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N&SS - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What can malignant skin cancers be divided into?

A

Melanoma and non-melanoma

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2
Q

What are the non-melanoma skin cancers?

A

Basal cell carcinoma and squamous cell carcinoma

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3
Q

Which is the most life-threatening type of skin cancer?

A

Malignant melanoma

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4
Q

Why is melanoma bad bad bad?

A

Life threatening and affects younger population as well as older

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5
Q

What is the single most preventable factor for skin cancer?

A

Sun exposure ☀️

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6
Q

Which skin cancer is a malignant tumour of epidermal keratinocytes?

A

BCC

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7
Q

Describe BCC

A
  • slow growing
  • locally invasive
  • normally in older individuals
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8
Q

Does BCC metastasise?

A

Rarely

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9
Q

Which is the most common type of malignant skin tumours?

A

BCC

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10
Q

What are the main risk factors for BCC?

A
  • UV exposure
  • Hx of frequent/severe sunburn in childhood
  • Skin type 1
  • Age
  • Male
  • Hx of skin cancer
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11
Q

Where do BCCs usually present?

A

On face, head, or neck

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12
Q

How do most BCCs look?

A

Nodular

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13
Q

What is the treatment of choice for BCC?

A

Surgical excision

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14
Q

Why is surgery the choice treatment for BCC?

A

Allows examination of the tumour and its margins

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15
Q

What do we do for BCCs that are high risk or recurrent tumours?

A

Mohs micrographic surgery (excision of the lesion and tissue borders are progressively excised until specimens are microscopically free of tumour)

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16
Q

Do we use radiotherapy for BCCs?

A

Yeep, if surgery is not appropriate

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17
Q

How do we treat low risk, or small BCCs?

A

Other methods eg cryotherapy, curettage and cautery, topical treatment

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18
Q

Can BBC go bad?

A

They can locally invade and cause tissue destruction

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19
Q

What is the prognosis for BCC?

A

Depends on size/site/type/growth etc and grade and stage of tumour

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20
Q

What are the features of SCC?

A
  • locally invasive malignant tumour

- affects epidermal keratinocytes or its appendages

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21
Q

Can SCCs metastasise?

A

Yes

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22
Q

What is the criteria for referring for 2ww if melanoma is suspected?

A

Suspicious pigmented skin lesion with a score of 3 or more
OR
dermoscopy suggests malignant melanoma

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23
Q

What scoring system do we use for malignant melanoma?

A

7 point weighted checklist - major features score 2 points each, minor score 1 point

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24
Q

What are the major points on the 7 point weighted checklist?

A

Change in size
Irregular shape
Irregular colour

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25
Q

What are the minor points on the 7 point weighted checklist?

A

Largest diameter over 7mm
Inflammation
Oozing
Change in sensation

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26
Q

What system can we use to check a skin lesion for red flags?

A

ABCDEF:

  • Asymmetry
  • Border not regular
  • Colours - uniformity, number
  • Diameter
  • Evolution
  • Funny looking (ugly duckling)
27
Q

With the types of skin cancers, which should be referred down the 2ww pathway if suspected?

A

Melanoma and SCC.

BCC can usually have normal referral unless there are special circumstances

28
Q

How common are SCCs?

A

Very - 2nd most common skin cancer after BCC

29
Q

Where are most SCCs found?

A

On the head and neck area of caucasian men, often paler people who have lived in sunny countries e.g. Australians, sunset migraters

30
Q

What are the risk factors for SCC?

A
  • UV light exposure
  • Fair skin/blonde/red hair
  • Chemical carcinogen exposure
  • HPV
  • Immunodeficiency
  • Chronic inflammation
  • Pre-malignant conditions
31
Q

How do SCCs present?

A

As an indurated nodular kerainising tumour

Or

Crusted tumour that may ulcerate

Its very variable

32
Q

How should a suspected SCC be investigated?

A

Hx and visual investigation -> 2ww referral to dermatology for excisional biopsy and histology.

Incisional or punch biopsy may be appropriate.

33
Q

When are punch biopsies more appropriate than excisional biopsies?

A

When the lesion is large, in a cosmetically sensitive area, or if it is close to a vital structure.

34
Q

If an SCC is extensive, how can we investigate further?

A

Imaging inc. CT, esp. lymph nodes, and MRI for H&N spreading.

FNA or excisional biopsy of enlarged nodes.

35
Q

How are SSCs staged?

A

TNM, translated into Stage 0-IV disease.

36
Q

How are SCCs treated?

A

Options include:

  • Curettage and cautery
  • Cryotherapy/cryosurgery
  • Topical Imiquimod/5-FU/diclofenac
  • Photodynamic therapy
  • Radiotherapy
37
Q

Which sites increase the risk of SCC metastasising?

A 
-Site - lip, ear, or sites that never usually see the sun
Area of radiation/thermal injur
-Diameter over 2cm
-Deeper than 4mm
-Poor differentiation
-Host immunosuppression
38
Q

What is the prognosis associated with SCC?

A

5 yr survival is 25-40%

39
Q

What are the pre-malignant conditions of the skin?

A

Actinic keratosis

Bowen’s disease

40
Q

What is actinic keratosis?

A

Thickened scaly groeth of skin caused by sunlight.

41
Q

What causes actinic keratosis?

A

UV-induced DNA damage within the skin

42
Q

What can happen to actinic keratosis?

A

It can resolve spontaneously, stay stable, or progress to Bowen’s disease or SCC.

43
Q

What other signs of sun damage might be present with actinic keratosis?

A

Telangiectasia
Elastosis
Pigmented lesions

44
Q

How are actinic keratosis graded?

A

Grade 1 - slightly palpable (better felt than seen)
Grade 2 - moderately thick
Grade 3 - very thick, hyperkeratotic

45
Q

What general advice can we give to pts with aktinic keratosis?

A
  • Limit sun exposure, and use sun protection
  • Emollients for symptom relief
  • Report changes, keep an eye on existing lesions
46
Q

How can we treat AK medically?

A

Topical 5-FU
Diclofenac gel
Imiquimod cream

Cryotherapy
Photodynamic therapy
Curettage or excision

47
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ - it is intraepidermal.

48
Q

What does Bowen’s disease look like?

A

Slow growing, erythematous, hyperkeratotic patch or plaque with an irregular, sharply demarcated border.

49
Q

How is Bowen’s disease managed?

A 
It isn't really - in some situations, observation may be the best option.
Topical - 5-FU and Imiquimod 5% cream.
Cryotherapy
Surgery
Photodynamic therapy
50
Q

What is the prognosis associated with Bowen’s disease?

A

Excellent! Even better with treatemtn!

Untreated, only 3% progress to invasive SCC, but mets are rare.

51
Q

Where are normal skin melanocytes found?

A

In the basal layer of the epidermis

52
Q

Why are people with darker skin less likely to get skin cancer?

A

The melanocytes produce more melanin which protects the skin from UV damage.

53
Q

How do most skin melanomas spread?

A

They spread out within the epidermis

54
Q

What are the 4 types of skin melanoma?

A

Lentigo maligna
Superficial
Nodular
Acral lentiginous

55
Q

Tell me about nodular melanoma.

A

Most aggressive type

Rapidly growing, pigmented nodule which bleedsor ulcerates.

56
Q

Tell me about acral lentiginous melanoma.

A

Pigmented lesions on the palm, sole, or under the nail.

57
Q

Tell me about lentigo maligna melanoma.

A

Patch of lentigo maligna develops a papule or nodule

58
Q

Tell me about superficial melanoma.

A

Large flat irregularly pigmented lesion which grows laterally before vertical invasion.

59
Q

Tell me about who gets malignant melanoma.

A

M

60
Q

What are the risk factors for malignant melanoma?

A
  • Personal Hx of melanoma
  • Naevi
  • Sun exposure
  • Fair skin
  • FHx
  • Actinic keratosis
61
Q

What is the primary treatment for malignant melanoma?

A

Wide local excision with re-excision if the margins are inadequate.

62
Q

For more advanced melanoma, what are the treatment options?

A
  • Completion lymphadenectomy with sential node mets
  • Lymph node dissection
  • Adjuvant radiotherapy
  • Palliation
63
Q

Which systemic treatments can be used for malignant stage IV melanoma?

A

Targeted Rx (tyrosine kinase inhibitors)
Immunotherapy
Cytotixic chemotherapy

N&SS - Dermatology (9 decks)

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