Skin cancers

Question 1

Most common but least dangerous skin cancer?

Answer 1

BCC

Question 2

Does BCC commonly mets?

Answer 2

Rarely but can be locally destructive

Question 3

Usual age of presentation? Where on skin?

Answer 3

Middle age

Sun exposed sites

Question 4

Risk factors ? (2)

Answer 4

Fair skin and UV light exposure

Question 5

Pattern of sun exposure in BCC?

Answer 5

Intermittent sun damage during childhood

Question 6

Growth over what sort of time period?

Answer 6

Slow growing over years

Question 7

3 types of BCC?

Answer 7

Nodular
Superficial
Infiltrative

Question 8

Morphology of nodular BCC?

Answer 8

Raised lesion/nodule that is “pearly”, rolled edge, telangectasia (may have central ulcer/crater)

Usually on face

Question 9

Morphology of superficial BCC?

Answer 9

Red scaly plaque with raised smooth edge

Question 10

to Dx BCC?

Answer 10

Clinical/biopsy

Question 11

Treatment?
1st line? (conservative)
Medical ?
Surgical ?

Answer 11

1) Leave alone and monitor
2) Topical imiquimod or fluorouracil
3) Conventional excision or Mohs surgery

Also - cryotherapy, curretage, photodynamic therapy, radiotherapy

Question 12

When would you give medical treatments?

Answer 12

Superficial lesions at low risk sites

Question 13

Pre-cursor of SSC found on sun exposed sites typically head which are white/yellow crusts (ass erythema and scale) ?
Slow or fast growing?

Answer 13

Actinic keratosis

Slow growing

Question 14

Dx actinic keratosis ?

Answer 14

Clinical/biopsy

Question 15

T of actinic keratosis?

Answer 15

Topical flurouracil/imiquimod
Sun avoidance/sun cream
Cryotherapy

Question 16

When would you use surgical excision/curettage to treat an actinic keratosis?

Answer 16

If atypical, unresponsive to medical treatment or SSC suspected

Question 17

Pre cursor of SSC that is typically found on shins of older women?

Answer 17

Bowens disease

Question 18

Morphology of bowens ?

Answer 18

Slowly enlarging red scaly plaques with flat edge (usually solitary lesion)

Question 19

Surgical T?

Medical T?

Answer 19

Cryosurgery, curretage, excision

Imiquimod/fluorouracil

Question 20

2nd most common skin cancer ?

Answer 20

SSC

Question 21

SSC - mets ?

Answer 21

Potential to metastesize

Question 22

Usual age of presentation?

Answer 22

Middle age - sun exposed sites

Question 23

Risk factors?

Answer 23

HPV, fair skin, cumulative sun damage over years (chronic exposure - from occupation etc)
Immunosupression (transplant patients)

Question 24

Growth speed?
Morphology?
Ass symptoms from lesion?

Answer 24

Growth over months
Firm erythematous plaque
Scale, crust, bleeding, ulceration, itch and tenderness

Question 25

Dx?

Answer 25

Biopsy

Question 26

Management?

Answer 26

Conventional or Mohs surgery | Screen for mets

Question 27

Melanoma risk factors?

Answer 27

Fair skin, sunbeds, immunosuppression, family or personal history

Question 28

Classic history of sun exposure?

Answer 28

Intermittent sun damage/severe burning in childhood

Question 29

Different types of melanoma: | Most common type, relatively long radial growth phase (horizontal growth)?

Answer 29

Superficial spreading

Question 30

Superficial spreading morphology?

Answer 30

Slowly enlarging pigmented lesion (colour variation and irregular border)

Question 31

Type of melanoma that enters straight into vertical growth phase and has worse prognosis? (most aggressive type melanoma)

Answer 31

Nodular

Question 32

Nodular morphology? Mets?

Answer 32

Darkly pigmented and mets early

Question 33

Most common type in black/asian skin - occurs on palms soles and subungual areas?

Answer 33

Acral lentiginous melanoma

Question 34

Non pigmented melanoma?

Answer 34

Amelanotic

Question 35

Type of melanoma seen in older men/women typically on the face on chronic sun exposed site (not intermittent) ? Typically is an abnormally growing mole

Answer 35

Lentigo maligna

Question 36

Usual presentation of melanoma?

Answer 36

Pt presents with a change in what they thought was a mole

Question 37

ABCDE assesment?

Answer 37

``` Asymmetry Border (irregular) Colour (variable) Diameter (>6mm) Elevation (or evolution) ``` Also ugly duckling sign

Question 38

Dx ?

Answer 38

Clinical/biopsy

Question 39

For any unusual growing or changing pigmented lesion - what treatment considered ? Margins with surgical excision?

Answer 39

Excision biopsy of entire lesion Surgical excision with 2mm margins

Question 40

What do we check for prognosis indication?

Answer 40

Breslow thickness

Question 41

Breslow thickness allows what?

Answer 41

prognosis indication and the extent of local excision thats required or if SNB required

Question 42

Follow up treatment once Dx confirmed ?

Answer 42

Wider local excision (to ensure complete removal)

Question 43

``` Excision margin based on breslow thickness: Breslow thickness of - a) 0-1mm b) 1-2mm c) 2-4mm d) >4mm ??? ```

Answer 43

a) 1cm b) 1-2cm c) 2-3cm d) 3cm