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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What are the non-melanoma skin cancers?

A

Basal cell cancer

Squamous cell cancer

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2
Q

Risk factors for non-melanoma skin cancer

A 
UV radiation 
Photochemotherapy 
Chemical carcinogens
X ray and thermal radiation 
HPV
Familial cancer syndromes
Immunosuppression
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3
Q

Features of BCC

A

Slow growing
Locally invasive
Rarely metastasise

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4
Q

What does a BCC look like?

A 
Nodular
Pearly rolled edge 
Telangiectasia 
Central ulceration 
Arborizing vessels on dermoscopy
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5
Q

Treatment of BCC

A 
Surgical excision 
Curettage 
Cryotherapy 
Topical cream
- imiquimod
- fuorouracil 
Radiotherapy 
Vismodegib (advanced BCC)
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6
Q

When is vismodegib used?

A

Locally advanced BCC not sutiable for surgery or radiotherapy
Metastatic BCC

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7
Q

SEs of vismodegib

A 
Hair loss
Weight loss
Altered taste 
Muscle spasms 
Nausea 
Fatigue
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8
Q

Features of SCC

A

Usually on sun exposed sites
Can metastasise
Fast growing

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9
Q

Presentation of SCC

A

Tender
Scaly/crusted or fleshy growths
Can ulcerate

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10
Q

What are SCC derived from?

A

Keratinising squamous cells

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11
Q

Treatment of SCC

A

Excision

+/- radiotherapy

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12
Q

What is a keratoacanthoma?

A

Variant of SCC

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13
Q

Features of keratoacanthoma

A

Erupts from hair follicles on sun damaged skin
Grows rapidly
May shrink after a few months and resolve

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14
Q

Treatment of keratoacanthoma

A

Surgical excision

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15
Q

Risk factors for melanoma

A 
UV radiation 
Genetics
- fair skin 
- red hair
- blue eyes
- tendency to burn easily 
Familial melanoma and melanoma susceptibility genes
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16
Q

What is the ABCDE rule of melanoma?

A 
Asymmetry 
Border
Colour 
Diameter
Evolution
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17
Q

What is the 7 point checklist for melanoma?

A 
Major features
- change in size
- change in shape
- change in colour 
Minor features
- diameter > 6mm
- inflammation 
- oozing or bleeding
- mild itch or altered sensation
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18
Q

What is the biologic progression of melanoma?

A 
Benign nerves
Dysplastic nerves 
Rapid growth phase
Vertical growth phase
Metastatic melanoma
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19
Q

Types of melanoma

A 
Superficial spreading malignant melanoma
Lentigo maligna melanoma
Nodular melanoma 
Acral Lentiginous melanoma/subungual melanoma 
Ocular melanoma
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20
Q

Treatment of melanoma

A 
Urgent surgical excision 
Wide local excision 
Sentinel lymph node biopsy
Chemo / immunotherapy 
Regular follow up 
1 and 2 prevention
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21
Q

Treatment of metastatic melanoma

A

Ipilimumab
Pembrolizumab
Vemurafenib and Dabrafenib

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22
Q

Causes of cutaneous metastases

A

Can be secondary to primary skin malignancy such as melanoma
Due to primary solid organ malignancy

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23
Q

Most common causes of cutaneous metastases

A

Breast
Colon
Lung

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24
Q

Treatment of cutaneous metastases

A

Treat underlying malignancy
Local excision
Localised radiotherapy
Symptomatic

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25
Q

Causes of cutaneous lymphoma

A

Secondary disease from systemic / nodal involvement

Primary disease from abnormal neoplastic proliferation of lymphocytes in the skin

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26
Q

What is mycosis fungoides?

A

Most common form of cutaneous T cell lymphoma

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27
Q

Cause of mycosis fungoides

A

Unknown

28
Q

Who gets mycosis fungiodes?

A

Older > young

M > F

29
Q

Stages of mycosis fungiodes

A 
Patch 
- flat, red, dry oval lesions 
- usually covered sites 
- may slowly enlarge or spontaneously resolve 
- may itch 
Plaque
- patches become thickened 
- generally itch
Tumour
- large irregular lumps 
- can ulcerate 
- arises from existing plaques or normal skin 
- more likely to have metastatic spread
Metastatic spread
- infiltration of neoplastic cells in lymph nodes, blood and solid organs
30
Q

Investigations for mycosis fungiodes

A

Blood - sezary cells

CT

31
Q

What is sezary syndrome?

A

Red man syndrome

CTCL affecting skin of the entire body

32
Q

Presentation of sezary syndrome

A

Entire body affected
Skin thickened, scaly and re
Very itchy
Lymph node involvement

33
Q

In sezary syndrome, what is found in the blood? What are these?

A

Sezary cells

These are atypical T cells

34
Q

Prognosis for sezary syndrome

A

Poor

Median survival 2-4 years

35
Q

Treatment of cutaneous lymphoma

A 
Depends on stage
Topical steroids
PUVA or UVB
Localised radiotherapy 
Interferon 
Bexarotene
Low dose methotrexate
Chemo 
Total skin electron beam therapy 
Extracorporeal photophoresis
Bone marrow transplant
36
Q

What is cutaneous lymphoma?

A

A subtype of NHL that starts in the skin

37
Q

What is total skin electron beam therapy?

A

Type of radiotherapy consisting of very small electrically charged particles
Delivers radiation primarily to superficial layers i.e. epidermis and dermis
Spares deeper tissues and organs

38
Q

What is extracorporeal photophoresis?

A

Leucocytes collected from blood
Collected white cells mixed with psoralen which makes the T cells sensitive to UVA radiation
Exposed to UVA radiation, damaging diseased cells
Treated cells reinfused back to patient

39
Q

Another name of BCC

A

Rodent ulcers

40
Q

What is the most common type of cancer in the western world?

A

BCC

41
Q

Definition of bowens disease

A

Intraepidermal SCC

42
Q

Who is bowens disease common in?

A

Elderly

Females

43
Q

What is the chance of bowens disease causing invasive skin cancer?

A

3%

44
Q

Presentation of bowens disease

A

Red scaley patches

Sun exposed areas such as lower limbs

45
Q

Management options of bowens disease

A

Topical 5-fluorouracil or imiquimod
Cryotherapy
Excision

46
Q

What is leukoplakia?

A

Pre malignant condition which presents as white, hard spots on the mucous membranes of the mouth

47
Q

Who is leukoplakia more common in?

A

Smokers

48
Q

What is leukoplakia a diagnosis of?

A

Exclusion

49
Q

What else should be considered as differentials of leukoplakia?

A

Candidiasis

Lichen planus

50
Q

What can leukoplakia transform into and in what % of people?

A

SCC

1%

51
Q

What is a lipoma?

A

Common, benign tumour of adipocytes

52
Q

Pathology of lipoma

A

Generally found in subcutaneous tissues

May rarely also occur in deeper adipose tissue

53
Q

How common is lipoma transformation to liposarcoma?

A

Very rare

54
Q

Who are lipomas most commonly seen in?

A

Middle aged adults

55
Q

Presentations of lipoma

A

Lump

  • smooth
  • mobile
  • painless
56
Q

Management of lipoma

A

May be observed

If diagnosis uncertain or surrounding structures compressed then may be removed

57
Q

What are the features that would suggest sarcomatous change of a lipoma?

A

Size > 5cm
Increasing size
Pain
Deep anatomical location

58
Q

Most aggressive type of melanoma

A

Nodular

59
Q

What are the margins of excision malignant melanoma related to?

A

Breslow thickness

60
Q

What are the Breslow thickness excision margins?

A 
Lesions 0 - 1mm thick 
- 1cm
Lesions 1 - 2mm thick 
- 1 - 2cm (depending upon site and pathological features
Lesions 2 - 4mm thick 
- 2 - 3 cm (depending on site and pathological features)
Lesions >4 mm thick 
- 3cm
61
Q

What is the single most important factor in determining prognosis of patients with malignant melanoma?

A

Invasion of depth of a tumour (Breslow depth)

62
Q

Prognosis of malignant melanoma related to the Breslow thickness

A

< 1mm - 5 year survival 95 - 100%
1 - 2 mm - 80 - 96%
2.1 - 4mm - 60 - 75%
>4mm - 50%

63
Q

Risk factors for SCC of skin

A

Excessive exposure to sunlight / psoralen UVA therapy
Actinic keratoses
Bowens disease
Immunosuppression
Smoking
Long standing leg ulcers (marjolins ulcer)
Genetic conditions e.g. xeroderma pigmentosum

64
Q

Is metastases common or rare in SCC?

A

Rare, 2 - 5%

65
Q

Gold standard management for morpheoic BCC

A

Mohs Micrographic surgery

66
Q

Explain mohs micrographic surgery

A

Microscopic examination of excised tissues DURING the surgery
Useful in tumours with poorly defined edges / cosmetic areas as it ensures the whole tumour has been excised while minimising the removal of healthy tissue

Dermatology (11 decks)

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