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Flashcards in Skin Cancers Deck (74):
1

Most deadly skin cancer
Is caused by a virus and is rare

Merkel cell carcinoma

2

Buckman 6 step is a framework for ___

breaking bad news

3

Buckman 6 step =

initiate
focused Hx - how much does ptnt know
how much do they want to know
share info
acknowledge feelings
plan and follow through

4

ABCDE for melanoma

Asymmetry
Border irregularity
Colour variation
Diameter >6mm
Evolving

5

Breslow thickness is for the extent of ___ measured from ___
measured in ___

melanoma
top of graular layer down
mm

6

3 main types of melanoma =

superficial spreading melanoma (70%)
nodular melanoma (10%)
lentigo maligna melanoma (10%)

7

rarer type of melanoma that occurs at palms soles around and under big toenail =

acral lentiginous melanoma

8

Type of melanoma that develops quickly, usually on chest/back, grows downwards

nodular melanoma

9

risk of metastasis in superficial spreading melanoma

low risk

10

melanoma type that grows v slowly, usually face and outdoorsy elderly =

lentigo maligna melanoma

11

Ix for melanoma

excision biopsy => if >1mm deep check lymph nodes (biopsy/US) if stage 3 => CT

12

Rx for in situ melanoma ( in epidermis)

excision/imiquimod cream
check ups

13

Rx for Stage 1-2 melanoma (in dermis)

excision
specialist follow up

14

Rx for Stage 3 melanoma (lymph nodes)

excision
possible radio (decrease recurrence risk)
perhaps excise nodes

15

Rx for Stage 4 melanoma ( metastasised)

all possibilitoes:
sx
chemo
radio
biological therapy
regular specialist check up

16

skin cancers tend to be homo/heterogenous

heterogenous - later cells acquire a slightly different final mutation

17

normal Ras: growth factor>receptor>___ binds to GTP > can bind to ___>kinase>___

Ras
Raf
division and proliferation

18

the Ras pathway in an oncogenic Ras

no growth factor but stil Ras binds to GTP and stays bound/slow to turn off = proliferation

19

p53 stops cells at __ if they are defective

G1 checkpoint

20

in p53 mutation___binds to __ causing cell progression through the cell cycle

Cdk:G/S cyclin

21

chronic UV radiation eg.
increases risk of ___ cancer by __%

outdoor worker
Squamous cell carcinoma 77%

22

intense intermittent/recreational UV radiation eg.
increases risk of __+__ by __%

holidays and outdoor leisure
melanoma 60%
basal cell carcinoma 43%

23

burning by UV radiation eg.
increases risk of __+__ by x__

pain/blistering burn
melanoma and basal cell carcinoma x2

24

artificial UV radiation eg.
increases risk of __+__+__ by __%

sunbeds
SCC 67%
melanoma 16-59%
BCC 29-40%

25

scale used to assess skin type

Fitzpatrick

26

2 genetic conditions that increase risk of skin cancer

albinism
xeroderma pigmentosum

27

xeroderma pigmentosum
defect is in __
increases risk of skin cancer by ___ in under 20yos
median age of skin cancer =

DNA repair genes
2000x
10yo

28

chemical risk factors for NMSC:

coal tar
soot
creosate
petroleum
shale oils
arsenic

29

IS factors that increase the risk of skin cancer

UC and Crohns
azathioprine
cyclosporin
adalimumab
transplants

30

the UV radiation that causes sunburn

B

31

UVB is more/less damaging that UVA
wavelengths =

1000x more
290-320nm

32

2 types of direct DNA damage caused by UVB

cyclobutane pyrimidine dimers (CPDs)
yrimidine-pyrimidone (6-4) photo products

33

wavelength of UVA
deeper/more superficial penetration that UVB

320-400nm
deeper

34

mutation passed on in UVB damaged cells =

GG is entered where AA should be entered or vice versa

35

UVA causes __ __ DNA damage - especially deoxyguanosine > ___
causes ____ mutation

indirect oxidative
8-oxo-deoxyguanosine
GC>AT point mutation

36

in UVA and UVB radiation skin damage normal cell repair response =

UVA = base excision repair
UVB = nucleotide excision repair

37

UV induces IS by :

reduces langerhans in skin, Treg generation and anti-inflam cytokines

38

important mutation in BCC

PTCH1

39

PTCH1 mutation in BCC causes ___activation > no longer stops ___ > activates __ > cell proliferation and angiogenesis activators induced

Hedgehog
SMO receptor
transcription factor Gli1/2

40

drug used to treat BCC by binding to SMO

vismodegib

41

important mutations in melanoma

Ras Raf MAPK
>50% have activating B-Raf mutation mostly V600E

42

melanoma treatments that target B-raf or MEK

B-raf = vemurafenib and dabrafenib
MEK = tramatenib

43

2 genes that cause familial melanoma

CDKN2A
CDK4

44

melanoma drugs targeted to c-KIT and their function =

dasatinib + imatinib
prevent cell growth

45

melanoma drugs that target B-raf and their function =

vemurafenib
dabrafenib (with trametinib due to rapid resistance for 6-7mnths)
prevent cell growth

46

melanoma drug that targets MEK and its function

trametinib
prevent cell growth

47

melanoma drugs that target CTLA-4 on Ts and their function

ipilimumab + tremelimumab
T cell activation to enable tumour cell killing

48

melanoma drug that targets PD-1 on Ts and its function

pemprolizumab
T cell activation to enable tumour cell killing

49

ugly duckling sign that suggests melanoma

brown patch with otherwise healthy skin and few freckles

50

BCC make up __% of NMSCs

75%

51

characteristics of BCC

pearly
painless
slow growing lump/non-healling ulcer
visible vessels
usually facial
central rodent ulcer
locally invasive

52

morphoeic BCC means it is =

infiltrative - may look small but has roots so difficult to excise

53

characteristics of SCC

hyperkeratotic lump/ulcer
on sun damaged skin
grow fast
painful +/bleed
ear, lip and scalp are high risk sites

54

pre cursor lesions of SCC

actinic keratoses and Bowen's disease

55

appearance of solar keratosis

dry, scaly patches - only 2/3 layers of epidermis

56

appearance of Bowen's disease

erythematous plaque, whole epidermis

57

Resembles SCC- common low grade benign tumour of pilosebaceous unit that grows rapidly

keratocanthoma

58

genetic defect in xeroderma pigmentosum

defect in 1/7 NER genes

59

Major features of Naevoid BCC/Gorlin's Syndrome

early onset/multiple BCCs
palmar pits
jaw cysts
ectopic calcification falx

60

Naevoid BCC syndrome is also called ___
is ___ inherited

Gorlin's syndrome
auto dominant

61

Butterfly disease is also known as ___
causes ___ which are a risk for ___
caused by a hereditary ___ deficiency

Recessive dystrophic Epidermolysis Bullosa (RDEB)
mutilating ulcers
SCC
Type VII collagen deficiency

62

transplant hands =

after transplant hands have field cancerisation with precancerous and SCC lesions

63

Leser Trelat sign =
found in ___

eruptive appearance of seborrhoeic keratosis
may indicate malignancy

64

3 types of BCC

nodular
superficial
morphoeic

65

morphoeic BCC has prominent ____ with ___ margins and can spread along __

desmoplastic fibrous stroma
poorly defined
nerves

66

precursor of SCC that is a scaly plaque/patch, irregular border and no dermal invasion

Bowen's disease (may mimic inflammation)

67

Rare genetic causes of SCC

XP
RDEB

68

firm to touch nodule that often has increased pigment around rim

dermatofibroma

69

craggy and looks like a maryland cookie

basal cell papilloma

70

Rx for NMSC -

Sx/photodynamic therapy (ALA PDT)
5% imiquimod cream

71

Rx for common pre-cancers

solaraze, 5 FU, resurfacing
cryotherapy
PDT or imiquimod

72

5 layers of the scalp Superficial to deep

SCALP
Skin
CT
Aponeurosis
Loose CT
Periosteum

73

To test sensory CNV of face

close eyes and lightly brush face with cotton bud and theyll tell you when feel it

74

best ratio for sides of an elliptical excision

3:1