Plastics skin cancer

Question 1

Pearly raised rolled ages with blood vessels visible and central ulceration. Patient noticed it getting bigger recently but thinks its been there a while, it started bleeding recently though

Answer 1

Nodular basal cell carcinoma

Question 2

What part of skin does melanoma occur?

Answer 2

Basal layer of epidermis at the demo-epidermal junction

Question 3

common sites of melanoma in men v women

Answer 3

Males 40% on trunk
females 40% on legs
dark skinned - more on paln, sole, nailbed

Question 4

What % of melanoma arise form a pre-exsiting lesion, List those lesions

Answer 4

25%
- Benign melanocytic naevus
- Atypical or dysplastic naevus
Atypical lentiginous junctional naevus
- Large or giant-sized congenitalmelanocytic naevus

Question 5

What skin phototype is more prone to ephelides?

Answer 5

Freckles - type 1

there is no increase in melanocytes here

Question 6

Difference between ephelides and lentigo simplex?

Answer 6

Lentigo simplex is not caused by sun exposure

Question 7

Difference between solar actinic lentigo and ephelides?

Answer 7

Solar lentigo are caused by sun exposure later in life

Question 8

What are melanocytic naevi and when is there a risk

Answer 8

Benign proliferation of melanocytes
1 in 100,000 risk of change to melanoma.
That risk is increased by increased number of naevi or an increased number of dysplastic naevi

Question 9

What mutation typically causes acquired melanocytic naevi?

Answer 9

BRAF mutation

Question 10

criteria for dysplastic naevus syndrome

Answer 10

All 3:
>100 naevi
> 6 dysplastic naevi
one naevus > 8mm diameter

Question 11

T/F Melanoma in situ increases the risk fo developing another primary melaona

Answer 11

True

Question 12

What is lentigo maligna

Answer 12

A variant of melanoma in situ on chronically sun damaged skin
Commonly on head an neck
Often large with indistinct margins

Question 13

Gorlin syndrome is a risk factor for what

Answer 13

BCC

Question 14

Thin translucent rolled border with microerosions over scaly pink patch of skin on the face

Answer 14

Superficial BCC

Question 15

Tx options for BCC

Answer 15

Surgical excision / Moh’s micrographic sx
Radiotherapy
topical 5 GU/imiquimod

Question 16

Precursor to 60% of SCC

Answer 16

Actinic keratosis

Question 17

cells involved in actinic keratosis

Answer 17

Proliferation of atypical epidermal keratinocytes

Question 18

Tx of actinic keratosis

Why treat actinic keratosis?

Answer 18

Cryotherapy
typical 5FU
surgical excision
Tx because risk of progression to SCC

Question 19

How does BCC spread?

Answer 19

Locally invasive

Question 20

How does SCC spread?

Answer 20

Can metastasise via lymphatics so must examine the draining lymph nodes

Question 21

cells involved in SCC

Answer 21

Epidermal keratinocytes

Question 22

Tender, ulcerated scaly / crusted lesion on lips

Answer 22

SCC

lips - poor prognosis

Question 23

SCC in situ aka

Answer 23

Bowen’s disease

Question 24

what percentage of melanoma arise de novo

Answer 24

75%

Question 25

what diameter of a naevus is a characteristic that may be suspicious of melanoma

Answer 25

> 6mm

Question 26

Most common type of melanoma

Answer 26

Superficial spreading

will have irregular asymmetric borders

Question 27

Rate of growth of nodular melanoma

Answer 27

rapid - weeks or months

Question 28

Acral lentiginous melanoma is most common in what skin types

Answer 28

Types 5 and 6

On palmar, plantar an subungual surfaces

Question 29

excision biopsy taken of a skin lesion and comes back as invasive melanoma or bcc, next step?

Answer 29

Sentinel LN biopsy

Question 30

How is melanoma staged?

Answer 30

Breslow thickness and lymph node involvement with TNM staging

Question 31

What is the breslow thickness?

Answer 31

A prognostic factor used in staging of melanoma to determine the 5yr survival and also to decide on the excision margin needed.
It is the depth of tumour measured from the epidermis to the thickest part of the lesion.

Question 32

Breslow thickness and excision margins

Answer 32

in situ = 5mm
<1mm = 1cm
1.01-2mm = 1-2cm
2.1-4mm = 2-3cm 
>4mm = 3cm

Question 33

What melanomas require SLNB?

Answer 33

T1b ( <0.8 with ulceration) and greater

so also anything greater than 1mm with or without ulceration

Question 34

Who gets chemo with melanoma?

Answer 34

Patients with disease progression after optimal tx with other systemic therapies

Question 35

Breslow thickness and 5yr survival rates

Answer 35

in situ = 95-100%
<1mm = 95-100%
1-2mm = 80-95%
2-4mm = 60-75%
>4mm = 50%