  • grow as macules either as in-situ or with dermal micro invasion (RGP)
  • can invade dermis (VGP)
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9
Q

is nodular melanoma a VGP?

A

yes

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10
Q

presentation of melanoma

A 
Asymmetry
ill-defined border
two or more colours
wide diameter, non symmetrical 
speed of change
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11
Q

when is speed of change the most important factor in presentation?

A

atypical mole syndrome

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12
Q

spread of malignant melanoma

A
  • dermal lymphatics
  • regional lymph nodes
  • blood
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13
Q

diagnosis of malignant melanoma

A
  • Breslow thickness (deepest part of the tumour from granular layer)
  • other prognostic indicators are ulceration, mitotic rate, invasion, lymph node involvement
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14
Q

management of malignant melanoma

A
  • targeted therapy e.g. vemurafenib, dabrafenib
  • excision of lesions
  • sun protection measures
  • chemo/radiotherapy
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15
Q

example of a benign epidermal tumour

A

seborrheic keratosis (basal cell papilloma)

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16
Q

define seborrheic keratosis

A

benign proliferation of epidermal keratinocytes

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17
Q

sites of seborrheic keratosis

A

face

trunk

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18
Q

presentation of seborrheic keratosis

A 
ageing skin
well-defined
stuck on appearance (greasy hyperkeratotic surface)
acanthosis
sign of Leser-Trelat
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19
Q

management of seborrheic keratosis

A

reassurance

cryotherapy if troublesome

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20
Q

what is special about precancerous dysplasias

A

they show squamous dysplasia

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21
Q

examples of precancerous dysplasia

A
  1. Bowen’s disease
  2. actinic keratosis
  3. viral lesions
22
Q

describe Bowen’s disease

A

full thickness dysplasia of epidermal keratinocytes (SCC in situ, no dermal invasion)

23
Q

presentation of Bowen’s disease

A

scaly patch/plaque
irregular border
legs
can mimic inflammatory conditions

24
Q

management of Bowen’s disease

A

imiquimod cream

surgical management

25
Q

diagnosis of Bowen’s disease

A

diagnostic biopsy

26
Q

define actinic keratosis

A

common precursor of SCC (low rate of progression)

27
Q

presentation of actinic keratosis

A

sun-exposed sites
scaly patch
several atypical lesions- Bowenoid

28
Q

management of actinic keratosis

A

non-surgical

29
Q

describe precancerous dysplasia viral lesions

A

associated with HPV 16

found on anogenital skin

30
Q

list of management options for precancerous dysplasia

A
  • surgery
  • cryotherapy
  • 5-fluorouracil cream
  • imiquimod
  • PDT
31
Q

examples of invasive malignancies that are non-melanoma

A
  1. basal cell carcinoma

2. squamous cell carcinoma

32
Q

genetics of BCC

A

mutations in PTCH1

hedgehog signalling pathway

33
Q

location of BCC

A

sun exposed sites

34
Q

presentation of BCC

A

slow growing
painless and often ignored
locally destructive
no metastasis

35
Q

three types of BCC

A

nodular
superficial
infiltrative (morphoeic)

36
Q

management of basal cell carcinoma

A 
vismodegib
excision
imiquimod
PDT
cryotherapy
37
Q

diagnosis of BCC

A

skin biopsy

38
Q

presentation of nodular BCC

A

pearly nodule

blood vessels visible

39
Q

presentation of superficial BCC

A

erythematous, scaly, irregular bordered plaque

pearly whipcord margin

40
Q

presentation of infiltrative BCC

A

waxy
scar-like plaque
indistinct border

41
Q

associations of squamous cell carcinoma

A 
elderly
immunosuppressed
chronic leg ulcers
chronic lupus vulgaris
xeroderma pigmentosum
dystrophic variant epidermolysis bullosa
42
Q

presentation of SCC

A

hyperkeratotic wart/ulcer/lump
fast growth
painful
bleeding

43
Q

spread of SCC

A

can spread locally to bone and lymph nodes

44
Q

management of SCC

A

excision

45
Q

describe miscellaneous tumours

A

enormous range that can arise from sweat glands, smooth muscle, arrector pili, lymphatics, Langerhans, Merkel and fat

46
Q

five risk factors for skin cancer development

A 
sun exposure 
genetic predisposition 
immunosuppression
environmental carcinogens
phototoxic drugs
47
Q

how does sun exposure cause skin damage

A

multiple p53 mutations
UVB direct DNA damage
UVA indirect oxidative damage deeper into the skin
depletes Langerhans

48
Q

genetic predispositions to skin cancer

A
  • DNA repair syndrome xeroderma pigmentosum
  • albinism: congenital AR absence of melanin
  • Gorlin’s syndrome: AD condition with multiple BCC
  • recessive dystrophic epidermolysis bullosa
49
Q

examples of phototoxic drugs

A 
voriconazole
thiazide diuretics
NSAIDS
anti-TNF
azathioprine
50
Q

describe Gorlin’s syndrome

A

naevoid basal cell carcinoma

51
Q

describe albinism

A

absence or defect of tyrosine

visual problems too due to lack of pigment (photophobia, nystagmus, amblyopia)

Dermatology: Key Information (35 decks)

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