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Dermatology > Non-Melanoma skin cancers and benign skin tumours > Flashcards

Non-Melanoma skin cancers and benign skin tumours Flashcards

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1
Q

What are some examples of premalignant lesions

A

actinic keratosis

intraepidermal carcinoma /bowens/SCC in-situ

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2
Q

whats another name for actinic keratosis

A

solar keratosis

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3
Q

what % of people are affected by actinic keratosis

A

20%

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4
Q

what is the risk of progression to SCC for actinic keratosis

A

<1:1000 p/y

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5
Q

what are features of actinic keratosis

A

single or multiple lesions, macular/patches of scaling skin with erythema, usually in sun exposed areas in older people

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6
Q

what symptoms to actinic keratosis have

A

usually asymptomatic

may be sore/itch

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7
Q

what are the treatment options for AK

A 
do nothing - 25% resolve spontaneously 
cryotherapy - 95-100% cure rate
5FU cream 
curettage and cautery 
PDT
diclofenac gel
imiquimod
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8
Q

how do you choose first line treatment for AK

A

discrete lesions = cryotherapy

5-FU for diffuse lesions

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9
Q

what is intraepidermal carcinoma

A

dysplasia extending through the full thickness of the epidermis

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10
Q

where is IEC/Bowens usually found

A

lower legs of elderly women

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11
Q

whats the risk of malignant transformation for IEC/Bowens

A

3-5%

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12
Q

whats the treatment option for IEC/Bowens

A 
5-FU cream
cryotherapy
curettage/cryotherapy
excision
PDT
imiquimod
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13
Q

when is cryotherapy avoided for IEC/Bowens

A

if on lower legs to avoid ulceration

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14
Q

what is preferred when treating Bowens/IEC if ulceration is particularly risky (IE cryotherapy is contraindicated)

A

PDT (photodynamic Therapy)

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15
Q

what are some examples of non-melanocytic malignant lesions

A

BCC

SCC

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16
Q

what proportion of non-melanocytic malignant lesions are BCCs

A

80%

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17
Q

what are features of BCCs

A

slow growing, asymptomatic lesion with a rolled/pearled edge , usually on sun exposed areas

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18
Q

what are the subtypes of BCCs

A

nodular
superficial
morpheic/sclerosis
pigmented

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19
Q

what are most common areas for BCCs to be on

A

trunk

face

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20
Q

what are features of BCCs at high risk of recurrence

A 
increased size 
central face
poorly defined margins 
morpheic-subtype
histological invasion
previous treatment failure
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21
Q

whats the first line treatment for BCC

A

surgical excision with 5mm margins

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22
Q

whats the treatment success for first-line intervention for BCC + whats the recurrence rate

A

95% , 2%

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23
Q

what is done for BCCs with high risk of recurrence + whats the success rate of that surgery

A

moh’s micrography, 99% BCC, 95% for high risk recurrence BCCs

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24
Q

what is moh’s micrography surgery

A

bulk of tumour is excised
margins removed carefully with a biopsy punch and each punch is quickly examined with reports giving histological analysis in 4 directions (e.g. 12 clear, 3,6,9 tumour)

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25
what are risks of radiotherapy for BCC
radionecrosis and possible SCC at the site
26
what is imiquimod - + how useful is it
topical immune modulator, good for low risk tumours, increased recurrence rates compared to surgery but decreased cosmetic damage
27
what should always be done if a BCC is suspected
confirm with biopsy
28
which non-melanocytic malignant lesion has the highest risk for metastasis
SCC
29
whats the 5 year survival for SCC
75-90%
30
what factors increase the risk for mets for SCCs
``` ear/lip SCC >2cm increased depth non sun exposed areas poor differentiation immunosuppresion mucosal subtype perineural invasion ```
31
what are features of SCCs
much shorter timeframe (weeks) , firm skin coloured nodule with keratinised surface/soft fleshy nodule with eroded surface and a non healing wound
32
what is the best treatment for SCCs +whats its success
Excision with a 4mm margin, 95%
33
what can be used for small primary SCC
curettage and cautery
34
what are some examples of non-melanocytic benign lesions
``` dermatofibroma neurofibroma epidermoid and pilary cysts keratocanthoma strawberry naevus cherry angioma pyogenic granuloma seborrhoeic keratosis viral warts cutaneous horn ```
35
what is a dermatofibroma
benign discrete solitary dermal nodules on the extermities of young adults overlying epidermis pigmented
36
what is the iceberg effect
a nodule feels bigger than it is
37
how do you manage a dermatofibroma
leave alone unless there is diagnostic doubt
38
what is a neurofibroma
PNS neural sheath tumour
39
what is the aetiology of neurofibroma
90% stand alone tumours | 10% in NF-1
40
what are some features of neurofibromatosis-1
cafe au lait patches axillary freckling lisch nodules
41
what are epidermoid/pilar cysts
common swelling with a central punctum what ruptures with a foul-smelling material histologically lined with epidermis or outer sheath or hair follicle (hence epidermoid/pilar)
42
how do you treat epidermoid/pilar cysts
excision
43
what are keratocanthomoas
rapidly enlarging pink papule that then forms a crater in the center, rapidly resolves in 6-12 months but leaves an ugly scar
44
who tends to get a keratocanthoma + where does it tend to be
fair individuals, on sun exposed areas
45
what other dermatological lesion does a keratocathoma look like + how is it different
an SCC- but its quite symmetrical and faster growing
46
what is a strawberry naevus
haemangioma present within a few weeks of birth raised compressible swelling with bright red surface
47
how is a strawberry naevus managed
do nothing as usually spontanteously resolves - 50% by 5, 90% by 9
48
what are complications with strawberry naevus and how do you manage
bleed/ulceration following trauma = observe/reassure functional issues = high dose systemic steroids plastic surgery rarely done
49
what is a cherry angioma
benign red papules seen on the trunks of middle-aged + eldery people
50
what is a pyogenic granuloma
common benign acquired haemangioma developing at sites of trauma most commonly in kids-young adults bright red raised lesions
51
whats an important differential for a pyogenic granuloma
amelanotic malignant melanoma
52
how do you remove a pyogenic granuloma
curettage and cautery
53
what is seborrhoeic keratosis
common benign epidermal tumour found usually in >50s on the face/trunk looks like 'stuck on' yellow/brown macules/plaques +/- scaling
54
what % of schoolchildren have a viral wart at any one time
4-5%
55
what virus is most commonly associated with viral warts
HPV, (1,2,4)
56
what are the types of viral wart
``` common plantar mosaic plane facial anogenital ```
57
what are the features of a common wart
smooth initially, eventually hyperkeratotic on face/genitals often multiple pain is rare
58
what are the features of a plantar wart
rough surfaces surrounded bt a horny collar, bleeding capillary loops (black dots) distiguish from corns, usually in multiples and painful
59
what are the features of a mosaic wart
rough plawues of individual warts, most commonly on soles, palms and around fingers/ not painful
60
what are features of plane warts
smooth flat-topped papules, found on face brow and back of hand, become inflamed then resolve spontaneously, skin coloured/light brown usually multiple usually painless
61
what are features of facial warts
in breard area of males most commonly spread by shaving ugly but painless
62
what are features of anogenital warts
papillomatous cauliflower-like lesions with moist macerated vascular surface they may coalesce to form giant lesions vaginal/anorectal mucosa may be affected
63
what should be suspected if there is anogenital warts in kids
sexual abuse | but usually, it is autoinoculation from other areas
64
what is a cutaneous horn + how should it be managed
compacted keratin - always do histology as there may be an AK/IEC/SCC at the base may also be seborrheic keratosis
65
what are some risk factors for skin cancer
``` long term UV exposure fair skin type increased age immunosuppression genetic site of chronic inflammation HPV (SCC) ```
66
what genetic syndromes are higher risk for skin cancer development
gorlin's syndrome for BCC | Xeroderma Pigmentosum

Dermatology (12 decks)

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