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Z Year 2 BRS MSK > Skin Cancers 2 > Flashcards

Skin Cancers 2 Flashcards

(59 cards)

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1
Q

When is keratinocyte dysplasia/carcinoma common?

A
  • pale skin types

- solar induced UV damage

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2
Q

What are the stages of keratinocyte dysplasia?

A
  1. Actinic keratoses
  2. Bowen’s disease
  3. Squamous cell carcinoma
  4. aBasal cell carcinoma
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3
Q

What is actinic keratoses?

A

Dysplastic keratinocytes

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4
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ

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5
Q

What is squamous cell carcinoma?

A

Potential for metastasis/ death

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6
Q

What is basal cell carcinoma?

A
  • (Virtually) never metastasises

- Locally invasive

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7
Q

What is the pathogenesis of basal cell carcinoma?

A

UV radiation

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8
Q

What is the pathogenesis of basal cell carcinoma dependent on?

A

stroma produced by dermal fibroblasts

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9
Q

What happens in the stroma in basal cell carcinoma (BCC)?

A
  1. Cross talk between tumour cells and mesenchymal cells of stroma
  2. Receptors for PDGF are upregulated in Stroma
  3. but PDGF is upregulated in tumour cells
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10
Q

What is the activity of BCC like?

A

proteolytic activity e.g. metalloproteinases and collagenases – degrade pre-existing dermal tissue and facilitate spread of tumour cells

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11
Q

What genes loose function in BCC?

A
  1. Loss of function in chromosome 8q (PTCH gene)
    - Sonic Hedgehog-Patched signalling pathway
    / SHH signalling is required for growth of established BCCs
  2. p53 mutations are also important – majority are missense mutations that carry a UV signature
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12
Q

Why does squamous cell carcinoma develop?

A
  • UV radiation

- Genetic alterations

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13
Q

What genes make an impact in squamous cell carcinoma?

A
  1. P53
  2. CDKN2A
  3. NOTCH1 or NOTCH2 (Wnt / β-catenin signalling)
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14
Q

What are the process of squamous cell carcinoma development?

A
  1. Normal skin
  2. Epidermal p53 clone
  3. Squamous cell dysplasia
  4. Squamous cell carcinoma in situ
  5. Invasive squamous cell carcinoma
  6. Metastasis of squamous cell carcinoma
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15
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

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16
Q

How common is BCC compared to keratinocyte carcinomas?

A
  • BCC:SCC 4:1
  • Both commoner in pale skin types
  • Both more common in men vs women (2-3:1)
  • Median age at diagnosis of BCC is 68
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17
Q

What are the risk factors keratinocyte carcinomas?

A

•UV exposure
- PUVA
•Fair skin
•Genetic syndromes

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18
Q

What are the genetic syndromes that cause keratinocyte carcinomas?

A
  1. Xeroderma pigmentosum
  2. Oculocutaneous albinism
  3. Muir Torre syndrome
  4. Nevoid basal cell carcinoma syndrome*
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19
Q

What are the other risk factors of kertinocyte carcinomas?

A
  1. Nevus sebaceous
  2. Porokeratosis
    3, Organ transplantation (immunosuppressive drugs)
  3. Chronic non-healing wounds
  4. Ionising radiation
    - Airline pilots
  5. Occupational chemical exposures
    - Tar, polycyclic aromatic hydrocarbons,
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20
Q

What are atypical keratinocytes confined to?

A

epidermis

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21
Q

Where does actinic keratoses develop?

A

sun-damaged skin - usually head, neck, upper trunk and extremities

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22
Q

What does actinic keratoses look like?

A
  1. Erythematous macule or scale or both-> thick papules or hyperkeratosis or both
  2. Sometimes cutaneous horn
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23
Q

How do you distinguish actinic keratoses from SSC?

A

sometimes difficult – requiring biopsy

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24
Q

What is the risk of progression from actinic keratoses to SCC?

Study These Flashcards
A

0.025–16% per year for any single lesion

25
What is Bowen's disease?
Squamous cell carcinoma in situ
26
What does Bowen's disease look like?
Erythematous scaly patch or slightly elevated plaque
27
When might Bowen's disease arise?
de novo or from pre-existing AK
28
What can Bowen's disease resemble?
- actinic keratoses - psoriasis - chronic eczema
29
What is the treatment of actinic keratoses and Bowen's disease?
1. 5-fluorouracil cream 2. Cryotherapy 3. Imiquimod cream 4. Photodynamic therapy 5. Curettage and cautery 6. Excision
30
When might squamous cell carcinoma arise?
within background of sun-damaged skin
31
When can squamous cell carcinoma look like?
1. Erythematous to skin coloured 2. Papule 3. Plaque-like 4. Exophytic 5. Hyperkeratotic 6. Ulceration
32
What is the localisation of SCC?
Trunk and limbs > 2cm; Head / neck > 1cm; Periorificial zones
33
What are the margins of SCC like?
Ill-defined
34
How fast does SCC grow?
Rapidly growing
35
When is SCC common?
* Immunosuppressed patients | * Previous radiotherapy or  site of chronic inflammation
36
What is the histology like in SCC?
1. Grade of differentiation: poorly differentiated 2. Acantholytic, adenosquamous, demosplastic subtypes 3. Tumour thickness - Clark level: >6mm, Clark IV, V 4. Invasion beyond subcutaneous fat 5. Perineural, lymphatic or vascular invasion
37
What is keratocanthoma?
•Controversial entity | - Pseudo-malignancy vs variant of SCC
38
What are the characteristics of keratoacanthoma?
Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core
39
How does keratocanthoma resolve?
slowly over months to leave atrophic scar
40
Where do keratocanthoma occur?
- occur on head or neck  / sun exposed areas | - Difficult to distinguish clinically and histologically from squamous cell carcinoma
41
What are investigations of SCC?
1. Often clinical diagnosis sufficient 2. Diagnostic biopsy may be taken if diagnostic uncertainty 3. Ultrasound of regional lymph nodes ± FNA if concerns regarding regional lymph node metastasis
42
What is SCC treatment?
* Examination of rest of skin and regional lymph nodes * Excision * Radiotherapy * Cemiplimab for metastatic SCC
43
When do you use radiotherapy SCC?
- Unresectable |  - High risk features e.g. perineural invasion
44
What is the secondary prevention of SCC?
- Skin monitoring advice | - Sun protection advice
45
When does BCC arise?
within sun damaged skin
46
What are the main subtypes of BCC?
1. Nodular 2. Superficial 3. Morpheic 4. Infiltrative 5. Basisquamous 6. Micronodular
47
How common is nodular BCC?
- Most common subtype | - Accounts for approximately 50% of all Basal cell carcinomas
48
How does nodular BCC present?
shiny, pearly papule or nodule
49
What does superficial BCC look like?
Well-circumscribed, erythematous, macule / patch or thin papule /plaque
50
What does BCC morphoeic look like?
1. Slightly elevated or depressed area of induration 2. Usually light-pink to white in colour - More aggressive behaviour - Extensive local destruction
51
Is BCC mophoeic common?
less common
52
What is basisquamous BCC like?
Histological features of both basal cell carcinoma and squamous cell carcinoma
53
What is micronodular BCC like?
1. Resembles nodular basal cell carcinoma clinically | 2. More destructive behaviour – high rates of recurrence and subclinical spread
54
What are the investigations for BCC?
* Often clinical diagnosis sufficient | * Diagnostic biopsy may be taken
55
What are the differential diagnosis of BCC?
1. Squamous cell carcinoma 2. Adnexal (sebaceous) carcinoma 3. Merkel cell carcinoma
56
What is the stages of treatment for BCC in Mohs?
1. First thin layer removed 2. Another thin layer removed 3. Another thin layer removed 4. Final layer of cancer removed - examine each one before taking another so no margin taken
57
When is Mohs micrographic surgery used in BCC treatment?
1. Recurrent basal cell carcinoma 2. Aggressive subtype (morpheic / infiltrative / micronodular) 3. Critical site (if nose/eye)
58
What are the other option of BCC treatment?
1. Topical therapy e.g. 5-Fluorouracil, Imiquimod 2. Photodynamic therapy 3. Curettage (as iceberg can still reccur with this) 4. Radiotherapy 5. Vismodegib - selectively inhibits abnormal signalling in Hedgehog (Hh) pathway
59
What are some differential diagnsosi of SCC?
1. BCC 2. Viral wart 3. Merkel cell carcinoma

Z Year 2 BRS MSK (18 decks)

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