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Dermatology > Skin cancer > Flashcards

Skin cancer Flashcards

1
Q

Pathogeneis of skin cancer

A

At least two distinct pathways interact or converge to cause skin cancer

    1. Direct action of UV on target cells (keratinocytes) for neoplastic transformation via DNA damage
  2. Effects of UV on the host’s immune system
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2
Q

Main skin cancer types

A
  • basal cell carcinoma
  • squamous cell carcinoma
  • malignant melanoma
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3
Q

Basal cell carcinoma

A

most common tyep of skin cancer

The process of creating new skin cells is controlled by a basal cell’s DNA.

A mutation in the DNA causes a basal cell to multiply rapidly and continue growing when it would normally die. Eventually the accumulating abnormal cells may form a tumour

PTCH gene mutation may predispose

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4
Q

basal cell caricnoma subtypes

A
  • nodular
  • superficial
  • pigmented
  • morphoeic/sclerotic
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5
Q

What type of BCC is this? and describe it

A
  • Nodule ie > 0.5cm raised lesion
  • Shiny “pearly”
  • Telangectasia / blood vessels
  • Often ulcerated centrally

nodular

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6
Q

What type of skin cancer is this? and describe it

A

Superficial

  • sits on surface
  • look at whole picture
  • evidence of sun damage
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7
Q

What type of BCC is this? and decribe

A

Pigmented

  • darker skin types
  • raised
  • pearly
  • erythema at base
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8
Q

What type of BCC is this? and desccribe

A
  • white shiny plaque
  • pink
  • subtle BVs
  • less defined edges
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9
Q

Treatment - basal cell carcinoma

A
  • Gold standard – Surgical excision 3-4mm margin
  • Curettage and cautery
  • Cryotherapy
  • Photodynamic therapy
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10
Q

Squamous cell carcinoma

A
  • may occur in normal skin or in skin that has been injured (burns) or chronically inflammated
  • originates from keratinoctes
  • 2nd commonest skin cancer
  • skin regularly exposed to sunlight
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11
Q

Describe thiis squamous cell carcinoma

A
  • rough
  • scaily
  • ulcerate
  • no broken BVs
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12
Q

Treatment of squamous cell carcinoma

A
  • Gold standard – Surgical excision 4mm margin
  • Curettage and cautery

Pre-malignant /squamous cell in-situ

  • Topical imiquimod / 5-fluorouracil cream
  • Cryotherapy
  • Photodynamic therapy
  • Sun protection
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13
Q

Melanoma definition

A

malignant tumour or melanocytes

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14
Q

Melanoma skn cancer risk factors

A
  • UV exposure (sunburn)
  • Genetic (mutatin in CDKN2a)
    • sporadic V600e (mtation of vailne by glutamate at 600), overactive BRAF sigalling
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15
Q

Types of melanoma

A
  • superficial spreading
  • nodular
  • lentigo melanoma
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16
Q

Desribe superficial spreading malignant melanoma

A
  • 70%
  • plaque
  • radial growth
17
Q

Describe nodular melanoma

A
  • thicker, deeper,
  • vertical growth
  • very dark
  • raised up
18
Q

Types of growht in melanoma

A

Radical growth: initial tendency of a melanoma to grow horizontally within the epidermis (in situ) and superficial dermal layers, often for a prolonged period. Melanoma cells do not have the capacity to metastasize, no evidence of angiogenesis

Vertical growth: With time, melanoma grows downwards into deeper dermal layers as an expansive mass lacking cellular maturation

19
Q

Types of staging of melanoma

A

Describes how deeply it has grown into the skin, and whether it has spread

Type of melanoma staging systems:

  • Clark Scale: How deeply the melanoma has gone into the different layers of skin
  • Breslow scale : measures the thickness of the melanoma in the skin
  • TMN staging: describes the thickness of the melanoma and whether there is any spread to lymph nodes or other parts of the body
20
Q

Clark levels

A

5 year survival in nonulcerated tumors is 97% for Breslow thickness of 0 to 1.0 mm 91% for 1.01 to 2.0 mm

79% for 2.01 to 4.0 mm

71% for > 4.0 mm

21
Q

Treatment of melanoma

A
  • Surgical excision
    • (Breslow < 1mm) – 1cm margin
    • (Breslow > 1mm) – 2cm margin
  • If metastatic – chemotherapy, isolated limb perfusion
  • •New chemo trials
  • •Vaccine therapy
  • Biologic antibodies to Vascular growth factors ( bevacizumab ) or BRAF genetic defects (vemurafenib)
  • Long term follow up
  • Assessment for Lymph node / organ spread
  • Genetic testing
22
Q

Clinical features of melanom

A
  • Most occur in skin
  • May occur in oral or anogenital mucosal surfaces, oesophagus or meninges, eye
  • symptomatic

Most important clinical sign is a change in the colour or size of a pigmented lesion

  • Melanomas exhibit changes in pigmentation
  • Borders are irregular and notched

Clincial warning signs

  • Enlargement of pre-existing mole
  • Itching or pain in a pre-exisiting mole
  • Development of new pigmented lesion during adult life
  • Irregularity of borders of a pigmented lesion
  • Variegation of colour within a pigmented lesion

ABCD of melanoma

Asymmetry
Border
Colour
Diameter ( >6mm)
Evolution (change of an exisiting nevus)

EFG (only nodular melanoma)

– elevated above the skin surface

  • firm to the touch
  • growing

Dermatology (10 decks)

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