Derm- skin cancer

Question 1

what is basal cell carcinoma

Answer 1

a skin cancer originating from the basal keratinocytes within the epidermis, usually secondary to DNA damage caused by UV radiations

Question 2

what is the most common malignant skin tumour

Answer 2

basal cell carcinoma

Question 3

most commonly involved sites of basal cell carcinoma

Answer 3

sun-exposed areas of head and neck

Question 4

risk factors for basal cell carcinoma

Answer 4

family history/previous history
genetic syndromes
pale skin/light hair- Fitzpatrick type I/2
high levels of sun/UV exposure
immunosuppression
chronic inflammation
smoking
old age and male sex

Question 5

is basal cell carcinoma slow/fast growing?

Answer 5

slow growing

Question 6

does basal cell carcinoma often mestastesize?

Answer 6

rarely- almost never

Question 7

what do nodular basal cell carcinomas look like

Answer 7

shiny
pearly nodule
superficial telangiectasia
may be ulcerated

Question 8

what do superficial basal cell carcinomas look like

Answer 8

erythematous
well-demarcated
scaly plaques
often larger than 20mm at presentation

Question 9

what are infiltrative basal cell carcinomas characterised by

Answer 9

thickened yellowish plaques

Question 10

typical management of nodular basal cell carcinoma

Answer 10

excise

Question 11

typical management of superficial basal cell carcinoma

Answer 11

non-surgical

Question 12

typical management of infiltrative basal cell carcinoma

Answer 12

Mohs surgery

Question 13

which type of basal cell carcinoma may be ulcerated

Answer 13

nodular basal cell carcinoma

Question 14

what is squamous cell carcinoma

Answer 14

malignant tumour that arises from supra-basal keratinocytes

Question 15

what is the most common skin cancer in the immunosuppressed population

Answer 15

squamous cell carcinoma

Question 16

which type of skin carcinoma may be painful and/or bleed

Answer 16

squamous cell carcinoma

Question 17

what factors determine a poor prognosis in squamous cell carcinoma

Answer 17

metastases
size- diameter >20mm
depth- >4mm
poorly differentiated
immunocompromised

Question 18

what is malignant melanoma

Answer 18

proliferation of atypical melanocytes with potential for dermal invasion and widespread metastasis

Question 19

abcde checklist for skin cancer

Answer 19

a- asymmetry
b- irregular Border
c- variable Colour
d- diameter >6mm
e- evolution/elevation

Question 20

what is the Breslow depth

Answer 20

measured from the granular layer of the epidermis down to the deepest point of invasion
Smaller the depth = better prognosis

Question 21

what is the most aggressive type of melanoma

Answer 21

nodular melanoma

Question 22

where does nodular melanoma often present

Answer 22

trunk

Question 23

how does nodular melanoma usually present

Answer 23

rapidly growing pigmented nodule, which bleeds or ulcerates

Question 24

what are acral malignant melanomas

Answer 24

subtype of melanoma that arise as pigmented lesions on the palm or sole or under the nail, and usually present late

Question 25

what is different about the way nodular melanomas grow compared to other melanomas that make them more aggressive

Answer 25

grow vertically from the outset

Question 26

breslow thickness- confined to epidermis (in-situ) 5 year survival rate?

Answer 26

100% 5 year survival

Question 27

breslow thickness- <0.76mm 5 year survival rate?

Answer 27

90% 5 year survival

Question 28

breslow thickness- >3mm 5 year survival rate?

Answer 28

60% 5 year survival rate

Question 29

when breslow thickness is >1mm what investigation should be carried out?

Answer 29

sentinel node biopsy

Question 30

what is the most common type of melanoma

Answer 30

superficial spreading melanoma

Question 31

what are Actinic (solar) keratoses

Answer 31

partial thickened dysplasia of epidermal keratinocytes

Question 32

A small minority (<1%) of actinic keratoses undergo malignant transformation into what type of skin cancer?

Answer 32

squamous cell carcinoma

Question 33

what do Actinic (solar) keratoses look like

Answer 33

scaly, erythematous papules/patches that feel gritty and rough

Question 34

where do Actinic (solar) keratoses appear

Answer 34

sun exposed skin- marker of chronic skin damage

Question 35

what is Bowens disease

Answer 35

squamous cell carcinoma in situ- full thickness dysplasia of epidermal keratinocytes

Question 36

where does Bowens disease typically occur

Answer 36

lower legs in fairer skin women torso in men

Question 37

what is Keratoacanthoma

Answer 37

Rapidly growing epidermal tumours

Question 38

what is the management of keratoancanthoma

Answer 38

surgical excision- may spontaneously resolve within a few months but can be difficult to distinguish between SSC

Question 39

what is cryotherapy

Answer 39

extreme cold, liquid nitrogen, applied to tumour to destroy tumour

Question 40

what is curretege

Answer 40

use of a curette to scrape or remove tissue from the body

Question 41

what is cautery

Answer 41

the use of heat or chemicals to destroy or remove abnormal tissue

Question 42

what is the downside of using cryotherapy in patients with darker skin

Answer 42

may cause hypopigmentation in long term

Question 43

weaknesses of using curretege to remove tumour

Answer 43

possibly painful risk dyspigmentation scarring MUST AVOID SUN

Question 44

topical therapies used to treat dysplastic/pre-malignant skin lesions

Answer 44

fluorouracil cream imiquimod cream

Question 45

what should patients be warned about before using fluoroucil cream

Answer 45

lesion may erupt and become worse before it gets better avoid sun exposure

Question 46

squamous cell carcinoma in situ can also be referred to as what

Answer 46

Bowens disease

Question 47

actinic keratosis is the result of DNA damage by which type of UV rays?

Answer 47

UVB rays

Question 48

when surgically excising a lesion how much do you excise

Answer 48

all of it- 1cm laterally for every 1mm depth

Question 49

what skin cancer looks like a picket fence with a pearly border

Answer 49

basal cell carcinoma