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Year 4: DERM > Cancer > Flashcards

Cancer Flashcards

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1
Q

Which type of UVA is most associated with NMSC? [1]

UVA
UVB
UVC

A

UVB

UVA -> Aging + also skin cancer
UVB -> Burning + NMSC

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2
Q

What are risk factors for malignant melanoma? [5]

A

UV Radiation
- UVB causes direct DNA damage

Skin Type
- (Fitzpatrick Skin types I & II)

Melanocytic naevi
- multiple (>100) or giant (>20 cm) naevi
- Congenital melanocytic naevi (moles present from birth, or that develop within the first few months after birth, are called congenital melanocytic nevi)
- Atypical mole syndrome (AMS): >1 pigmented lesions on the iris; >1 naevi on buttocks or instep naevi on anterior scalp; ≥2 atypical naevi; >100 naevi

Genetics
- CDK4, xeroderma pigmentosum, melanocortin 1 receptor

Previous skin cancer
- Previous melanoma

Immunosuppression
- HIV/AIDS
- Organ transplant recipient
- Lymphoproliferative disease
- Anti-TNF treatment

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3
Q

FYI

Fitzpatrick Skin types

A
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4
Q

If you have over [] moles, you are more likely to get melanoma skin cancer [1]

A

100

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5
Q

Describe the basic pathophysiology of MM

A

Melanoma originates from uncontrolled proliferation of melanocytes in the basal epidermis.

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6
Q

Describe how Congenital Melanocytic Naevi (moles) are classified based on size. Describe the clinical implications of the different sizes [3]

A

CMNs: Present at birth or develop shortly after birth.

Small and medium sized CMNS pose little risk

Large / giant sized CMNS have up to 10% lifetime risk of becoming MM.

NB: if multiple; add up total size

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7
Q

§

Describe why CMNs turning into MMS are often difficult to detect [1]

Which age group is predominately affected? [1]

A

2/3 are sub-epidermal and 31% in CNS

70% MM occur before age of 10 years

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8
Q

Which is the most common place to get MM in men?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

A

Which is the most common place to get MM in men?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

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9
Q

Which is the most common place to get MM in women?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

A

Which is the most common place to get MM in women?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

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10
Q

Histologically, melanomas are divided into five major subtypes.

What are they? [5]

A

Superficial spreading (70%)
Nodular (15%)
Lentigo maligna (10%)
Acral lentiginous (< 5%)
Desmoplastic melanoma (< 1%)

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11
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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12
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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13
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Lentigo maligna
- Lentigo maligna is an early form of melanoma in which the malignant cells are confined to the tissue of origin, the epidermis
, hence it is often reported as ‘in situ’ melanoma. It occurs in sun damaged skin so is generally found on the face or neck, particularly the nose and cheek. It grows slowly in diameter over 5 to 20 years or longer.

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14
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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15
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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16
Q

Which of the following are typically more seen at a more advanced stage.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Which of the following are typically more seen at a more advanced stage.

They transition immediately into the vertical growth phase. Because of this, it is usually diagnosed at a more advanced stage.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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17
Q

[] occurs in the elderly on chronically sun-exposed sites.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

[] occurs in the elderly on chronically sun-exposed sites.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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18
Q

What is the most common manifestation of melanoma? [1]

A

Superficial Spreading Melanoma (70%)

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19
Q

Name this type of melanoma [1]
Which population are most likely in? [1]

A

Nodular Melanoma (10-25%)
Met. early; older populations

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20
Q

Acral Lentiginous Melanoma (5%)

A
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21
Q

Name this type of melanoma [1]
What sign is shown here? [1]

A

Subungual melanoma

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22
Q

Name this type of melanoma [1]

Characteristics? [+]

A

Amelanotic Melanoma
- no melanin
- firm
- grow fast
- look harmless

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23
Q

Describe A-E of suspecting melanoma [5]

A
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24
Q
A
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25
Describe what is meant by dermoscopy [1]
Use polarised and non-polarised light: - look at demoscopic features to recognise melanomas
26
How do you investigate for MM? [1]
All patients require a **careful skin** and **lymph node examination.** - ALWAYS send for histology - Suspicious lesions should be excised with a **narrow (2mm) margin** - **NEVER** shave or curette a suspected melanoma
27
Management is complex and guided by the **Melanoma Multidisciplinary Team (MDT)**. Describe the different treatment options
**Surgical**: - **WLE** represents the standard treatment for primary melanoma. Involves removal of the biopsy scar with a surrounding margin of ‘healthy’ skin, with fat, down to muscular fascia. This margin is determined by the Breslow thickness. - **Sentinel Lymph Node Biopsy (SLNB)** - **Electrochemotherapy** is a relatively new therapy for patients with locally advanced melanoma. **Medical** (typically adjuvant therapy) - Chemotherapy - Radiotherapy - Immunotherapy
28
What does the Breslow thickness (mm) of a MM mean? [1] What does the Clark level (I-V) refer to? [1] What thickness inidcates a thin [1] and thick melanoma [1]
**Breslow thickness (BT)** is based on the **vertical thickness of the tumour in millimetres.** **Clark level (I-V)** is a histological classification with estimated prognosis based upon the **anatomical level of invasion into the skin.** **Breslow Thickness and Clark level** **Thin melanoma**: < 0.8mm **Thick melanoma:** >0.8mm
29
Which factors determine if a MM prognosis? [5]
**Breslow thickness** **Clark level** **Ulceration** - . It is suggestive of an aggressive tumour phenotype with greater likelihood for invasion and metastasis. **Mitotic index** (an indicator of cell turnover) is also an important histological finding.
30
What are the two types of Non-Melanoma Skin Cancer? [2]
Basal Cell Carcinoma (BCC) Squamous Cell Carcinoma (SCC
31
Dx? [1] Slow growing Solitary nodule Central ulceration Rolled pearly edges Telangiectasia
Basal Cell Carcinoma (BCC)
32
What are the two types of NMSC? [2]
**Basal Cell Carcinoma (BCC)** **Squamous Cell Carcinoma (SCC)**
33
Describe the characteristics of **Basal Cell Carcinoma (BCC)**
* **Shiny pink/red lump** * Slow growing, over months to years * Sometimes **red flat patches** * Form a **recurrent** **crust** that doesn’t heal * **Over time bleed/ulcerate in the middle, but may not be painful** * Usually **sun-exposed sites**: face, ears, scalp, hands, upper trunk * **Rarely metastasise** ## Footnote TURP: **T**elangiectasia **U**lceration **R**olled edges **P**early edges
34
Which type of skin cancer is most common? [1]
Basal Cell Carcinoma (BCC) (75%)
35
Risk Factors for BCC? [7]
* Fair skin: blue eyes, red/blonde hair * UV exposure * Previous skin cancer * Previous radiotherapy * Arsenic ingestion * Immunosuppression * Genetic disease: Gorlin syndrome & Xeroderma pigmentosum
36
Which genetic conditions are a risk factor for BCC? [2]
Genetic disease: * **Gorlin syndrome** * **Xeroderma pigmentosum**
37
Describe what is meant by **Gorlin syndrome** [1]
A rare **autosomal dominant condition** that occurs as a result of gene mutation, specifically the **PTCH1** **gene**. Individuals with Gorlin syndrome typically **begin to develop BCCs during adolescence or early adulthood**.
38
Describe test often perform in clinic to test for BCC [1]
39
What are the clinical sub-types of BCC? [5] Describe how the present
There are several clinical sub-types of BCC, including: **nodular** - **red / flesh-coloured** and have well-defined borders with overlying **telangiectasias**. As they grow, they may develop central ulceration (**Rodent** **ulcer**). **superficial** - slow-growing erythematous plaques that may be dry or crusted or have a slight bluish tinge **morphoeic** - scar-like lesion or indentation; they commonly occur on the upper trunk or face. **pigmented** - Pigmented BCCs may be difficult to distinguish from melanoma. **basosquamous**: - A rare, but aggressive form of BCC with increased risk of recurrance and even metastasis.
40
Describe this type of BCC [1]
**Morphoeic BCC** - sclerotic (scarred)
41
**Describe this type of BCC [1]**
Pigmented BCC
42
Types of BCC: **[]** and **[]** BCCs are considered low-risk, whereas **[]** is high-risk due to their extensive local spread and high recurrence rate.
**Nodular** and **superficial** BCCs are considered **low-risk**, whereas **morpheaform** is **high-risk** due to their extensive local spread and high recurrence rate.
43
Describe the Dx [2] and Mx [3] of BCC
**Diagnosis** History Skin biopsy from ulcer edge **Management** Excision Radiotherapy Superficial BCCs – 5-flourouracil or imiquimod cream
44
Describe the different treatment options for low and high risk BCC [+]
The main goal of treatment is the **complete** **removal** of the **tumour** with **preservation** of the **function** and **cosmesis** of the **affected area.** The type of treatment depends on whether the BCC is **low or high risk** **Low risk:** - **complete** **surgical** **removal** or **electrodesiccation** and **curettage** **(ED&C)** - **Superficial BCCs** – 5-flourouracil or imiquimod cream **High risk** - **Mohs micrographic surgery** is a specialist removal method for non-melanoma skin cancers with high recurrence risk - As an alternative for high-risk lesions, **simple resection with adjunct radiotherapy** has been recommended
45
Dx? [1]
**Squamous cell carcinoma**
46
Describe the characteristics of SCC [+]
* **Enlarging scaly/crusted lump**s * Grow **rapidly** over weeks * May **ulcerate** * Often **tender**/painful/bleed (except in IC ptx) * Usually arise within **pre-existing actinic keratosis** or intraepidermal carcinoma * Commonly **face, lips, ears, hands and limps** * **Rarely metastasises** * Often have **hyperkerotic horn** / no rolled border
47
Dx? [1] Describe this [1]
**Actinic Keratoses** - **hyperkeratotic papules on a background of sun-damaged skin** - Actinic keratosis involves the formation of **precancerous scaly lesions on the skin** - Actinic keratoses have around a **10% risk of developing into an SCC,** therefore monitoring and treatment are important
48
Describe the management options for Actinic Keratoses [4]
**Management options include**: - prevention of further risk: e.g. sun avoidance, sun cream - **fluorouracil cream**: typically a 2 to 3 week course. The skin will become red and inflamed - **sometimes topical hydrocortisone** is given following fluorouracil to help settle the inflammation - **topical diclofenac**: may be used for **mild AKs**. Moderate efficacy but much fewer side-effects - **Imiquimod** can be used for lesions on the face and scalp when cryotherapy or other topical treatments cannot be used.
49
Superficial form of SSC = ? [1]
**Bowens Disease**
50
Describe what is meant by Bowen's disease [1]
**Bowen’s disease** (also known as SCC in situ) occurs when the cancerous cells are c**onfined to the epidermis**.15 It can also progress into **invasive SCC,** so it is important to monitor and treat Bowen’s disease promptly.
51
Describe the management of squamous cell skin cancer [3]
**Surgical excision** with **4mm** **margins** if lesion **< 20mm** in diameter. If tumour **>20mm** then margins should be **6mm.** **Mohs micrographic surgery** may be used in **high-risk patients** and in **cosmetically important sites.**
52
Squamous skin cell cancer commonly mets to...[3]
The most commonly affected sites are **lungs, liver and brain.**
53
Describe the differences in a good and bad prognosis for squamous skin cell cancer [4]
**High-risk features include:** Size: >2mm deep or >20mm wide Site: face, ear, genitals, hands, feet Recurrence Immunosuppressed individual Poor differentiation (histologically) Perineural invasion (histologically) High tumour budding *Geeky medics^*
54
For Bowen’s disease, therapies such as **[]** or therapies like **[]** are first-line management
For Bowen’s disease, **destructive** **therapies** such as **cryotherapy** or topical therapies like **5-fluorouracil are first-line managemen**t.8
55
Dx? [1]
**Seborrheic Keratoses**
56
How do you differentiate **Seborrheic Keratoses** between melanoma? [2]
**SK**: - well-demarcated, waxy, '**stuck-on**' appearing papules or plaques with a greasy surface - usually **asymptomatic**, although they may **become irritated or itchy.** **Melanoma**: - **asymmetrical** **lesion** with **irregular** **borders** and **varied colours** within one lesion - It tends to **evolve** over time - a key feature that distinguishes it from SK. However, definitive diagnosis for both conditions should ideally be made through biopsy followed by histological examination. ## Footnote Melanoma on the left; SK on the right
57
# H Describe the characteristics of Seborrheic Keratoses [+]
* Very common * Present in >90% of people over 60 * Increase in number with time * Often develop in middle aged * Waxy or warty surface * Flat or plaques * Stuck on appearance
58
Tx for serborrheic keratoses? [2]
* **reassurance** about the benign nature of the lesion is an option * options for removal include **curettage, cryosurgery and shave biopsy**
59
Name and describe this type of skin condition [3]
**Junctional Naevi** * Mole * Flat * Pigmented * Regular, symmetrical, static appearance | GO over
60
What are solar lentigo?
**Solar lentigo** - is a harmless patch of darkened skin. It results from exposure to ultraviolet (UV) radiation, which causes local proliferation of melanocytes and accumulation of melanin within the skin cells (keratinocytes) - aka **sun spots**
61
Name and describe this type of skin condition [3]
* **Compound Naevi** Mole **Central raised area** Surrounded by flat pigmentation
62
Name and describe this type of skin condition [3]
**Junctional Naevi** Flat Pigmented Regular, symmetrical, static appearance
63
Name and describe this type of skin condition [3]
**Intradermal Naevi** * Protrude from the skin surface * Pigmented or flesh coloured
64
Name and describe this type of skin condition [1]
**Blue Naevi** - solitary, bluish, smooth surfaced macule, papule or plaque. They are generally round or oval in shape.
65
On palm of hands or feet Dx? [1]
Acral Naevi
66
Name and describe this type of skin condition [1]
**Naevus Spilus** - Nevus spilus, also known as speckled lentiginous nevus, is a light brown or tan birth mark, speckled with small, dark spots or small bumps. - **Malignant change very rare**
67
Name and describe this type of skin condition [1]
**Dermatofibroma** - common benign fibrous skin lesions. They are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury
68
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Year 4: DERM (20 decks)

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