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Year 4 Cancer Care and Haem > Skin Cancer > Flashcards

Skin Cancer Flashcards

(58 cards)

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1
Q

Describe the distribution of melanocytes in different races?

A

Melanocytes are found in equal numbers between black and white ethnicities but melanocytes in black races produce more protective melanin

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2
Q

Why might melanomas be found later in darker skinned ethnicities?

A

Reduced public/physician awareness
Lower index of suspicion
Challenging detection (more likely acral)

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3
Q

Name two non cancerous melanocyte growths

A

Moles
Freckles

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4
Q

Name the four types of Malignant Melanoma

A

Lentigo Maligna
Superficial Melanoma
Nodular Melanoma
Acral Lentiginous

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5
Q

How do Superficial Melanomas present?

A

Irregularly pigmented
Grow laterally before vertically

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6
Q

How do Nodular Melanomas present?

A

Most aggressive
Rapidly growing pigmented nodule that bleeds/ulcerates

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7
Q

How do Acral Lentiginous Lesions present?

A

Pigmented lesions on palm/sole/nail bed

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8
Q

Where are the common sites of metastases from Malignant Melanoma?

A

Lymph nodes
Liver
Lung
Bone
Brain

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9
Q

Give four risk factors for Malignant Melanoma

A

Naevi
Sun Exposure
Skin Pigmentation (Fitzpatrick 1 or 2)
Immunosupression

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10
Q

Describe the risk factor ‘Naevi’ in terms of Malignant Melanoma

A

Individual with >100 common naevi or >2 atypical naevi

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11
Q

What is Atypical Mole Syndrome?

A

> 100 common naevi
AND
2 atypical naevi
AND
Naevi on unusual sites

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12
Q

Describe the risk factor ‘Sun Exposure’ in terms of Malignant Melanoma

A

Sharp short bursts of acute exposure in childhood, or severe sunburn

Post Sunbed use

Cumulative moderate occupational exposure may be protective in some

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13
Q

Using the A to E mnemonic, how can Malignant Melanomas be described?

A

Asymmetry
Border (uneven, scalloped)
Colour (variety in shade/colour)
Diameter (>6mm)
Evolving

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14
Q

There is a point system for examining Malignant Melanomas, and if patients score >3 then they require a 2ww. State the major factors scoring 2 points

A

Change in size
Irregular Shape
Irregular Colour

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15
Q

There is a point system for examining Malignant Melanomas, and if patients score >3 then they require a 2ww. State the minor factors scoring 1 point

A

Largest diameter >7mm
Inflammation
Oozing
Change in sensation

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16
Q

What are excisional biopsies?

A

Suspicious lesions are completely excised with 1-2mm margin
Includes subcut fat to ensure full dermal sample

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17
Q

When are incisional biopsies used?

A

Reserved for large lesions
Cosmetically sensitive
Close to vital structures

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18
Q

Name three types of histological analysis carried out on Malignant Melanoma biopsies

A

Breslow Thickness
Ulceration
Mitotic Index

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19
Q

What is Breslow Thickness?

A

Based on vertical thickness of tumour in mm

From Stratum Granulosum to point of maximum infiltration

Correlates with mortality

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20
Q

What is Mitotic Index?

A

Indicator of cell turnover
Number of mitoses per mm2

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21
Q

If the Malignant Melanoma is high risk, what other investigations should be done?

A

PET CT
LDH (Risk Stratifying)

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22
Q

Name two different ways to stage Malignant Melanomas

A

TNM
AJCC (American Joint Committee on Cancer)

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23
Q

Are Malignant Melanomas radiosensitive?

A

No

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24
Q

What levels should be maximised before initiating management for Malignant Melanomas?

25
How are Stage 0-2 Malignant Melanomas managed?
Stage 0 - Topical Imiquimod or Excision with 0.5cm margin Stage 1 - Excision with 1cm margin Stage 2 - Excision with 2cm margin
26
Describe some management options for more advanced Malignant Melanomas
Lymph node dissection Adjuvant radiotherapy Topical Imiquimod Electrochemotherapy Palliative surgery
27
Give two examples of Biological agents for Malignant Melanoma
Dabrafenib (BRAF V600 +ve) Bevacizumab (VEGF)
28
Give an example of an Immunotherapy agent used to treat Malignant Melanoma
Ipilimumab (Targets T lymphocytes and stimulates their anti tumour effects)
29
How is stage 1A Malignant Melanoma followed up?
2-4 times in first year then discharge
30
How is stage 1B-2B Malignant Melanoma followed up?
3m for 3y then 6m for 2y
31
How is Stage III Malignant Melanoma followed up?
3m for 3y then 6m for 2y and surveillance imaging
32
How is Stage IV Malignant Melanoma followed up?
Personalised follow up
33
What is a Mucosal Melanoma?
Rare and primarily affecting head and neck, vulvovagial and anorectal Typically older patients Worse prognosis
34
Name two common Non Melanoma Skin Cancers
Basal Cell Carcinoma Squamous Cell Carcinoma
35
Name two rarer Non Melanoma Skin Cancers
Merkel Cell Carcinoma Kaposi's Sarcoma
36
Give four risk factors for Non Melanoma Skin Cancers
UV radiation Chronic Inflammation HPV Hereditary Conditions
37
Define Basal Cell Carcinoma
Slow growing, locally invasive malignant epidermal skin tumours, commonly occuring on sun exposed regions of the body, rarely metastasising
38
Name four genetic predispositions to Basal Cell Carcinoma
p53 mutations Albinism Gorlins Syndrome Xeroderma Pigmentosum
39
How does Gorlin Syndrome present?
Autosomal dominant condition increasing risk of BCC Multiple early onset BCCs Hyperteorism Palmar and Plantar Pits Falx Calcification
40
Name the five types of Basal Cell Carcinoma
Nodular (60-80%) Superficial Morpheic Pigmented Basosquamous
41
How does Nodular BCC present?
TURP Telangiectasia, Ulceration, Rolled Edges, Pearly Edge Central ulcer = rodent ulcer
42
How do Superficial BCC present?
Erythematous plaques (commonly on trunk and limbs) Difficult to distinguish from dermatitis/SCC
43
How do Morpheic BCC present?
Presents as a scar like lesion Commonly occurring on upper trunk/face Deeply invasive
44
How do Pigmented BCC present?
Difficult to distinguish from Melanoma
45
How do Basosquamous BCC present?
Rare and aggressive form with increased risk of recurrence and metastases
46
Give four BCC features that would make it high risk
>2cm Poorly defined Perineural/Perivascular incasion Immunosupression
47
The definitive management for BCC is excision and histological analysis. What margins are required for low and high risk?
Low risk -> 4-5mm margin High risk -> atleast 5mm margin, and referral for Mohs Micrographic surgery considered
48
What is Moh's Micrographic surgery?
Tumour is excised at an oblique angle in a series of stages and examined microscopically Further excision until all margins negative
49
If there is a low risk lesion, BCC may be treated by other treatments such as:
Cryotherapy Electrosurgery
50
When is radiotherapy for BCC appropriate?
For recurrent disease In cosmetically sensitive areas
51
What is Photodynamic Therapy?
Light + Topical Photosensitising Agent to produce tumour destruction Good cosmetic results but lengthy process
52
Squamous Cell Carcinomas make up around 20% of non melanoma skin cancer. How do they present?
Rapidly growing red papule or non healing lesion Ulceration Bleeding May have background of Actinic Keratoses
53
What makes a Squamous Cell Carcinoma more likely to metastasise?
Recurrent disease Large Size Certain sites (eg lip)
54
Name 5 management options for Squamous Cell Carcinoma
Surgical excision (+histological analysis) Cryotherapy (small low risk lesions) Radiotherapy (if small and well localised, or as adjuvant) Chemotherapy (Cisplatin) Cetuximab
55
What is Merkel Cell Carcinoma?
Rare malignant skin tumour arising in head/neck/limbs that has neuroendocrine features pathologically
56
How does Merkel Cell Carcinoma present?
Red/purple nodule with overlying shiny epithelium
57
How is Merkel Cell Carcinoma managed?
Ideally surgery (+/- adjuvant chemoradio)
58
Define Selective and Extended Neck Dissection
Selective : One or more lymphatic groups preserved based on pattern of metastases Extended : Extra lymphatic or non lymphatic structures are removed

Year 4 Cancer Care and Haem (16 decks)

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