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10. Dermatology > Skin Cancer > Flashcards

Flashcards in Skin Cancer Deck (29)
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1

What are the 3 main types of skin cancer?

Basal cell carcinomas
Squamous cell carcinomas
Malignant melanoma

2

Describe the effect of UV light on keratinocytes. (2)

1. UV light causes DNA damage and mutations (e.g. p53 mutations)
a. This causes abnormal cell proliferation

2. UV light also causes impaired DNA repair
a. Therefore p53 mutations cannot be corrected before they cause cancer

3

Describe the effect of UV light on the immune system. (2)

1. UV light damages immune system in the skin; causes immunosuppression

2. This causes impaired immunosurveillance
a. Therefore cancer cells are not detected/removed, allowing cancer development

4

What are the 4 subtypes of basal cell carcinoma?

Nodular BCC
Superficial BCC
Pigmented BCC
Morphoeic/sclerotic BCC

5

Describe the clinical features of a nodular BCC. (5)

Nodule (raised lesion, 0.5+cm)
Shiny, "pearly" appearance
Telangiectasia
Well-defined border
Central ulcer

6

Describe the clinical features of a superficial BCC. (4)

Flat lesion (rough but NOT raised)
Shiny margin (BUT matte centre)
Some telangiectasia
Beginnings of ulceration

7

Describe the clinical features of a pigmented BCC. (5)

Nodule (raised lesion, 0.5+cm)
Shiny, "pearly" appearance
Telangiectasia
Well-defined border
Central ulcer
Brown/black discolouration due to melanin

8

Describe the clinical features of a morphoeic/sclerotic BCC. (4)

Flat lesion
Similar colour to the rest of the skin
Infiltration into surrounding tissue
Shiny, "pearly" appearance

9

What is the standard method of treating BCC?

What other treatment options exist if this one is not tolerated? (5)

Surgical excision (margins: 5mm)

OTHER OPTIONS:
Curretage and cautery
Cryotherapy
Photodynamic therapy
Topical imiquimod/5-fluorouracil
Mohs micrographic surgery

10

List 4 disadvantages of photodynamic therapy.

Very painful
Takes 3-4 hours
Needs to be done at least twice
No margin control

11

Describe the process of Mohs micrographic surgery. (3)

1. Skin is excised piece by piece

2. Pathologist is present and tests the skin biopsies as they are taken
a. This continues until a bit of skin is removed that doesn't have any cancer in it

3. This results in the smallest area of excision possible

12

What are the 2 types of pre-malignant change seen before squamous cell carcinoma?

Actinic keratosis
Bowen's disease

13

Describe the clinical features of actinic keratosis. (3)

Pre-malignant
Yellow-white scales
Crumbly crust

14

Describe the clinical features of Bowen's disease. (3)

Pre-malignant
Red, scaly plaque
Carcinoma in situ

15

Describe the clinical features of malignant squamous cell carcinoma. (3)

Hyperkeratosis (scaling)
No ulceration
May be raised

16

What is the standard treatment for malignant SCC? (1)

How would you treat pre-malignant skin lesions? (3)

How would you prevent recurrence of SCC? (2)

MALIGNANT SCC:
Surgical resection (margins: 5mm)

PRE-MALIGNANT CONDITIONS:
Topical imiquimod/5FU
Cryotherapy
Photodynamic therapy

PREVENTION OF RECURRENCE:
Always use sun protection
Regular skin checks

17

What is the risk of metastasis in squamous cell carcinoma?

10-30%

18

What are the 2 pre-malignant melanoma conditions?

Lentigo maligna
Melanoma in situ

19

Describe the pathophysiology of malignant melanoma. (4)

1. UV light causes DNA damage

2. Pre-malignant lesions are formed

3. Pre-malignant lesions develop into melanoma, which has 2 growth phases:
a. Radial growth phase - expands laterally
b. Vertical growth phase - expands deeper into skin

4. Melanoma may metastasise via lymphatics

20

List the 6 subtypes of malignant melanoma.

Superficial spreading malignant melanoma
Nodular melanoma
Subungual melanoma
Amelanotic melanoma
Acral melanoma
Lentigo maligna melanoma

21

Describe the features of a suspicious skin lesion in suspected malignant melanoma. (6)

Irregular colour
Irregular shape
Change in size/shape/colour
Itching
Ulceration/bleeding
Satellite tumours

22

Other than a suspicious skin lesion, describe the clinical features of malignant melanoma. (5)

OTHER SKIN FEATURES:
Regressed primary tumour
Lentigines (singular: lentigo)

NAIL CHANGES:
Single melanonychia (single band of pigment)
Hutchinson's sign (spread of pigment from nails into the skin)
Pseudo-Hutchinson's sign (appearance of spread into the skin, though actually only due to a pigmented nailbed visible through translucent skin)

23

How do you classify malignant melanoma? (2)

Breslow depth (mm; depth of the furthest affected melanocyte)

Clark's level

24

What is the standard treatment for malignant melanoma? (1)

What further treatment is needed in high risk melanomas? (3)

Which further assessments would you do? (3)

Surgical excision
-Breslow <1mm: 1cm margin
-Breslow 1+mm: 2cm margin PLUS further treatment

FURTHER TREATMENT:
Chemotherapy
Vaccine therapy
Biologic drugs, e.g.
-Bevacizumab
-Vemurafenib

FURTHER ASSESSMENT:
Assessment of lymph nodes/metastases
Genetic testing
Long term follow up

25

List 4 genetic tumour syndromes which might cause skin cancer.

Gorlin's syndrome
Brook Spiegler syndrome
Gardner syndrome
Cowden's syndrome

26

Describe the clinical features of Gorlin's syndrome. (3)

Multiple BCCs
Jaw cysts
Increased risk of breast cancer

27

Describe the clinical features of Brook Spiegler syndrome. (2)

Multiple BCCs
Trichoepitheliomas (from hair follicles)

28

Describe the clinical features of Gardner syndrome. (3)

Soft tissue tumours
Polyps
Bowel cancer

29

Describe the clinical features of Cowden's syndrome. (3)

Multiple hamartomas
Thyroid cancer
Breast cancer