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N&SS - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

(63 cards)

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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
What are the minor points on the 7 point weighted checklist?
Largest diameter over 7mm Inflammation Oozing Change in sensation
26
What system can we use to check a skin lesion for red flags?
ABCDEF: - Asymmetry - Border not regular - Colours - uniformity, number - Diameter - Evolution - Funny looking (ugly duckling)
27
With the types of skin cancers, which should be referred down the 2ww pathway if suspected?
Melanoma and SCC. BCC can usually have normal referral unless there are special circumstances
28
How common are SCCs?
Very - 2nd most common skin cancer after BCC
29
Where are most SCCs found?
On the head and neck area of caucasian men, often paler people who have lived in sunny countries e.g. Australians, sunset migraters
30
What are the risk factors for SCC?
- UV light exposure - Fair skin/blonde/red hair - Chemical carcinogen exposure - HPV - Immunodeficiency - Chronic inflammation - Pre-malignant conditions
31
How do SCCs present?
As an indurated nodular kerainising tumour Or Crusted tumour that may ulcerate Its very variable
32
How should a suspected SCC be investigated?
Hx and visual investigation -> 2ww referral to dermatology for excisional biopsy and histology. Incisional or punch biopsy may be appropriate.
33
When are punch biopsies more appropriate than excisional biopsies?
When the lesion is large, in a cosmetically sensitive area, or if it is close to a vital structure.
34
If an SCC is extensive, how can we investigate further?
Imaging inc. CT, esp. lymph nodes, and MRI for H&N spreading. FNA or excisional biopsy of enlarged nodes.
35
How are SSCs staged?
TNM, translated into Stage 0-IV disease.
36
How are SCCs treated?
Options include: - Curettage and cautery - Cryotherapy/cryosurgery - Topical Imiquimod/5-FU/diclofenac - Photodynamic therapy - Radiotherapy
37
Which sites increase the risk of SCC metastasising?
``` -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
What is the prognosis associated with SCC?
5 yr survival is 25-40%
39
What are the pre-malignant conditions of the skin?
Actinic keratosis | Bowen's disease
40
What is actinic keratosis?
Thickened scaly groeth of skin caused by sunlight.
41
What causes actinic keratosis?
UV-induced DNA damage within the skin
42
What can happen to actinic keratosis?
It can resolve spontaneously, stay stable, or progress to Bowen's disease or SCC.
43
What other signs of sun damage might be present with actinic keratosis?
Telangiectasia Elastosis Pigmented lesions
44
How are actinic keratosis graded?
Grade 1 - slightly palpable (better felt than seen) Grade 2 - moderately thick Grade 3 - very thick, hyperkeratotic
45
What general advice can we give to pts with aktinic keratosis?
- Limit sun exposure, and use sun protection - Emollients for symptom relief - Report changes, keep an eye on existing lesions
46
How can we treat AK medically?
Topical 5-FU Diclofenac gel Imiquimod cream Cryotherapy Photodynamic therapy Curettage or excision
47
What is Bowen's disease?
Squamous cell carcinoma in situ - it is intraepidermal.
48
What does Bowen's disease look like?
Slow growing, erythematous, hyperkeratotic patch or plaque with an irregular, sharply demarcated border.
49
How is Bowen's disease managed?
``` 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
What is the prognosis associated with Bowen's disease?
Excellent! Even better with treatemtn! Untreated, only 3% progress to invasive SCC, but mets are rare.
51
Where are normal skin melanocytes found?
In the basal layer of the epidermis
52
Why are people with darker skin less likely to get skin cancer?
The melanocytes produce more melanin which protects the skin from UV damage.
53
How do most skin melanomas spread?
They spread out within the epidermis
54
What are the 4 types of skin melanoma?
Lentigo maligna Superficial Nodular Acral lentiginous
55
Tell me about nodular melanoma.
Most aggressive type | Rapidly growing, pigmented nodule which bleedsor ulcerates.
56
Tell me about acral lentiginous melanoma.
Pigmented lesions on the palm, sole, or under the nail.
57
Tell me about lentigo maligna melanoma.
Patch of lentigo maligna develops a papule or nodule
58
Tell me about superficial melanoma.
Large flat irregularly pigmented lesion which grows laterally before vertical invasion.
59
Tell me about who gets malignant melanoma.
M
60
What are the risk factors for malignant melanoma?
- Personal Hx of melanoma - Naevi - Sun exposure - Fair skin - FHx - Actinic keratosis
61
What is the primary treatment for malignant melanoma?
Wide local excision with re-excision if the margins are inadequate.
62
For more advanced melanoma, what are the treatment options?
- Completion lymphadenectomy with sential node mets - Lymph node dissection - Adjuvant radiotherapy - Palliation
63
Which systemic treatments can be used for malignant stage IV melanoma?
Targeted Rx (tyrosine kinase inhibitors) Immunotherapy Cytotixic chemotherapy

N&SS - Dermatology (9 decks)

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