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Year 4 Dermatology > Skin tumours > Flashcards

Skin tumours Flashcards

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1
Q

What are the different types of skin cancers

A

Non-melanoma: BCC and SCC

Melanoma

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2
Q

list precancerous lesions of SCC

A

AK

Bowen’s disease

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3
Q

what is the commonest type of skin cancer

A

BCC

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4
Q

what is AK

A

Actinic keratosis is a precancerous skin lesion from accumulative photodamage causing partial thickness dysplastic keratinocytes

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5
Q

What is Bowen’s disease

A

carcinoma in situ / full thickness dysplasia

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6
Q

appearance of AK

A

scaly, crusty, erythematous

sun exposed areas e.g. H+N, ears

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7
Q

appearance of Bowen’s disease

A

erythematous
scaly, dry plaque
lower legs of older ladies

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8
Q

list genetic conditions that can predispose to skin cancer

A

albinism
epidermolysis bullosa
Gorlin’s syndrome
Xeroderma pigmentosum

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9
Q

list iatrogenic factors that can predispose to skin cancer

A

immunosuppression - steroids, ciclosporin, biologics
phototherapy
radiotherapy

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10
Q

List risk factors for developing skin cancer

A 
increased sun exposure and burning 
sunbeds, holidays, no suncream...
age 
FH and genetics
immunosuppression - drugs 
naevi
Fitzpatrick skin type 
smoking
radiation 
chronic wound / ulcer 
chemicals
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11
Q

SCC are usually as a result from intermittent burning episodes, true or false

A

false, they result from cumulative UV exposure

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12
Q

BCC and melanomas are usually as a result from intermittent burning episodes, true or false

A

true

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13
Q

risk factors for melanoma

A 
personal/FH
number of moles 
excess sun exposure 
sunbed use 
multiple sunburns
fair skin
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14
Q

List major criteria for changing moles

A

change in shape, size and colour

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15
Q

List minor criteria for changing moles

A

diameter >6mm
bleeding
sensory change
inflammation

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16
Q

Clinical features of malignant melanoma

A 
ABCDE
Asymmetry 
irregular Border 
multiple Colours 
Diameter >6mm
fast Evolution
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17
Q

what tool can be used to examine skin lesions more closely

A

dermastocope

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18
Q

causes for changing moles

A

melanoma
psoriasis
eczema
halo naevus

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19
Q

examples of melanocytic naevi

A 
blue naevus 
congenital 
Spitz 
normal naevi 
dysplastic 
halo 
atypical
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20
Q

advise for a patient with atypical naevi

A

regular monitoring

sun protection

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21
Q

what are atypical naevi a marker of

A

patient’s tendency to develop melanoma

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22
Q

does chopping out atypical naevi reduce risk of melanoma

A

no, there is still the same genetic risk and they could appear in ‘normal’ skin

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23
Q

what are the different subtypes of melanoma

A 
superficial spreading 
acral / lentiginous 
lentigo maligna 
nodular
amelanotic
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24
Q

all types of melanoma have radial growth phase (RGP), true or false

A

false
Nodular melanoma just has VGP
the rest have RGP initially and may develop VGP

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25
Do nodular melanomas have the worst prognosis?
yes because they have VGP from the outset therefore increased risk of metastasis
26
What is Lentigo maligna
discolouration of the skin which is pre malignant for lentigo maligna melanoma more likely in sun damaged skin and in the elderly still in radial growth phase
27
what is acral lentiginous melanoma
melanoma on the soles or palms or even nails and mucosal surfaces
28
What is amelanotic melanoma
melanoma without the brown colouration occurs from dedifferentiation as the cells have become so advanced they have lost their original function of producing colour
29
only VGP melanomas can metastasise, true or false
true
30
drugs for advanced melanoma
chemo, radiotherapy | immunotherapy
31
what is used to determine prognosis in melanoma
Breslow thickness
32
define breslow thickness
measure of deepest tumour cell from the granular layer of the epidermis in mm KL is very variable in different body sites which would give a false impression of the Breslow thickness
33
what is the prognosis if the breslow thickness is: <1mm >4mm
``` <1mm = 95% 5 year survival >4mm = 50% 5 year survival ```
34
in acral lentiginous melanoma, what is the name of the sign for melanoma originating from the nail matrix
Hutchinsons sign
35
what are BCC
slow growing skin lesions
36
describe the appearance of a typical BCC
raised nodular lesion with a pearly shine, rolled edges and telangiectasia central ulceration
37
prognosis of BCC
good prognosis as they rarely metastasise don't need immediate excision however they are locally invasive and if left alone can become destructive and disfiguring
38
types of BCC
``` superficial infiltrative - like a tree stump, blur margins nodular cystic multicentric morphoeic ```
39
management of BCC
surgical excision | Mohs surgery
40
what is Mohs surgery
surgical excision of a BCC where tissue conservation is important to attain good cosmetic outcome e.g. nose, ears, eye tumour is removed in stages and assessed until clear margins are achieved
41
non-surgical options for superficial BCC
imiquimod / aldara cream PDT (superficial non life threatening skin cancers) cryotherapy
42
management of AK
cryotherapy for solitary lesions mild AK - solaraze/topical diclofenac imiquimod or 5-FU / efudix for more severe AK sun protection
43
management of Bowens disease
cryotherapy imiquimod 5FU PDT
44
features of SCC
fast growing lesions potential to metastasise scaly, painful, bleeding sun exposed areas - scalp, ears, lips
45
what should be done in the case of advanced SCC
palpate for regional lymph nodes as there is the potential for metastasis
46
Who is more at risk of mouth SCC
smokers
47
what is a keratoacanthoma
fast growing lesions with a central plug of keratin that behave like SCC but regress in size spontaneously generally they are excised as they resemble SCC and so are treated in the same way
48
what skin cancer can develop over a chronic wound/ulcer
SCC
49
what is the most common skin cancer in immunosuppressed individuals post transplant
SCC | More at risk of HPV strains that predispose to SCC development
50
what are seborrhoeic keratoses / warts
basal cell papillomas benign lesions with warty appearance cerebreform under dermatoscope can be brown, pink, white, yellow
51
management of seborrhoeic keratoses
nothing | cryotherapy if bothersome
52
features of lipoma
subcutaneous mobile swelling
53
what are dermatofibromas
benign proliferation of fibroblasts usually in response to insult e.g. insect bite
54
features of dermatofibromas
``` limbs firm lumps pigmentation static asymptomatic itch squeezing can cause dimpling ```
55
epidermoid cyst = sebaceous cyst, true or false
true
56
features of epidermoid cysts
firm well defined pus discharge left alone unless problematic - remove
57
what are acrochordons
skin tags benign associated with metabolic syndrome left alone or undergo cryotherapy
58
what are haemangiomas
benign overgrowth of blood vessels
59
what can haemangiomas be mistaken for initially
melanoma | dermatoscope helps to differentiate colour
60
what is a pyogenic granuloma
overgrowth of vascular and granulation tissue following trauma bleeds easily exaggerated healing response
61
management of pyogenic granuloma
curettage and cautery or excision histology to exclude rare types of melanoma risk of intense bleeding risk of recurrence
62
describe features of a merkel cell tumour
rare malignancy of merkel cells in the epidermis viral origin fast growing and poor prognosis
63
cutaneous B cell lymphoma
new lump in an older patient
64
what is Kaposi's sarcoma
AIDS associated condition | vascular tumour
65
pigmented BCC
classic BCC with a brown colour
66
management of neglected, large BCC
radiotherapy | BCC are radiosensitive
67
types of naevi
junctional compound intradermal
68
what naevus has an increased risk of melanoma
atypical naevi
69
management of atypical naevi
skin surveillance
70
management of malignant melanoma
surgical excision with 2mm margins initially +- SNLB if thicker than 1mm genetic therapies - BRAF inhibitor immunotherapy
71
management of lentigo maligna ?melanoma
biopsy from more concerning looking parts excision - ?graft if near the eye imiquimod cream surveillance if patient is old and frail
72
acral melanomas tend to be related to genetic conditions rather than sun damage, true or false
true
73
who is more at risk of amelanotic melanomas
Skin types 1+2 albinism (not vitiligo, they have lost their melanocytes)
74
new skin lesion in a man with prostate cancer with rapid growth, worrying?
yes | rapid onset is concerning
75
Merkel cell tumour
fast growing viral origin poor prognosis
76
when would you prefer not to excise a lesion?
multifocal lesions and poor healing site e.g. lower legs
77
management of B cell lymphoma
radiotherapy
78
Which of the following naevi are flat and raised: junctional compound intradermal
junctional - flat compound - raised intradermal - raised

Year 4 Dermatology (16 decks)

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