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Yr 3 - Core Conditions > Dermatology - Skin Tumours > Flashcards

Dermatology - Skin Tumours Flashcards

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1
Q

What is a melanocytic naevus?

A

A pigmented mole - melanocytic naevus is a type of melanocytic tumour (benign) that contains naevus cells (composed of melanocytes).

It can be a direct precursor lesion of melanoma

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2
Q

What are the 3 types of melanocytic naevi

A

Junctional naevus – Between the epidermis and the dermis, flat, usually mid to dark brown.

Compound naevus – Within the dermis and at the epidermal-dermal junction, raised centre with a flat surrounding area, often hairy.

Intradermal naevus – Within the dermis, raised, often hairy, paler.

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3
Q

What is melanoma?

A

A malignant tumour arising from melanocytes (pigment cells)

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4
Q

What is melanoma?

A

A malignant tumour arising from melanocytes (pigment cells) in the skin.

  • In situ → confined to epidermis
  • Invasive → spread to dermis through basement membrane
  • Metastatic → spread to other tissues via lymphatic system or to organs via bloodstream
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5
Q

How are in situ melanomas cured?

A

With excision

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6
Q

What is the risk of recurrence and/or metastasis of melanomas based on?

A

Breslow thickness

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7
Q

What is Breslow thickness?

A

Breslow thickness is the measurement of the depth of the melanoma from the surface of your skin down through to the deepest point of the tumour.

  • <1mm thick = low risk
  • 1-4mm thick = intermediate risk
  • >4mm thick = high risk
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8
Q

What layer of the epidermis are melanocytes found in?

A

Basal layer

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9
Q

What do melanocytes produce?

A

Melanin

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10
Q

What is melanin?

A

A protein that protects skin cells by absorbing UV.

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11
Q

Are melanocytes found equally in black and white skin?

A

Melanocytes are found in equal numbers in black and white skin, but melanocytes in black skin produce much more melanin (dark brown/black skin less likely to be damaged by UV radiation).

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12
Q

What is the most common type of melanoma?

A

Superficial spreading melanoma

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13
Q

How does superficial spreading melanoma grow?

A

Grows flat and horizontally first (spread within epidermis) and later grows vertically

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14
Q

What is the most aggressive form of melanoma?

A

Nodular

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15
Q

How does nodular melanoma grow?

A

Grows rapidly in the vertical plane

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16
Q

What are the 4 types of melanoma

A
  1. Superficial spreading melanoma (most common)
  2. Nodular melanoma (most aggressive)
  3. Lentigo maligna melanoma
  4. Acral lentiginous melanoma
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17
Q

What type of melanoma occurs on palms/soles and under nails?

A

Acral lentiginous melanoma

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18
Q

What is amelanotic melanoma?

A

melanoma with no pigment

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19
Q

What is the ABCDE of melanoma?

A

The ‘ABCDE’ of melanoma is an acronym designed to help the public and clinicians identify features in a skin lesion that may suggest an early or in situ melanoma

  • Asymmetry
  • Border irregularity (melanoma often has a ‘scalloped’ border)
  • Colour variation (a variegated lesion consists of many colours)
  • Diameter >6mm
  • Evolves over time (size, shape)

Other symptoms: bleeding, itching, pain

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20
Q

What diameter would indicate potential melanoma?

A

>6mm

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21
Q

If a lesion has any of the ABCDE features, what should you do?

A

If a lesion has any of these features, it should be referred urgent under the 2 week wait pathway for suspected malignant melanoma

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22
Q

What is the 7 point check list for melanoma?

A
  • Major signs:
    • Change in size
    • Change in shape
    • Change in colour
  • Minor signs:
    • Diameter >7mm
    • Inflammation
    • Altered sensation
    • Crusting/bleeding/oozing
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23
Q

How is Breslow thickness established?

A

Using histology

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24
Q

What is a strong predictor of outcome in melanoma?

A

Breslow thickness

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25
What Breslow thickness indicates the need for a sentinel node biopsy?
\>1mm - look for evidence of metastases and stage the cancer
26
What staging system is used for melanoma?
TNM: * Stage 0 – In situ melanoma * Stage 1 – Think melanoma \<2mm in thickness * Stage 2 – Thick melanoma \>2mm in thickness, or \>1mm thickness with ulceration * Stage 3 – Melanoma spread to invade local lymph nodes * Stage 4 – Distant metastases
27
What is basal cell carcinoma?
A **locally invasive** tumour of the **epidermal (basal) keratinocytes**.
28
Give some risk factors for basal cell carcinoma
* Type I or II skin (fair skin which always burns and never or rarely tans) * History of frequent or severe previous sun burn * Outdoor occupation or hobbies * Personal or FH of skin cancer * Immunosuppression * Increasing age * Male sex * Gorlin’s syndrome (rare, hereditary)
29
What is the most common type of skin cancer?
Basal cell carcinoma
30
Prognosis of BCC?
Rarely metastasise, very rarely a threat to life.
31
Describe the typical appearance of BCC
**Nodular** (most common): * Shiny or **pearly** nodule with smooth surface * Blood vessels cross its surface (**telangiectasia**) * Central depression or **ulceration** * Edges **rolled**
32
What is a rodent ulcer?
BCC lesion where the centre is **necrotic** or **ulcerated** (sometimes called a rodent ulcer)
33
Management of BCC?
Depends on size, location, type and local guidelines – but majority are managed surgically.
34
What is the most common excision of BCC?
Surgical **_excision_** with 4mm margin (most common)
35
What is Mohs Micrographic Surgery?
Mohs micrographic surgery, or Mohs surgery, is a precise surgical technique in which the complete [excision](https://dermnetnz.org/topics/skin-biopsy/) of [skin cancer](https://dermnetnz.org/topics/skin-cancer/) is checked by microscopic margin control. It
36
Purpose of Mohs Micrographic Surgery?
* Use in high-risk areas of face e.g. eyes lips, nose * Very good for ill-defined lesions/need for tissue sparing
37
What cells does SCC arise from?
**epidermal keratinocytes**
38
What is the 2nd most common skin cancer?
SCC
39
Prognosis of SCC?
* Can metastasise which can be fatal * Prognosis favourable (5 year survival of 99%) if SCC is detected early
40
HPV infection can increase your risk of which skin cancer?
SCC
41
Describe the precursors to SCC
Actinic keratosis → Bowen’s disease → SCC
42
What is Bowen's disease also known as?
SCC in situ
43
What is the most common SCC precursor?
Actinic keratosis
44
Painful lesions BCC vs SCC
BCC - not painful SCC - can be painful, tender, bleed
45
Describe the lesion in SCC
**Irregular**, **ill-defined** **red nodule** with **scale** and **ulceration** or **crust** (keratotic)
46
What thickness of SCC is associated with greatest risk?
\>2mm
47
What are the 3 main types of SCCs?
1. Cutaneous horn 2. Keratoacanthoma 3. Carcinoma cuniculatum
48
Where is carcinoma cuniculatum located?
Sole of foot
49
SCC vs BCC:
50
Is seborrhoeic keratosis benign or malignant?
Benign
51
What is seborrhoeic keratosis?
Benign, warty, epidermal growths which occur commonly with **skin ageing**. Despite the name, there is **no relation with sebum, sebaceous lands nor a seborrhoeic distribution**
52
How common is seborrhoeic keratosis?
Very common in older adults (estimated over 90% of adults aged \>50 y/o)
53
Describe the dermatological features of seborrhoeic keratosis
* Well-defined borders * ‘Stuck on’ warty plaque with a fissure keratin surface (greasy) * Colour varies * Slow growing
54
Is seborrhoeic keratosis a precursor for skin cancer?
No
55
What is a lipoma?
A non-cancerous tumour made up of **fat** **cells** – caused by a proliferation of **adipose** **tissue**. It grows slowly under the skin in the subcutaneous tissue.
56
Presentation of lipomas?
* Can be solitary (more common in women) or multiple (more common in men) * Asymptomatic * Slow rowing (years) * Soft, smooth, mobile, subcutaneous nodule
57
What is a **rare** complication of lipomas?
Liposarcoma
58
Treatment of lipomas?
Usually no treatment required (may be surgically removed if impacting upon nearby muscles)
59
What is an epidermoid cyst?
A benign cyst derived from the **infundibulum** or **upper portion of a hair follicle**, _encapsulated_ in a thin layer of epidermis-like epithelium. Typically filled with **keratin** and **lipid**-**rich** **debris**. ## Footnote AKA follicular infundibular cyst, epidermal cyst, keratin cyst.
60
What is the cause of an epidermoid cyst?
Epidermal cell proliferation
61
Do epidermoid cysts more commonly affect men or women
Men 2x
62
Features lesion in epidermoid cyst?
* Skin-coloured/yellow, firm, round nodules * May have a central punctum * May have **offensive smelling** **keratinous contents**
63
What is a dermatofibroma?
A common, benign fibrous nodule usually found on the skin of the lower legs.
64
Who may be affected by **eruptions** of dermatofibromas?
**Immunosuppressed** people
65
Describe a dermatofibroma
* Firm, fibrous, derma nodules or papules * Usually \<1cm diameter * Skin dimples upon compression (pinch sign) * Pale centre
66
Management of a dermatofibroma?
Often no treatment required
67
What are Campbell de Morgan spots?
Cherry angioma that describes a **benign** **vascular** **skin** **lesion**.
68
Cause of Campbell de Morgan spots?
Proliferating **_endothelial_** cells (these are the cells that line the inside of a blood vessel) and subsequent blood vessel overgrowth. Aetiology unknown.
69
Presentation of Campbell de Morgan spots?
* Number of spots increases with age * Common on mid-trunk * Lesion: Red/purple/black papules or macules
70
Treatment of Campbell de Morgan spots?
Usually no treatment required (may be removed for cosmetic reasons).
71
What are fibroepithelial polyps also known as?
Skin tags
72
What are fibroepithelial polyps?
A common, soft, harmless lesion that appears to hang off the skin.
73
Which virus may be associated with the development of fibroepithelial polyps?
HPV

Yr 3 - Core Conditions (33 decks)

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