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Skin cancer Flashcards

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1
Q

what are the risk factors for skin cancer (4)

A

sun exposure
age
genetics
immunosuppression

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2
Q

how does UVA increase risk of skin cancer

A

indirect oxidative damage

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3
Q

how does UVB increase risk of skin cancer

A

direct DNA damage

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4
Q

what genetic influences are there on skin cancer (3)

A

albinism
xeroderma pigmentation
naevoid basal cell carcinoma syndrome

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5
Q

what is albinism

A

do not produce melanin

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6
Q

what function does melanin have in preventing skin cancer

A

protects DNA in the basal layer form sun exposure

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7
Q

what causes xeroderma pigmentation

A

abnormal XP genes

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8
Q

why are XP (xeroderma pigmentation) genes important in preventing skin cancer

A

XP (xeroderma pigmentation) genes are needed to repair DNA damaged by sunlight

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9
Q

what is naevoid basal cell carcinoma syndrome

A

familial increased likelihood of cancer

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10
Q

what causes of immunosuppression increase skin cancer risk (3)

A

immunosuppressive drugs
autoimmune conditions (eg crohns)
organ transplant

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11
Q

how does skin cancer present in post organ transplant (immunosuppressed) patients

A

‘transplant hands’ = changes to hands may be malignant

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12
Q

which type of skin cancer is malignant

A

melanoma

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13
Q

what are the 2 type of non-melanoma skin cancer

A

basal cell carcinoma (BCC)

squamous cell carcinoma (SCC)

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14
Q

what is an oncogene

A

an overactive form of a gene = regulates cell division, can be switched off but not switched off

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15
Q

what is the difference between a proto-oncogene and an oncogene

A

a proto-oncogene can be switched on and off, an oncogene can only be switched on

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16
Q

UVB causes direct DNA damage, what happens to the damaged DNA

what happens if this doesnt occur

A

NER (nucleotide excision repair) recognises damaged DNA and ‘fills it in’

if this doesnt occur = damaged DNA is replicated = mutations arise

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17
Q

what base change usually occurs in the damaging of DNA by UVB

A

TT to CC

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18
Q

UVA causes indirect damage via what mechanism

A

oxidation of DNA bases

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19
Q

how are oxidised DNA bases usually repaired

A

by base excision repair (BER)

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20
Q

which base change usually occurs in the damaging of DNA by UVA

A

C to A

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21
Q

are melanomas more or less common than non-melanoma skin cancers

A

less

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22
Q

are melanomas more or less serious than non-melanoma skin cancers

A

more

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23
Q

are melanomas more common in young or elderly

A

young

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24
Q

are melanomas more common in males or females

A

females

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25
what skin types are a risk factor for melanoma
skin type I/II
26
what are the 4 types of melanoma
superficial melanoma (SSM) acral/mucosal lentiginous melanoma (A/MLM) lentigo maligna melanoma (LMN) nodular melanoma
27
which type of melanoma is most common
superficial melanoma
28
where do superficial melanomas present
trunk/limbs
29
what is the general pathophysiology of melanomas (growth phases and presentation)
radial growth phase (RGP) = present as macules | vertical growth phase (VGP) = invade and mitose in the dermis = present as lumps
30
in which growth phase can melanomas metastasise
vertical growth phase
31
what differs in the pathophysiology of nodular melanomas to the other melanomas
there is no horizontal growth phase
32
what differs in the presentation of nodular melanomas to the other melanomas
they dont present as macules, just as nodules
33
what differentiates a melanoma from a non-melanoma skin cancer (BCC or SCC)
``` ABCDE Asymmetry Border (irregular) Colour (>2) Diameter (>6mm) Evolution (changing) ```
34
what is the treatment of malignant melanomas
elliptical excision biopsy followed by further surgery/radiotherapy/chemo
35
what is the pharmacological treatment of malignant melanoma (eg if surgery is contraindicated)
drugs to prevent cell growth | drugs that activate T cells to enable tumour cell killing
36
which drugs prevent cell growth in malignant melanomas
end in -nib think - you want to 'nip it in the bud'
37
which drugs activate T cells to enable tumour cell killing in malignant melanomas
end in -umab
38
what are the signs of poor prognosis in malignant melanomas (4)
ulceration lymph involvement metastasis tumour depth (Breslow thickness >4mm)
39
how is Breslow thickness measured for the prognosis of malignant melanomas
granular layer to deepest part of tumour
40
a Breslow thickness of
<1mm
41
a Breslow thickness of >?mm in a malignant melanoma has a poor prognosis (50% 5 year survival)
>4mm
42
how long does it take a malignant melanoma to be >4mm deep (Breslow thickness)
6 months
43
is a basal cell carcinoma malignant or not
no
44
where does a basal cell carcinoma arise from
keratinocytes in the basal layer of the epidermis
45
what % of non-melanoma skin cancers are basal cell carcinomas
75
46
are basal cell carcinomas fast or slow growing
slow growing (take years)
47
what genetic mutation causes basal cell carcinomas
PTCH1 mutation
48
what signalling pathway does a PTCH1 cause in basal cell carcinomas
hedgehog signalling pathway = causes cell proliferation
49
what are the 3 types of basal cell carcinoma
nodular superficial infiltrative
50
how does a nodular basal cell carcinoma present (3+location)
pearly colour raised lesion rodent ulcer location - usually on face, head, neck
51
how does a superficial basal cell carcinoma present (+location)
pink/red patch ( looks like eczema but wont go away with cream!) crusted location - usually trunk, shoulders
52
how would you differentiate between eczema and a superficial basal cell carcinoma
eczema will go away with cream (emollients etc)
53
how would you treat a superficial basal cell carcinoma
extensive surgery
54
how does a infiltrative basal cell carcinoma present (+location)
waxy, scaly plaque thickened skin location - usually in middle of face
55
what is the treatment for basal cell carcinoma (4)
vismodegib (blocks hedgehog signalling pathway = prevents proliferation) radiotherapy 5% imiquimod cream mohs surgery - if superficial
56
what is mohs surgery
when the skin is biopsied throughout the surgery so that only cancerous cells are being removed
57
what is the prognosis for basal cell carcinoma (good/bad)
good if treated
58
is squamous cell carcinoma a type of melanoma
no
59
where does squamous cell carcinoma arise from
keratinocytes in the epidermis (anywhere in epidermis)
60
are squamous cell carcinomas fast or slow growing
fast growing (take months)
61
where do squamous cell carcinomas arise
sun damaged skin (eg face, ears, hands)
62
what are the precancerous lesions associated with squamous cell carcinomas (not BCCs) (2)
actinic keratosis | bowens disease
63
what is the treatment of precancerous squamous cell carcinoma lesions
cryotherapy | NOT surgery
64
where do actinic keratosis typically present
head/neck
65
how does actinic keratosis present (not the same as actinic lenitigines)
thick, crusty or scaly skin | red
66
which precancerous squamous cell carcinoma lesion presents on the shins of females as a red and scaly plaque
bowens disease
67
where does bowens disease usually present
on the skins of females
68
how does bowens disease present
red and scaly plaque | non pigmented
69
how does bowens disease look on histology
full thickness dysplasia of keratinocytes
70
if a patient present with a 'horn', what type of skin cancer do they have why
squamous cell carcinoma a 'horn' is keratinised (not BCC as they only have keratinocytes from basal layer, SCC have keratinocytes from everywhere in epidermis)
71
is it worrying if a squamous cell carcinoma bleeds
no, treated the same as any other squamous cell carcinoma, same prognosis
72
how are squamous cell carcinomas treated (2)
elliptical excision biopsy | 5% imiquimod cream
73
are squamous cell carcinomas more or less likely to spread than basal cell carcinomas where do they spread to/via
more likely - can spread along nerves and cause a new tumour growth just along from the original tumour site
74
is the prognosis of non-melanoma skin cancers (SCC and BCC) better or worse than melanomas
much better, 0.5% death rate
75
is a benign seborrheic keratosis (aka seborrheic wart, basal cell papilloma) benign or malignant
benign tumour, will not metastasise
76
how does a benign seborrheic wart present (5)
``` stuck on appearance warty surface well defined keratin pearls greasy appearance ```
77
do benign seborrheic warts present in the young or elderly
elderly
78
is a merkel cell carcinoma serious
yes, needs removal
79
which type of non melanoma skin cancer presents as 'picket fence' around cells on histology
nodular basal cell carcinoma
80
what is another name for a benign seborrheic wart
basal cell papilloma
81
which type of cancer looks as if it is 'stuck on'
basal cell papilloma (seborrheic wart)
82
which type of cancer has 'horn cysts' on histology
basal cell papilloma (seborrheic wart)

J Derm (23 decks)

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