Dermatology - skin cancer

Question 1

What are examples of non-melanoma skin cancer?

Answer 1

Basal cell cancer

Squamous cell cancer

Question 2

What is the more common non-melanoma skin cancer?

Answer 2

Basal cell cancer

Question 3

What are the risk factors for non-melanoma skin cancer?

Answer 3

UV radiation
Photochemotherapy - PUVA
Chemical carcinogens
X-ray and thermal radiation
HPV
Familial cancer syndromes
Immunosuppression

Question 4

What are the features of basal cell carcinoma?

Answer 4

Slow growing
Locally invasive
Rarely metastasise

Question 5

What are the types of basal cell carcinoma?

Answer 5

Nodular: pearly rolled edge, telangiectasia, central ulceration, arborising vessels on dermoscopy
Superificial
Pigmented
Morphoeic

Question 6

What is the treatment for basal cell carcinoma?

Answer 6

Excision
Curettage
Vismodegib

Question 7

What is the gold standard treatment for BCC?

Answer 7

Exicision

Question 8

What is Mohs surgery?

Answer 8

Precise surgical technique to remove skin cancer

Thin layers of cancer-containing skin progressively removed and examined

Question 9

What are indications for Mohs surgery?

Answer 9

Site
Size
Subtype
Poor clinical margin definition
Recurrent
Perineural or perivascular involvement

Question 10

What is the drug treatment for BCC?

Answer 10

Vismodegib

Question 11

What are the indications for use of Vismodegib?

Answer 11

Locally advanced BCC not suitable for surgery or radiotherapy
Metastatic BCC

Question 12

What does Vismodegib do?

Answer 12

Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
Can shrink tumour and heal visible lesions in some

Question 13

What are the side effects of Vismodegib?

Answer 13

Hair loss, weight loss, altered taste, muscle spasms, nausea, fatigue

Question 14

What is squamous cell carcinoma derived from?

Answer 14

Keratinising squamous cells

Question 15

Where is SCC usually found?

Answer 15

Sun exposed sites

Question 16

What are the features of SCC?

Answer 16

Can metastasise
Faster growing than BCC, tender, scaly/crusted or fleshy growths
Can ulcerate

Question 17

What is the treatment for SCC?

Answer 17

Excision +/- radiotherapy

Question 18

What is a high risk SCC?

Answer 18

Immunosuppressed
>20mm diameter
>4mm depth
Ear, nose, lip, eyelid
Perineural invasion
Poorly differentiated

Question 19

What is keratoacanthoma?

Answer 19

Variant of SCC

Question 20

Where does keratoacanthoma come from?

Answer 20

Erupts from hair follicles in sun damaged skin

Question 21

What is the treatment for keratoacanthoma?

Answer 21

Surgical excision

Question 22

What are the risk factors for malignant melanoma?

Answer 22

UV radiation
Genetic susceptibility: fair skin, red hair, blue eyes, tendency to burn
Familial melanoma

Question 23

What is the ABCDE rule for melanoma?

Answer 23

A = asymmetry
B = border
C = colour
D = diameter 
E = evolution

Question 24

What is the 7 point checklist for malignant melanoma?

Answer 24

Major features:
*Change in shape
*Change in size
*Change in colour
Minor features:
*Diameter more than 5mm
*Inflammation
*Oozing or bleeding
*Mild itch or altered sensation

Question 25

What is the bedside tool for assessing melanoma?

Answer 25

Dermoscopy

Question 26

What is biologic progression of melanoma?

Answer 26

``` Benign nevus Dysplastic nevus Radial growth phase Vertical growth phase Metastatic melanoma ```

Question 27

What are some of the different types of melanoma?

Answer 27

``` Superifical spreading malignant melanoma Lentigo maligna melanoma Nodular melanoma Acral lentiginous melanoma Subungal melanoma Ocular melanoma ```

Question 28

What is the treatment for melanoma?

Answer 28

``` Urgent surgical excision Wide local excision Sentinel lymph node biopsy Chemotherapy/immunotherapy Regular follow up Primary and secondary prevention ```

Question 29

What is the scale for measuring the depth of a melanoma?

Answer 29

Breslow thickness

Question 30

What are the drugs for malignant melanoma?

Answer 30

Ipilimumab Pembrolizumab Vemurafenib Dabrafenib

Question 31

What are the two forms of cutaneous lymphoma?

Answer 31

Primary cutaneous disease - abnormal neoplastic proliferation of lymphocytes in the skin Secondary cutaneous disease - from systemic/nodal involvement

Question 32

What are the two types of primary cutaneous disease?

Answer 32

Cutaneous T cell lymphoma | Cutaneous B cell lymphoma

Question 33

Which cutaneous lymphoma is more common?

Answer 33

Cutaneous T cell lymphoma

Question 34

What are the two most common types of cutaneous T cell lymphoma?

Answer 34

Mycosis fungoides | Sezary syndrome

Question 35

What is the most common cutaneous T cell lymphoma (CTCL)?

Answer 35

Mycosis fungoides

Question 36

What are the stages of mycosis fungoides (MF)?

Answer 36

1. Patch: flat, red, dry oval lesions, usually covered sites, may itch, difficult to differentiate from eczema/psoriasis 2. Plaque: patches become thickened and generally itch 3. Tumour: large irregular lumps, arise from existing plaques or normal skin, more likely to have metastatic spread 4. Metastatic

Question 37

What are the investigations for mycosis fungoides?

Answer 37

``` Bloods for sezary cells CT imaging (staging) ```

Question 38

What is Sezary syndrome also known as?

Answer 38

Red man syndrome

Question 39

What are the features of Sezary syndrome?

Answer 39

Skin thickened, scaly, red, very itchy

Question 40

What are Sezary cells?

Answer 40

Atypical T cells

Question 41

What is the treatment for cutaneous lymphoma?

Answer 41

``` Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose Methotrexate Chemotherapy Total skin electron beam therapy Extracorporeal photophoresis Bone marrow transplantation ```

Question 42

What is total skin electron beam therapy?

Answer 42

Type of radiotherapy consisting of very small electrically charged particles, delivers radiation to superficial layers: epidermis and dermis Spares deeper tissues and organs

Question 43

What is extracorporeal photophoresis?

Answer 43

Patients leukocytes collected and made sensitive to UVA radiation which damages diseased cells, treated cells reinfused back into patient

Question 44

What is cutaneous metastases secondary to?

Answer 44

Primary skin malignancy e.g. melanoma | Primary solid organ malignancy

Question 45

What is the treatment for cutaneous metastases?

Answer 45

Treat underlying malignancy Local excision Local radiotherapy Symptomatic

Question 46

What are the commonest skin cancers?

Answer 46

BCC, SCC

Question 47

What is the most serious skin cancer?

Answer 47

Melanoma

Question 48

What are rarer skin cancers?

Answer 48

Skin lymphomas | Skin metastases