👍🏻Dermatology👍🏻- Skin Cancer

Question 1

How can skin lesions be categorised?

Answer 1

Pigmented
Non-pigmented

Question 2

How can pigmented lesions by further subdivided?

Answer 2

Melanocytic and non-melanocytic

Question 3

What are the melanocytic lesions?

Answer 3

Melanocytic naevi
Solar lentigo
Lentigo maligna
Malignant melanoma

Question 4

What are the types of malignant melanoma?

Answer 4

Lentigo maligna
Lentigo maligna melanoma
Superficial spreading melanoma
Nodular melanoma
Acral lentiginous melanoma
Subungual melanoma
Amelanotic melanoma

Question 5

What is a melanoma?

Answer 5

Question 6

What is a lentigo maligna?

Answer 6

A melanoma in situ
Proliferation of malignant melanocytes within the epidermis
Common Sites: Face, neck, and sun-exposed areas in elderly individuals

Question 7

What do lentigo malignas look like?

Answer 7

Irregular shape
Light and dark brown colours
Size usually >2.0cm

Question 8

What is a lentigo maligna melanoma?

Answer 8

Invasive melanoma arising from Lentigo Maligna
Common Sites: Same as LM—primarily face and neck

Question 9

What are the characteristic features of a LMM?

Answer 9

Expanding pigmented lesion with increasing variation in colour and surface nodularity

Question 10

What are the two types of melanoma growth?

Answer 10

Question 11

What is a SSM?

Answer 11

Superficial Spreading Melanoma (SSM)
The most common type of melanoma (~70% of cases)
Common Sites: Men – trunk; Women – lower legs

Question 12

What is the appearance of an SSM?

Answer 12

Irregularly bordered, asymmetrical macule with multiple colors (brown, black, red, blue, or white)

Question 13

What is the growth pattern of SSM and how does it link to its prognosis?

Answer 13

Slow radial growth phase, followed by vertical growth
Good prognosis if growth remains horizontal
Vertical growth indicates aggression and ability to metastasis - poor prognosis

Question 14

What is de-pigmentation?

Answer 14

In up to 2/3 SSMs, regression due to host immune system response

Question 15

How do you diagnose an SSM?

Answer 15

Question 16

What occurs after vertical proliferation of malignant melanocytes (if there was no previous horizontal growth)?

Answer 16

Nodular malignant melanoma

Question 17

What are the key differences between SSM and nodular melanomas?

Answer 17

NM much more aggressive
Early vertical growth - No radial growth phase
NM has a raised nodule, SSM is flat
Much worse prognosis due to early invasion and metastasis risk

Question 18

What can occur within an SSM?

Answer 18

Nodular melanoma arising within a superficial spreading melanoma

Question 19

What is an acral lentiginous melanoma?

Answer 19

A rare but most common melanoma in darker-skinned individuals
Irregularly pigmented macule or patch on palms, soles, or under nails
Acral (hand and foot) surfaces
Slow radial growth, later becoming invasive

Question 20

What is unique to acral lentiginous melanomas?

Answer 20

Tumours always flat on feet due to constant pressure being applied

Question 21

What is a subungual melanoma?

Answer 21

subtype of Acral Lentiginous Melanoma affecting the nail unit
Thumb and big toe most affected

Question 22

What is the appearance of a subungual melanoma?

Answer 22

Longitudinal melanonychia (dark stripe on the nail)
Ulceration
Nail dystrophy
Hutchinson’s sign (pigmentation spreading to nail fold/cuticle)

Question 23

How are dermatological findings investigated?

Answer 23

Question 24

What is an amelanotic melanoma?

Answer 24

Melanomas do not always have to be pigmented
A nodule on the skin – always alarming
A non-pigmented melanoma, making diagnosis challenging

Question 25

What are the biggest risk factors for melanoma?

Answer 25

Family history of dysplastic nevi/melanoma Sunburns during childhood Intermittent burning exposure in unacclimatized fair skin Atypical/dysplastic nevi Personal history of melanoma

Question 26

What is the management for melanoma?

Answer 26

Question 27

What further investigations can be taken in melanoma management if disease thickness exceeds 0.8mm or there are sign of later stage disease?

Answer 27

Sentinel lymph node biopsy ( if thickness >0.8mm) PET-CT​ (if stage III&IV) MRI Brain​ (if stage III&IV)

Question 28

What is a pyogenic granuloma?

Answer 28

A benign, rapidly growing vascular lesion Nodulous Common on fingers, lips, face, and oral mucosa Caused by trauma, irritation or sometimes pregnancy Easily bleeds with minor trauma due to high vascularity

Question 29

Describe the appearance of a pyogenic granuloma

Answer 29

Bright red, dome-shaped lesion, often pedunculated

Question 30

What are the non-pigmented skin cancers?

Answer 30

Actinic keratosis- precancerous Bowen’s disease (SCC in situ) Squamous cell carcinoma Basal cell carcinoma

Question 31

What does "in situ" mean in dermatology?

Answer 31

Confined to the epidermis

Question 32

What is Bowen's disease?

Answer 32

SCC in situ

Question 33

What in this image suggests cancer?

Answer 33

Red dots - glomerular vessels Indicates cancerous histology

Question 34

What is actinic keratosis?

Answer 34

Dysplastic keratinocytes

Question 35

Compare actinic keratoses, Bowen's disease, SCC

Answer 35

Question 36

What are the treatments for AKs and Bowen's?

Answer 36

5 fluorouracil cream Cryotherapy Imiquimod cream Photodynamic therapy Currettage and cautery Excision

Question 37

What are the pros and cons of photodynamic therapy?

Answer 37

more expensive and unpleasant better cosmetic results (e.g. a lady with a SCC in situ on face may opt for photodynamic therapy)

Question 38

Outline the AK and Bowen's treatments

Answer 38

5-fluoracil cream - antimetabolite cream, causes appoptosis in dysplastic cells Cryotherapy - freezes lesions using liquid nitrogen Imiquimod cream - Immune response modulator - activates T-cell-mediated clearance of dysplastic cells Photodynamic therapy - Photosensitizing agent applied, followed by exposure to light - destruction of dysplastic cells Curettage & cautery - scraping lesion with curette then cauterizing base to destroy remaining cells Excision - complete surgical removal of lesion

Question 39

What is the clinical appearance of SCC?

Answer 39

Question 40

What is a keratoacanthoma?

Answer 40

Rapidly enlarging papule that evolves into a **sharply circumscribed, crateriform nodule with keratotic core** Over months, slowly **resolves** Difficult to distinguish clinically and histologically from squamous cell carcinoma

Question 41

Outline BCC

Answer 41

Superficial Well-focused arborising vessels and the occasional small blue globule Most common CANCER in the world – not skin cancer, CANCER

Question 42

How do BCCs usually present?

Answer 42

Question 43

What is the treatment for BCC or SCC?

Answer 43

Surgery Mohs surgery at high risk sites Radiotherapy

Question 44

What is Mohs surgery?

Answer 44