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dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What are actinic keratoses

A

Partial thickness dysplasia of epidermal keratinocytes

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2
Q

What can actinic keratoses transform into

A

Squamous cell carcinoma

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3
Q

Presentation of actinic keratoses

A

Scaly, erythematous papules or patches
Feel gritty and rough

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4
Q

Where do actinic keratoses present

A

Sun exposed areas: scalp, face, hands

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5
Q

Lesion based treatment of actinic keratoses

A

Cryotherapy, curettage and cautery

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6
Q

Field based treatments for actinic keratoses

A

Topical 5-fluorouracil, photodynamic therapy

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7
Q

What is another name for bowens disease

A

Intraepithelial carcinoma

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8
Q

What is bowens disease

A

SCC in situ
Full thickness dysplasia of epithelial keratinocytes

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9
Q

Who typically presents with bowens disease and where does it present

A

Lower legs of fair skinned women

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10
Q

How does bowens disease present

A

Slowly enlarging, well demarcated, scaly red plaque with an irregular border

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11
Q

Management of bowens disease

A

5-fluorouracil
Cryotherapy, photodynamic therapy

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12
Q

What are a keratoacanthomas

A

Rapidly growing epidermal tumours

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13
Q

When does a keratoacanthoma present

A

On sun exposed skin in later life

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14
Q

Presentation of keratoacanthoma

A

Red papules with a central, crater-like crust keratinous plug

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15
Q

Management of keratoacanthoma

A

Usually excised by can regress spontaneously after about 3 months

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16
Q

What is the most common malignant skin cancer

A

Basal cell carcinoma

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17
Q

What is a common name for a BCC

A

Rodent ulcer

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18
Q

Where do BCCs arise from

A

Basal keratinocytes

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19
Q

What is the main cause of BCC

A

Intense intermittent exposure to UV radiation

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20
Q

Genetic association with BCC

A

90% have an inactivating mutation of PTCH

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21
Q

Name some other risk factors for BCC

A

Immunosuppression, smoking, ionising radiation, trauma

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22
Q

Name 2 conditions associated with BCC

A

Xeroderma pigmentosum
Oculocutaneous albinism

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23
Q

Inheritance in oculocutaneous albinism

A

Autosomal recessive

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24
Q

Pathophysiology of oculocutaneous albinism

A

Absence or a defect of tyrosinase resulting in an absence of melanin

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25
Q

Describe the growth and spread of a BCC

A

Slow growing
Rarely metastasise
Can kill by invasion

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26
Q

What causes BCCs and SCCs

A

Epidermal keratinocyte DNA is damaged by solar UV radiation

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27
Q

History associated with BCC symptoms

A

Slow growing, just won’t heal, asymptomatic

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28
Q

Clinical features of a BCC

A

Rolled pearly edge, central ulceration, telangiectasia

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29
Q

Where do nodular BCCs usually present

A

On the face

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30
Q

Presentation of a superficial BCC

A

Erythematous, well demarcated scaly plaques
Slightly raised whipcord margin

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31
Q

How are infiltrative BCCs characterised

A

By thickened yellowish plaques

32
Q

Presentation of a pigmented BCC

A

Brown, blue or greyish
May resemble malignant melanoma

33
Q

In who is a pigment BCC more often seen in

A

Individuals with dark skin

34
Q

Investigations for BCC

A

Biopsy

35
Q

Management of a nodular BCC

A

Wide excision

36
Q

Management of a superficial BCC

A

NON-SURGICAL TREATMENT
cryotherapy, photodynamic therapy, topical imiquimod

37
Q

Management of inflitrative BCC

A

MOHs surgery

38
Q

Where do SCCs arise from

A

Supra-basal keratinocytes

39
Q

What is the biggest association with SCC

A

Lifetime cumulative sun exposure

40
Q

Genetic factors of SCCs

A

Fair skin type
Xeroderma pigmentosum
Oculocutaneous albinism

41
Q

State 2 precursors to SCC

A

Actinic keratoses
Bowens disease

42
Q

What’s another word for actinic

A

Solar

43
Q

What is the most common skin cancer in immunosuppressed patients

A

SCC

44
Q

Name some other risk factors for SCC

A

Smoking
Ionising radiation
Trauma

45
Q

Describe the growth and spread of SCCs

A

Locally invasive
Low but definite risk of metastases

46
Q

What are some high risk sites for SCC

A

Ear, lip and scalp

47
Q

Presentation of an SCC

A

Warty or hyperkeratotic lump or ulcer
Grow faster, may be painful and bleed

48
Q

Usual management of an SCC

A

Complete wide surgical excision

49
Q

Where does malignant melanoma arise from

A

Melanocytes in the basal layer of the epidermis

50
Q

What is the main association with malignant melanoma

A

Intermittent intense sun exposure

51
Q

Name some risk factors for malignant melanoma

A

Fair skin, multiple melanocytic naevi, family history of melanoma, immunosuppression

52
Q

Genetic association with malignant melanomas

A

Activating BRAF mutation

53
Q

Mutation seen in acral melanomas

A

c-kit mutations

54
Q

Describe a superficial spreading melanoma

A

Large, flat, irregularly pigmented lesion
Grows laterally before vertical invasion develops

55
Q

Where are superficial spreading melanomas commonly seen

A

on the trunk and limbs

56
Q

How do acral lentiginous malignant melanomas arise

A

Pigmented lesions on the palm or sole or under the nail

57
Q

What is a lentigo maligna melanoma

A

Invasive tumour that develops within pre-existing lentigo maligna

58
Q

Where do lentigo maligna melanomas usually present

A

Sun damaged face, neck or scalp

59
Q

What is the most aggressive type of melanoma

A

Nodular malignant melanoma

60
Q

Where do nodular malignant melanoma often occur

A

On the trunk

61
Q

How do nodular melanomas present

A

Rapidly growing pigmented nodules which bleeds or ulcerates

62
Q

What growth phase is a nodular melanoma always in

A

Vertical phase !!!

63
Q

Radial growth phase

A

Tumour grows horizontally within the epidermis

64
Q

Vertical growth phase

A

Tumour cells begin to invade deeper layers of the skin e.g. the dermis

65
Q

What is used to stage melanomas

A

Breslow thickness

66
Q

What is breslow thickness

A

Measures the vertical depth of invasion from the granular layer of the epidermis to the deepest tumour cell

67
Q

What melanomas can metastasise

A

Those in the vertical growth phase

68
Q

What do satellite deposits indicate

A

Local invasion of melanoma

69
Q

Where can melanomas commonly spread to in the blood

A

Skin/soft tissues, heart, lungs, GI tract, liver, brain

70
Q

History of symptoms in malignant melanoma

A

Changing pigmented lesions, itchy or bleeding

71
Q

What approach is used to suspect melanoma

A

ABCDE approach

72
Q

ABCDE approach in dermatology

A

Asymmetry
Border- irregular
Colour- 2 or more
Diameter- >6mm
Evolution- is it changing ?

73
Q

Management of malignant melanoma

A

Narrow complete excision

74
Q

What other assessment is useful in staging melanomas

A

Sentinel lymph node biopsy

75
Q

What happens if sentinel node biopsy is positive in malignant melanoma

A

Regional lymphadenectomy

76
Q

Management of advanced malignant melanoma

A

Chemo, immunotherapy, genetic therapies

77
Q

Genetic therapies offered for malignant melanoma

A

Imatinib for c-kit mutations
Debrafenib for BRAF mutations

dermatology (13 decks)

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