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Dermatology > Cancer > Flashcards

Cancer Flashcards

1
Q

Melanoma risk factors

A

FH
Light skin
Red hair

Sun exposure
Sunbed
Immunosuppressant

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2
Q

Melanoma molecular pathogenesis

A

MAPK pathway

KIT mutation - acral and muscosal melanoma

BRAF gene - Intermittent sun exposure, but low for high cumulative exposure

P16 - tumour suppressor

CD8+ T cell recognise melanoma specific antigens and may kill tumour cells
CD4+ helper cells also play a role

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3
Q

Melanoma types

A 
Superficial spreading 
Nodular 
Lentigo maligna 
Acral lentiginous 
Unclassifiable
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4
Q

Superficial spreading

A

Most common in fair skin

Grey

Horizontal growth then vertical growth - asymmetrical and irregular border

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5
Q

Nodular

A

Second most common

Blue to black or pink to red

Rapid

No asymmetry or border irregularity as no horizontal growth

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6
Q

Lentigo maligna

A

Elderly

Chronically Sun damaged skin

Asymmetrical brown to black and irregular border

Invasive Lentigo maligna melanoma

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7
Q

Acral lentiginous

A

Uncommon

70s

Palms and soles and around nails

More commonly POC

Amelonotic melanoma - lack pigment

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8
Q

Self detection

A 
Asymmetry 
Border irregularity 
Colour varitaion 
Diameter greater than 5mm
Evolving
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9
Q

Prognostic factors

A 
Increased Breslow thickness >1mm - from granular layer to bottom of tumour 
Ulcer
Age 
Male
Trunk, head, neck 
Lymph involvement
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10
Q

Melanoma investigation

A

Dermoscopy - not considered in isolation

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11
Q

Melanoma management

A

Primary excision down to subcutaneous fat - 2mm peripheral margin

If melanoma confirmed on primary excision - wider excision performed - margin determined by Breslow depth
5mm for in situ
10mm for more than 1mm thick

Sentinel lymphoma node biopsy - sentinel node closest and thus most likely to contain disease - offered for pT1b+

Imaging for stage 3 and 4 and 2 without SLNB

Immunotherapy or mutated oncogene target therapy for unresectable or metastatic

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12
Q

Keratinocyte carcinoma

A

Pale skin
UV damage

Actinic keratoses - Bowen’s disease - Squamous cell carcinoma (may metastasise) - basal cell carcinoma (never metastasise)

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13
Q

Basal cell carcinoma

A

Most common skin cancer

UV significant risk factor

Dependent on stroma produced by dermal fibroblast

Sonic hedgehog patched signalling pathway

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14
Q

Squamous cell carcinoma

A

UV radiation significant risk factor

Addition of genetic alterations - p53 most common

Ill defined
Rapidly growing
Immunosuppressed

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15
Q

Actinic keratoses

A

Confined to epidermis
Usually head, neck, upper trunk and extremities

Difficult to distinguish from SCC - need biopsy

Red and scaly

Treat with 5-flurouracil cream or cryotherapy

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16
Q

Bowen’s disease

A

SCC in situ

Erythematous scaly patch or slightly elevated plaque

Treat with 5-fluorouracil cream or cryotherapy

17
Q

Keratotic core

Resolves by itself

Pseudo malignancy or variant of SCC

A

Keratoacanthoma

18
Q

SCC investigation

A

Clinical diagnosis sufficient

Biopsy may be taken

USS of lymph nodes

19
Q

SCC treatment

A

Excision

Radiotherapy

Cemiplimab for metastatic

20
Q

Basal cell carcinoma types

A 
Nodular
Superficial 
Morpheic 
Infiltrative 
Basisquamous 
Micro Nodular
21
Q

Nodular - basal

A

Most common

Shiny pearly papule

22
Q

Superficial - basal

A

Plaque

23
Q

Morpheic - basal

A

Less common

Light pink to white

Scar like

Elevated or depressed

Extensive local destruction

24
Q

Basisquamous - basal

A

Both basal and squamous

25
Q

Micronodular- basal

A

Resemble Nodular

More destructive

26
Q

Basal cell carcinoma treatment

A

Standard surgical excision

Mohs micrographic surgery

27
Q

Cutaneous T cell lymphoma types

A

Sezary syndrome - triad of Erythroderma, generalised lymphadenopathy and neoplasticism T cells - systemic treatment
Mycosis fungoides - patch to plaque to tumour - treat with topical corticosteroids

Diagnosis require skin biopsy

28
Q

Human herpes virus 8

Immunosuppressed

Radiotherapy or treat underlying with antiviral

A

Kaposi sarcoma

29
Q

High anaplastic cells

Surgery and radiation

A

Merkel cell carcinoma

Dermatology (2 decks)

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