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Dermatology > Skin Cancer > Flashcards

Flashcards in Skin Cancer Deck (88):
1

Skin cancer (all types) are on the increase in Scotland, true or false

TRUE

2

What is the connection between the ageing population and skin cancer

There is a larger population of people with many years of UV exposure
Cumulative damage is a cause of the cancer

3

What is the most common cancer in 15-24 year olds

melanoma

4

Which property of melanocytes makes melanoma so dangerous

They are motile cells that can migrate
This means melanoma is much more likely to spread
Once it has metastasised it is very hard to treat

5

What measurement is used to determine prognosis of melanoma

Breslow thickness
Measures how deep in the skin layer the melanoma has gone
Thicker = worse prognosis

6

What is the chance of survival once melanoma has metastasised

5%

7

What is the ugly duckling sign

Can be a sign of melanoma
A skin mole/lesion that does not look like any others on the body

8

Do BCC's usually spread widely

No
Usually only invade locally and are very slow growing

9

How are BCC's usually treated

Skin surgery

10

Name some different types of BCC

Superficial - looks like a scaly plaque
Nodular
Infiltrative -not well defined (most dangerous)
Pigmented

11

What are some high risk sites for SCC

Ear
Scalp
Lip

12

What is a cutaneous horn

A large deposit of keratin
Protrudes from skin
Well demarcated
Early SCC

13

Where can SCC spread to

First go to lymph nodes
Bone

14

What is the survival rate for metastatic SCC

25%

15

What must you consider in a leg ulcer that doesn't heal

SCC

16

What is Bowen's disease

Carcinoma in situ
Precursor to SCC - often more aggressive forms
Appears as a scaly patch/plaque with an irregular border

17

What gene is mutated in xeroderma pigmentosum

Nucleotide excision repair gene
Means sufferers cannot repair damaged DNA
Much higher cancer risk

18

What are some of the early symptoms of xeroderma pigmentosum

Acute sunburn reaction on minimal exposure
Hugely photosensitive
Solar lentigines at early age
Dryness
Atrophy
Actinic keratoses

19

What does Type VII collagen deficiency increase your risk of

You get a lot of blistering as less collagen to anchor dermis and epidermis
High risk of SCC in wounded areas

20

What are some methods of skin cancer prevention

Behaviour - avoid midday, stay in shade
Clothing - cover up
Sunscreen
Check skin regularly

21

define cancer

An accumulation of Abnormal cells that multiply through uncontrolled cell division and spread to other parts of the body by invasion and/or distant metastasis via the blood and lymphatic system

22

how does cancer occur (generally)

Multi-step gene damage

23

what are the hallmarks of cancer

Resisting cell death
Inducing angiogenesis
Enabling replicative immortality
Invasions and metastasis
evading growth suppressors
Sustaining proliferative signalling

24

What characteristics enable cancer

Deregulating cellular energetics - cancer needs more energy so changes metabolism
Genome instability and mutation
Avoiding immune destruction
Tumour-promoting inflammation

25

What is an oncogene

Over-active form of a gene that positively regulates cell division
Drives tumour formation

26

What is a protooncogene

the normal, not yet mutated,
form of an oncogene
In normal

27

What is a tumour suppressor

Inactive or non-functional form of a gene that negatively regulates cell division
When functioning it prevents tumour formation

28

What Is RAS signalling

RAS protein is in the cell membrane
When growth factors bind they switch on RAS which drives cell proliferation

If RAS gets mutated and stays on permenantly it can cause cancer

29

What scale is used to determine a persons skin type

The Fitzpatrick skin type scale
Goes from 1-6

30

What are the 2 'types' of melanin

Eumelanin - black/brown pigment
Pheomelanin - yellowish pigment

31

What is the consequence of paler skin types producing pheomelanin

It doesn't absorb UV as well as eumelanin so paler skin types are more likely to burn

32

What sun exposure pattern is SCC most associated with

Life-long cumulative exposure
Occurs in sun exposed areas
Outdoor workers
Elderly

33

What sun exposure pattern is BCC and melanoma most associated with

Intermittent bursts of sun exposure
frequent holidays
Sunbeds

34

What causes a 4 fold increase in melanoma risk

childhood sunburn

35

What is the difference in the damage caused by UVA and UVB

UVA causes indirect damage to DNA
UVB causes direct

36

How is DNA usually repaired

NER detects and cleaves the damaged DNA
DNA polymerase fills the gap
DNA ligase joins edges

37

How is UV immunosuppressive

Keratinocytes will start to secrete immunosuppressive cytokines after UV exposure
Depletion of Langerhans cells in the skin and reduced ability to present antigens

38

Which mutation is associated with BCC formation

Mutations in PTCH1
Key part of hedgehog pathway

39

Which mutations are associated with melanoma

Mutations in the Ras/Raf/MAPK pathway
This signalling pathway leads to cell division and proliferation

40

Which gene targeted therapies are available for melanoma

Braf mutation inhibitor Vemurafenib
MEK inhibitors

41

Which components of the skin can skin tumours arise from

epidermis
melanocytes
dermis
appendages
lymphoid elements

42

what is the ration of melanocytes to basal keratinocytes

Somewhere between 1:5 and 1:10

43

Mutations in the MC1R gene increase your risk of melanoma - true or false

True
People with these mutations are freckly or red heads

44

Which people are ephilides most common in

Fair skinned
Red heads
ephilides are freckles!

45

Where do actinic lentigines usually appear

Face, forearms and dorsal hands

46

which naevi are at higher risk of becoming cancerous

More complex, larger naevi
More melanocytes involved

47

How do naevi progress through stages of development

Start as junctional in childhood
May become compound in adolescence
Finally intradermal in adulthood
Melanocytes move down

48

Describe sporadic dysplastic naevi

Not inherited
One to several
Slightly increased risk of melanoma

49

Describe familial dysplastic naevi

Will have lots of lesions
autosomal inherited condition
strong FH of melanoma
Risk is significantly increased

50

Describe dysplastic naevi

Both architecture and cells are atypical
Get fibrosis and inflammation
Epidermis not affected

51

What are halo naevi

Naevi with a peripheral halo of depigmentation - paler circle
Contain a lot of lymphocytes

52

What are blue naevi

Relatively uncommon
Entirely dermal - deep
Appear bluish in colour
Turn up in odd places
Contain pigment rich dendritic cells

53

What are Spitz naevus

Occur in the under 20's
Made of large spindle or epithelioid cells
Closely mimic melanoma but are usually benign

54

How does most melanoma arise

From de novo mutations
Acquired rather than genetic
Usually through UV exposure
Fairer skin is higher risk

55

Where does melanoma most commonly appear

Sun exposed sites
Scalp
Face
Neck
Arm
Trunk
Leg

56

Which factors would make you suspect melanoma

Change in lesion shape
Irregular pigmentation
bleeding
Development of satellite nodules
Ulceration
New pigmented lesion develops in adulthood

57

Where does acral/mucosal lentiginous melanoma occur

Feet and mucosal surfaces

58

Where does lentigo maligna melanoma occur

Face
Neck
Scalp

59

Which melanomas can metastasise

Only those that have entered vertical growth phase
All types can progress to this
Nodular will already be in this phase

60

Describe nodular melanoma

Will go straight into vertical growth phase
No evidence of RGP
sometimes considered more aggressive

61

What factors can indicate poor prognosis

Presence of ulceration
high Breslow thickness
high mitotic rate
lymph/vascular invasion
satellites
Node involvement

62

Which paths can melanoma use to spread

Local dermal lymphatics - get satellite lesions
Mets to lymph nodes
Spread through the blood - can go anywhere in body

63

How do you treat melanoma

Primary excision to give clear margins
Some also receive a sentinel node biopsy
If SN positive - regional lymphadenectomy

Mau also use chemo, immunotherapy or genetic therapy in advanced disease

64

What causes seborrheic keratosis

A benign proliferation of epidermal keratinocytes
Get thickened skin, hyperkeratosis

65

Palisading or picket fencing is a key histological sign of what condition

BCC

66

Who is most likely to present with Bowen's disease

Females
Mostly on lower leg

67

What actinic keratosis

common precursor to invasive SCC - very common
Occurs on sun exposed skin - scalp, face and hands
Variable epidermal dysplasia - atypical lesions

68

What are some viral precursors to skin cancer

Viral genital lesions are often dysplastic
HPV is often involved

69

what are some adverse prognostic features of SCC

thickness greater than 4mm
Lymphatic/vascular space invasion
Some sites have a poorer - scalp. ear, nose

70

What are the 5 main ways a skin disease could affect quality of life

Physical comfort - itch
Acceptability to self and others
Emotional well being
Social functioning
Confidence

71

What is a primary skin disease

One that is precipitated or exacerbated by emotional factors

72

What is a secondary psychiatric illness

One that is arising from or exacerbated by primary skin disease

73

What is the biopsychosocial model

That genetic, psychiatric and environmental factors overlap when causing a condition

74

What is Morgellons syndrome

A psychiatric skin manifestation where people think they are infested with bugs etc

75

How would you manage the psychological aspects of a skin disease

Listen to the patient
Empathise - be genuine
Cover ICE
Check for other social factors etc
Carry out psych assessment if necessary

76

What are the indications for skin biopsy

Rashes - to help diagnose
Tumours - help diagnose, remove malignancy or remove unwanted skin growths

77

What is a dermatofibroma

Benign nodule on skin
Firm to touch

78

why might biopsy of a rash not provide a diagnosis

Different conditions can have similar histology - e.g. different types of eczema
One condition can have several histology patterns

79

What are some potential treatments for skin conditions/ lesions

Drug therapy
Cryotherapy
Phototherapy
Surgery
Chemo/radiotherapy

80

How is 5% imiquimod cream used

Can be used to treat skin cancer
Causes regression of the tumour
Not the first choice of treatment as it doesn’t always work

81

How do you treat non-melanoma skin cancer

Traditionally surgery
Some new treatments becoming available - e.g. imiquimod cream

82

How do you treat melanoma skin cancer

Initially surgery
May need further surgery, radiotherapy or chemo

83

What are the 5 layers of the scalp

Skin
Connective tissue
Aponeurosis
Loose connective tissue
Periosteum

84

What are the different methods of local anaesthesia

Topical - takes some sensation away but doesn't achieve complete numbness
Local infiltration
Nerve block
Field block

85

What are some potential complications of skin biopsy

bleeding
wound dehiscence
infection
scarring
motor or sensory nerve damage
loss of function

86

List some basic skin surgery methods

Electrosurgery
Snip excision
Curettage
Shave excision
Punch biopsy
Elliptical excision
Laser
Photodynamic

87

What are the pros and cons of a punch biopsy

quick
produces good wound edges

Difficult to judge depth
Round holes don't heal well
Sample may be too small

88

What is a sentinel node biopsy

Inject dye to area and it allows you to track the first node that the cancer cells would get to
Determine area for node biopsy to check for spread