Signs And Symptoms

Question 1

Clinical presentation

Answer 1

Signs and symptoms, appearance by eye or on diagnostic imaging

Question 2

Histology

Answer 2

The study of cells at a microscopic level

Question 3

Pathology

Answer 3

The study of cause and effects of disease through examination of surgically removed organs, tissues, body fluids or autopsy

Question 4

What is a sign?

Answer 4

It is objective evidence of a disease that can be observed by others

Question 5

What are symptoms?

Answer 5

They are subjective and are only apparent to the patient. Ex- fatigue

Question 6

Signs and symptoms of prostate cancer

Answer 6

Sign - haematuria
Symptoms - nocturia, urinary, frequency

Question 7

Signs and symptoms of breast cancer

Answer 7

Signs - lump, nipple discharge/ needing, nipple inversion
Symptoms - none

Question 8

Signs and symptoms of lung cancer

Answer 8

Signs - persistent cough and haemptosis
Symptoms- none

Question 9

Signs and symptoms of oesophageal cancer

Answer 9

Signs- haematemesis
Symptoms- Dysphagia, dyspepsia

Question 10

Signs and symptoms of rectal cancer

Answer 10

Signs- diarrhoae/constipation , rectal bleeding
Symptoms - none

Question 11

Signs and symptoms of oral cancer

Answer 11

Signs - mouth ulcers, lump
Symptoms - none

Question 12

How are BCCs presented?

Answer 12

The affect the basal cells of the base of the epidermis. They’re slow growing and can vary in size (mm-cm in diameter). Bccs rarely metastasis

Question 13

Diagnostic factors of bccs

Answer 13

Pearly papules
Plaques, nodules, tumours with rolled borders
Scaly raised patch of irritated skin
Small crusts and non healing wounds
Spontaneous bleeding

Question 14

Percentage of treated NMSCs at different anatomical locations, by sex, England 2011

Answer 14

Male → 78% head and neck, 7% upper limbs, 10% trunk, 4% lower limbs

Females → 73% head and neck, 6% upper limbs, 8% trunk, 13% lower limbs

Question 15

What is noduloulcerative?

Answer 15

Macroscopically look translucent
Pearly while nodule with prominent telangiecstasia
Sometimes ulcerated area

Question 16

What are superficial bccs?

Answer 16

They’re important to distinguish clinically, from other types of bccs because they can frequently be managed medically avoiding excision

Question 17

Presentation of superficial bccs

Answer 17

Usually on upper trunk and shoulders
Erythematous, well demarcated scaly plaques
> 20mm
Often multicentric
Slow growing
Can be confused with Bowen’s disease, psoriasis, or eczema
Particularly responsive to medical rather than surgical treatment

Question 18

What is Morphoeic ?

Answer 18

Histologically part of the infiltrative group of bcc
Have poorly defined edges
Plaque of scar like tissue
Predominantly found on the face
Yellow-white waxy patch will ill defined edge

Question 19

Infiltrating bccs

Answer 19

They’re clinically a whitish, compact, not well defined plaque
Most common on upper trunk and face
Clinically often underestimated in size

Question 20

Pigmentation

Answer 20

Brown, blue or greyish lesions

•Nodular or superficial histology

•Pigmented basal cell cancers have dark areas and can look like warts or sometimes melanoma.

Question 21

What is basosquamous carcinoma?

Answer 21

Mixed BCC and SCC
•Basosquamous carcinoma is a rare malignancy
•Potentially more aggressive than other forms of BCC

Question 22

Rare diagnostic factors

Answer 22

•Local destruction with advanced lesions
Several centimetres in diameter and deeply eroding into the surrounding tissue

•Metastases associated with large or neglected BCC
Metastases are uncommon, but may occur in the lungs and bones, typically in association with a large long-standing neglected BCC

Question 23

What is primary cutaneous squamous cell carcinoma?

Answer 23

A malignant tumour → may arise from the keratinising cells of the epidermis or it’s appendages
It’s locally invasive
Potential to metastasise

Question 24

Key diagnostic factors ( of CSCC )

Answer 24

1.Growth over weeks/months
2.Indurated nodular keratinising or crusted tumour
3.Ulceration
4.Tenderness/pain
5.Small crusts and non-healing wounds
6.Non-healing scabs /spontaneous bleeding
7.A scar like area

Question 25

Presence of risk factors of a tumour

Answer 25

Age Sex Previous SCC, BCC or MM Smoking Actinic keratosis UV radiation Sun exposure /damage Fair skin Radiation exposure Arsenic exposure Xeroderma pigmentosum Gorlin-Goltz syndrome Transplant patients

Question 26

What is the presentation of CSCC

Answer 26

cSCC usually presents as an indurated nodular keratinising or crusted tumour that may ulcerate, or it may present as an ulcer without evidence of keratinisation.

Question 27

What is keratoacanthoma ?

Answer 27

rapidly growing, cutaneous rumour → generally presents as crateriform nodules in elderly, fair -skinned people

Question 28

What are the 3 clinical stages of keratoacanthoma?

Answer 28

Proliferation – sudden appearance of erythematous to flesh coloured papule with telangectasia and rapid enlargement (up to 2cm or more) •Maturation – becomes dome shaped with central keratinous core •Involution - resulting in a depressed hypopigmented scar

Question 29

What is verrucous carcinoma

Answer 29

Low grade variant of SCC with little potential for distant metastases •Although the pathogenesis of verrucous carcinoma remains unknown, HPV, chronic irritation, and chemicals have been implicated. •Bland histologic features make diagnosis challenging – superficial biopsy not usually sufficient to distinguish tumour type.

Question 30

What is acantholytic SCC?

Answer 30

A rare variant of SCC •Also referred to as adenoid, adenoacanthoma, or pseudoglandular SCC. •Composed of both solid and gland-like epithelial proliferations extending into the dermis. •Most commonly seen on sun exposed areas of the head and neck of elderly patients. •Most likely arises from acantholytic actinic keratoses •Significant male predominance.

Question 31

What are spindle cells?

Answer 31

Rare A exophytic tumour or an ulcerated mass on sun-exposed skin areas Typical for elderly population Arranged in a whorled pattered Are aggressive

Question 32

What are actinic keratosis/ solar keratosis?

Answer 32

Common pre-cancerous lesion Appears on skin frequently exposed to sun or artificial sources of UV •Mostly appear on sun exposed areas such as face, bald scalp, ears, shoulder, neck, back of hands and forearms. •Elevated, rough in texture and resemble warts

Question 33

What is Bowen's disease?

Answer 33

Bowen’s disease, Usually seen in sites of chronic sun exposure – hands, neck and head, but can occur on any mucosal surface. If not treated, it can progress to invasive SCC typically 3-5%