Skin Cancer

Question 1

What is the fastest increasing cancer in Scotland?

Answer 1

malignant melanoma

Question 2

Where is malignant melanoma most common?

Answer 2

Sun exposed sites - scalp, face, neck, arms, legs

Question 3

Where can a malignanct melanoma occur but this happens rarely?

Answer 3

eye, meninges, oesophagua, biliary tract, anus

Question 4

Define the Breslow thickness.

Answer 4

the depth frm the granular layer of the epidermis to the deepest melanoma cell

Question 5

What is the ABCDE of skin cancer?

Answer 5

A - aymmetry 
B - border 
C - colour
D - diameter 
E - Evolution

Question 6

Up to what diameter are you not concerned about a skin lesion?

Answer 6

6cm

Question 7

Apart from Breslow thickness, what else is an adverse prognostic indicator of skin cancer?

Answer 7

Ulceration
Satellite deposits of melanoma
High itotic rate
Lymphovascular invasions

Question 8

What are the 4 main types of malignant melanoma?

Answer 8

Superficial spreading melanoma
Acral/ mucosal lentiginous-acral and mucosal melanoma
Lentigo maligna melaoma
Nodular

Question 9

What is the most common subtype of malignant melanoma and where is this most commonly found?

Answer 9

Superficial spreading melanoma

trunks of men and legs of women

Question 10

Describe the appearance of a typical superficcial spreading melanoma.

Answer 10

Usually macule with irregular border and colour which may have been increasing in size for years (slow horizontal growth phase) before developing a nodule (rapid verticle growth phase)

Question 11

Where are Acral/ mucosal lentiginous-acral and mucosal melanomas most commonly found?

Answer 11

palms, soles, nials and mucosal sites of elderly population

Question 12

Where do Lentigo maligna melaoma usually appear?

Answer 12

Elderly face

Question 13

Where are nodular maligant melanomas found?

Answer 13

Varied sites but often trunk

Question 14

What is an amelanocytic melanoma?

Answer 14

Rare form of maligant melanoma where there is absent or minimal visible pigment

Question 15

In nodular melanomas what is there no clinical evidence of?

Answer 15

Radial growth phase

Question 16

Describe the typical appearance of a nodular melanoma.

Answer 16

Blue-black or red-skin coloured nodule whihc may be ulcerated or bleeding and has usually developed rapidly over preceding months

Question 17

How do malignant melanomas spread?

Answer 17

Local dermal - satellite deposits
Regional lymph node mets - common pattern of disease progression
Haematogenous spread

Question 18

How are MM treated?

Answer 18

Primary excision to give clear margins and SNB if indicated

Could give: chemo, immunotherapy, genetic therapies

Question 19

Melanomas on intermittently sun-exposed skin may have what mutation?

Answer 19

BRAF mutation

Question 20

What mutation do some acral melanomas have?

Answer 20

c-kit mutation

Question 21

What are basal cell carcinoma and squamous cell carciomas classified as?

Answer 21

Non-melanoma skin cancer

Question 22

How can basal cell carcinomas present?

Answer 22

Slow growing lump or non-healing ulcer 
painless, often ignored 
"pearly" or translucent but can be pigmented 
visible, arborising vessels 
scaly plaque - superficial BCC
Infiltrative - morphoeic BCC 
Poory defined margins

Question 23

Do BCC commonly metastasise?

Answer 23

No, locally invasive but rarely metastasie

Question 24

How do SCC present?

Answer 24

hyperkeratotic (crusty) or warty ump or non-healing ulcer
grow relatively fast
may be painful and/or bleed
arise on sun damaged skin

Question 25

Where are high risk sites for SCC?

Answer 25

ear face lip scalp

Question 26

What diseases are precursors to SCC?

Answer 26

Bowen's disease actinic keratosis Viral lesions (esp on anogenital skin)

Question 27

What is an adverse prognostic indicator of SCC?

Answer 27

Perineural spread

Question 28

What is the risk of mets in SCC? How does this affect prognosis?

Answer 28

5% risk of mets poor prognosis once metastatic 5 year survival rate of met SCC is 25%

Question 29

If you have one SCC, what is the likelihood that you will get another?

Answer 29

50% further SCC at 5 years

Question 30

What do actinic keratoses look like?

Answer 30

Erythematous sillver-scaly papules or patches with a conical surface and red base

Question 31

With actinic keratoses what does the background skin tend to look like?

Answer 31

Often inelastic, wrinkled and may show flat brown macules (solar lentigos) reflecting diffuse solar damage

Question 32

Where do actinic keratoses develop?

Answer 32

Sun exposed areas - scalp, face, hands

Question 33

If a patient has several actinic keratoses in one area, how can this be described?

Answer 33

"field damage" or more sever "field cancerisation"

Question 34

What treatment options are there for actinic keratoses?

Answer 34

cryotherapy topical 5-fluoroacil cream 5% imiquimod cream diclofenac gel

Question 35

How is Bowen's disease typicaly described?

Answer 35

"Isolated red scaly patch" | or patch looking ike psoriasis but ti has an irregular edge

Question 36

What is the underlying mechanism behind Bowen's disease?

Answer 36

Long term sun exposure leads to no maturation of cells giving parakeratosis on surface

Question 37

What are the treatments available for Bowen's disease?

Answer 37

cryotherapy topical 5-fluoroacil cream 5% imiquimod cream curettage

Question 38

List the potentiall pre-maligant skin conditions.

Answer 38

``` Actinic keratsis Bowen's disease Atypical/ dysplastic naevus syndrome Giant congenital melanocytic naevi Viral precursors associated with HPV ```

Question 39

What is the name for penile Bowen's?

Answer 39

Erythroplasia of Queryat

Question 40

In terms of sun damage, what is the typical description for that required to get SCC?

Answer 40

Chronic sumulative UV- exposure

Question 41

In terms of sun damage, what is the typical description for that required for the development of BCC and MM?

Answer 41

Intermittent intense sunburn episodes

Question 42

Does UVA directly cause DNA damage?

Answer 42

No - indirectly | UVB directly causes DNA damage

Question 43

What is the proper term for "liver spots"?

Answer 43

Solar lentigo

Question 44

Up to what % of sun damage occurs in the first 18 years of life?

Answer 44

Up to 80%

Question 45

Childhodd sunburn increases the risk of melanoma ... times?

Answer 45

4 x

Question 46

Which genetic conditions put you at an increased risk of skin cancer?

Answer 46

Xeroderma pigmentosum Albinism Naevoid basal cell carcinoma (Gorlin's) syndrome

Question 47

What is Gorlin's syndrome?

Answer 47

Autosomal dominant familial cancer syndrome | early onset and multiple BCCs

Question 48

For transplant patients on immunosuppresants, what is the most common form of skin cancer they can develop?

Answer 48

SCC

Question 49

Give some phototoxic drugs.

Answer 49

``` Vorconazole Anti-TNF BRAF inhibitors Thiazide diuretics NSAIDs ```

Question 50

Why might a biopsy of a rash not provide a diganosis?

Answer 50

Different skin conditions may have same histology | One cause of a skin pathology may hvae different histology patterns

Question 51

What is the most common form of skin surgery for skin lesions?

Answer 51

Elliptical excision

Question 52

Give some benefits of punch biopsy?

Answer 52

Quick | produces good wound edges

Question 53

Give some disavantages to using punch biopsy?

Answer 53

Difficult to judge depth round holes do not always heal well pathology sample may be too small

Question 54

What complications can occur after skin surgery?

Answer 54

``` Bleeding wound dehisence infection scarring loss of function motor or sensory nerve damage ```