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Flashcards in melissa cooper Deck (14):
1

where could a melanoma spread

 Local spread to skin and subcutaneous tissues
 Lymphatic spread to popliteal and inguinal lymph nodes
 Haematogenous spread to distant organs

2

should we all have skin checks

 Not currently in red book of preventative activities in Australian general practice
 SCREEN trial in Germany showed melanoma mortality was reduced by over 50%, 10 years
after population based screening trial introduced.

3

why isn't population screening of melanoma recommended in australia

Population based screening in not currently recommended in Australia on 3 grounds:
 Nonmelanoma skin cancer has a low mortality
 Melanoma frequency does not justify a mass population screening program on economic
grounds
 Instruments that would be used for mass screening (GP assessment) and other computer
assisted digital photography software are not sufficiently accurate at present.

4

what does a skin check involve

A targeted history aimed at:
 Identification and management of high-risk individuals
 Identification of any lesions that the patient is concerned about
A full skin examination
 Planning for excision or other treatment of any lesions thought not to be clinically benign
 Advising the patient on appropriate follow up intervals and the method of self examination.

5

Is UVA or UVB radiation more carcinogenic?

UVB

6

What is a benign neoplasm of:
1.Epidermal origin
2.Melanocytic origin
3.Soft Tissue origin

1. Warts, seborrheic keratosis
2. Naevi
3. Lipoma

7

What does EFG mean when referring to nodular melanoma?

It's an acronym to summarise nodular melanoma appearance
E - elevated
F -firm
G-growing

8

What are the differences in mutations between the first one i benign naevi, and the one in metastatic melanoma?

Benign naevi get a mutation in BRAF
Metastatic melanoma are missing TRMP1

9

Describe the process moving from a flat melanoma to a nodular melanoma

step 1 - preserved rete ridges are infiltrated by aggregates of melanoma cells
Step 2 - there is remodelling, with flattening of the dermal-epidermal junction, which is associated with inflammation, angiogenesis and fibroplasia. Macrophages get stuffed with melanin. Lesion is still flat
Step 3 - Angiogenesis factors have continued to make new blood vessels and the lesion spreads into the dermis. This is now an invasive tumour

10

Describe how prognosis changes based on Breslow thickness

11

What does clark level measure?

Level of invasion, related to anatomy of the skin

12

How do ulceration, satellite bodies and mitotic bodies affect prognosis for melanoma?

They are all adverse risk factors - in mitotic bodies, more than 1 per mm^2 is adverse

13

What's the chance of an adverse risk factor due to medical error if you are admitted to hospital?

16.6%

14

What are the four theories on why things go wrong?

Plague model - errors are an epidemic
Person model - errors are a product of wayward mental processes
Legal/moral model - responsible professionals shouldn't make errors
System model - errors are a fact of life, and adverse events are a product of many factors

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