Epidermal Tumours

Question 1

example of a benign epidermal tumour

Answer 1

seborrheic keratosis (basal cell papilloma)

Question 2

examples of precancerous dysplasia

Answer 2

Bowen’s disease
actinic keratosis
viral lesions

Question 3

examples of invasive malignancies

Answer 3

basal cell carcinoma

squamous cell carcinoma

Question 4

define seborrheic keratosis

Answer 4

benign proliferation of epidermal keratinocytes

Question 5

where is seborrheic keratosis usually located

Answer 5

face

trunk

Question 6

appearance of seborrheic keratosis

Answer 6

well-defined
small cysts/ depressions
warty
stuck on apperance
greasy hyperkeratotic surface

Question 7

define leser-trelat sign

Answer 7

abrupt eruptive onset of multiple seborrheic keratoses (paraneoplastic syndrome)

Question 8

management of seborrheic keratosis

Answer 8

reassurance

cryotherapy if troublesome

Question 9

define Bowen’s disease

Answer 9

full thickness dysplasia of epidermal keratinocytes

Question 10

diagnosis of Bowen’s disease

Answer 10

biopsy

Question 11

management of Bowen’s disease

Answer 11

non-surgical is imiquimod cream

Question 12

where is Bowen’s disease usually located?

Answer 12

legs

Question 13

appearance of Bowen’s disease

Answer 13

scaly patch/plaque
irregular border
can mimic inflammatory conditions

Question 14

where is actinic keratosis usually found

Answer 14

head

neck

Question 15

what is a common precursor of invasive SCC

Answer 15

actinic keratosis

Question 16

where is actinic keratosis usually found?

Answer 16

sun-exposed sites

Question 17

presentation of actinic keratosis

Answer 17

scaly with no signs of progression (can become SCC- more common in immunosuppressed)

Question 18

where are viral lesions found?

Answer 18

anogenital skin

Question 19

causes of viral lesions

Answer 19

HPV16

Question 20

management of precancerous dysplasias

Answer 20

cryotherapy
5-fluorouracil cream
imiquimod
PDT

Question 21

genetics of basal cell carcinoma

Answer 21

mutations in PTCH1 (hedgehog signalling pathway)

Question 22

where is basal cell carcinoma often located?

Answer 22

sun exposed sites

Question 23

appearance of BCC

Answer 23

slow growing
painless
picket fence pearly border

Question 24

three subtypes of BCC

Answer 24

nodular (pearly with blood vessels)
superficial (plaque with pearly whipcord margin)
infiltrative (waxy, scar-like plaque with indistinct borders)

Question 25

diagnosis of epidermal tumours

Answer 25

skin biopsy

Question 26

management of epidermal tumours

Answer 26

vismodegib
excision
imiquimod, PDT or cryotherapy

Question 27

who does squamous cell carcinoma arise in?

Answer 27

elderly

immunosuppressed

Question 28

where are SCC usually located?

Answer 28

sun-exposed sites
chronic leg ulcers
burns
chronic lupus vulgaris

Question 29

rare associations with SCC

Answer 29

xeroderma pigmentosum

dystrophic variant epidermolysis bullosa

Question 30

presentation of SCC

Answer 30

hyperkeratotic warty or crusted lump or ulcer
fast growth
painful
bleeds

Question 31

management of SCC

Answer 31

excision

Question 32

who does Kaposi’s sarcoma arise in?

Answer 32

HIV

immunosuppressed (transplant)

Question 33

appearance of Kaposi’s sarcoma

Answer 33

purple lesions (herpes)

Question 34

risk factors for development of skin cancer

Answer 34

• sun exposure
• genetic predisposition
• immunosuppression
• environmental carcinogens
• phototoxic drugs

Question 35

examples of genetic predispositions to skin cancer

Answer 35

xeroderma pigmentosum
albinism (congenital absence of melanin AR)
Gorlin’s syndrome
recessive dystrophic epidermolysis bullosa

Question 36

describe albinism

Answer 36

congenital absence of melanin (AR), absence or defect of tyrosine, lack on retina leads to visual problems e.g. photophobia, nystagmus and amblyobia

Question 37

describe Gorlin’s syndrome

Answer 37

AD condition with multiple BCC’s (naevoid basal cell carcinoma)

Question 38

examples of phototoxic drugs

Answer 38

voriconazole
thiazide diuretics
NSAIDs
anti-TNF
azathioprine