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Year 2- Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What are the two most common skin cancers seen>

A

Basal cells cancer
Squamous cell cancer

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2
Q

What are some of the risk factors for skin cancer?

A

UV radiation
Photochemotherapy
Chemical carcinogens
Ionising radiation
HPV
Familial cancer syndromes
Immunosuppression

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3
Q

When may photochemotherapy, a risk for skin cancer, be given?

A

As part of psoriasis treatment

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4
Q

Are basal cell carcinomas fast or slow growing?

A

Slow growing

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5
Q

Describe basal cell carcinomas

A

Slow growing, locally invasive, rarely metastasise
Pearly rolled edged lesions w central ulceration

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6
Q

What is the gold standard treatment for basal cell carcinomas?

A

Excision
Will leave a scar which is bigger than the carcinoma and a fair bit of unaffected skin is also removed to give a neater scar

->curettage in some circumstances, imiquimod if superficial

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7
Q

Mohs surgery can be used in the removal of skin carcinomas too.
When is it particularly useful?

A

If the carcinoma is in an awkward place like the nose

Removed piece by piece until fully removed

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8
Q

What are some of the indications for Mohs surgery?

A

Site e.g. nose
Size
Subtype
Poor clinical margin
Recurrent
Perineural or perivascular involvement

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9
Q

There is a therapy known as Vismodegib, what are the indications for this?

A

Locally advanced basal cell carcinoma which is not suitable for surgery or radiotherapy

Metastatic basal cell carcinoma

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10
Q

What does Vismodegib do?

A

Selectively inhibits abnormal signalling in the Hedgehog pathway
Can shrink tumours and heal visible lesions in some

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11
Q

What are some of the side effects of Vismodegib?

A

Hair loss
Weight loss
Altered taste
Muscle spasms
Nausea
Fatigue

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12
Q

Which cells is squamous cell carcinoma derived from?

A

Keratinising squamous cells

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13
Q

Where on the body are squamous cell carcinomas more common?

A

Sun exposed regions

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14
Q

Can squamous cell carcinomas metastasise?

A

Yes, up to 16%

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15
Q

Describe squamous cell carcinomas.

A

Faster growing, tender, scaly/crusted or fleshy growths
Can ulcerate

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16
Q

What is the treatment of squamous cell carcinomas?

A

Excision +/- radiotherapy

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17
Q

After excision of a basal cell carcinoma, follow up is not needed.
Following excision of a squamous cell carcinoma, follow up is needed if high risk. What are these high risk indications?

A

Immunosuppressed
>20mm diameter
>4mm depth
On the ear, nose, lip or eyelid
Perineural invasion
Poorly differentiated

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18
Q

Keratoacanthoma?

A

Variant of squamous cell carcinoma
Erupts from hair follicles in sun damaged skin
Grows rapidly but may shrink after a few months

->uncertainty to whether it is classified as benign or malignant

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19
Q

What is the management of keratoacanthoma?

A

Surgical excision

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20
Q

What are the risk factors for melanoma skin cancer?

A

UV radiation
Genetic susceptibility
Familial melanoma

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21
Q

The ABCDE rule can be used when looking at skin lesions. What does this stand for?

A

Asymmetry
Border
Colour
Discharge
Evolution

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22
Q

Regarding colour, what is worrying about a skin lesion?

A

Multiple colours of one lesion

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23
Q

Regarding border, what is worrying in a skin lesion?

A

If border is unclear and it is hard to figure out when the lesion stops and the skin starts

24
Q

Regarding diameter, what is worrying in a skin lesion?

A

Diameter > 7mm

25
Q

What is meant by evolution of a skin lesion?

A

Is the mole changing?

26
Q

In the seven point checklist when looking at moles or skin lesions, what are the three major features?

A

Change in size
Change is shape
Change in colour

27
Q

In the seven point checklist when looking at moles or skin lesions, what are the four minor features?

A

Diameter >5mm
Inflammation
Oozing or bleeding
Mild itch or altered sensation

28
Q

Which investigation can be used to look at a mole more closely?

A

Dermoscopy

29
Q

When is a melanoma considered to be metastatic?

A

When it penetrates into the dermis layer of the skin

->known as melanoma in situ when only in epidermis

30
Q

As a melanoma increases in length, what happens to its severity?

A

Becomes more severe as it is of higher risk of metastasising

31
Q

What is the most common type of melanoma seen?

A

Superficial spreading malignant melanoma

32
Q

Where is Lentigo Maligna Melanoma usually found on the body?

A

The face

33
Q

Do melanoma’s usually grow out or down first?

A

Out first, spreads along skin and then down

34
Q

Which type of melanoma doesn’t follow the rule and spreads down without going out first?

A

Nodular melanoma

35
Q

Which type of melanoma tends to appear on palms and soles and can be missed by patients as they often don’t know what it on the soles of their feet?

A

Acral Lentiginous Melanoma/Subungal Melanoma

36
Q

What is the treatment for ocular melanoma?

A

Removal of the eye

37
Q

What is the treatment fir melanomas?

A

Urgent surgical excision

38
Q

What does surgical excision of melanoma allow for?

A

Allows identification of the subtype of melanoma
Assess Breslow thickness (depth of melanoma from outermost layer of skin)

->deeper the Breslow thickness, poorer the survival rate

39
Q

After the urgent surgical excision, what else in done in the treatment of melanoma?

A

Wide local skin excision to ensure no cancer cells have been left
Sentinel lymph node biopsy

->sentinel lymph nodes are the first lymph nodes that the skin drains to

40
Q

Is chemo ever carried out for melanoma?

A

Almost never

41
Q

Is radiotherapy ever carried out in melanoma patients?

A

Rarely

->used more commonly for squamous cell carcinomas

42
Q

What extra treatment for be given for melanoma when there is metastatic disease?

A

Immunotherapy

->~can also be used if there is no metastatic disease but disease in the lymph nodes

43
Q

What do immunotherapies do?

A

Boost the immune system to try and get it to respond more quickly

44
Q

If you have had a melanoma, are you followed up?

A

Yes- stage one for 3 months to 1 year
Everyone else followed up 3 monthly for three years and then a further 2 years, 6 monthly

->this is because high risk of melanoma coming back or developing a new one

45
Q

What is cutaneous lymphoma?

A

Usually secondary cutaneous disease from systemic/nodal involvement

->can be primary but rarer

46
Q

What causes primary cutaneous disease?

A

Abnormal neoplastic proliferation of lymphocytes in the skin

->primary can be T cell lymphomas or B cell lymphomas, T cell more common

47
Q

What is the most common cutaneous T cell lymphoma?

A

Mycosis Fungoides

->although most common, still very rare more common in older patients, M>F

48
Q

What are the different stages of mycosis fungoides?

A

Patch- flat, red, dry lesions- can itch
Plaque- generally itch
Tumour- large irregular lumps which can ulcerate
Metastatic

49
Q

What is sezary syndrome often known as?

A

Red man syndrome

49
Q

Which investigations are done in someone with suspected mycosis fungosis?

A

Bloods for sezary cells
CT for staging (if metastatic and has spread to solid organs)

50
Q

What type of lymphoma is sezary syndrome?

A

Cutaneous T cell lymphoma

->there is lymph node involvement

51
Q

How does Sezary syndrome affect the skin?

A

Affects skin of whole body
Causes thickening, scaly and red itchy skin

52
Q

What is the treatment of cutaenous lymphoma?

A

Dependant on stage

Early stage:
Topical steroids
Phototherapy e.g. PUVA or UVB
Localised radiotherapy
Interferon or Bexarotene
Low dose methotrexate

Extensive:
Chemotherapy
Total skin electron beam therapy
Bone marrow transplant

53
Q

What does total skin electron beam therapy allow?

A

Delivers radiation to superficial layers i.e. epidermis and dermis, while sparing the deeper tissues ad organs

54
Q

Cutaneous metastases can be primary or secondary or due to primary organ malignancy.

Which solid organs does a cutaneous malignancy usually spread from?

A

Breast, colon and lung

55
Q

What is the treatment for cutaneous metastases?

A

Treat underlying malignancy
Local excision
Localised radiotherapy
Symptomatic treatment

56
Q
A

Year 2- Dermatology (10 decks)

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