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Dermatology > 1: Dermatological Malignancies > Flashcards

1: Dermatological Malignancies Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the ‘smart’ advice to avoid excess sun exposure

A 
Shade between 11am-3pm 
Make sure you don't burn 
Aim to cover up 
Remember look after children 
Then apply suncream
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2
Q

What features are suggestive of a malignant mole (A-E)

A 
Asymmetry 
Borders Irregular 
Colour > 2 
Diameter >6mm 
Evolution of a lesion
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3
Q

What is basal cell carcinoma also referred to as

A

Rodent ulcer

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4
Q

What is a basal cell carcinoma

A

Malignant proliferation of epidermal keratinocytes in the stratum basal

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5
Q

What is the most common malignant tumour of the skin

A

BCC

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6
Q

Which gender is BCC more common

A

Male (2:1)

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7
Q

What are three ‘causes’ of BCC

A
  • Genetic: Skin types I-III
  • Gorlin syndrome
  • Sun exposure
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8
Q

What are 5 risk factors for BCC

A
  • Sun exposure
  • History sunburn during childhood
  • Skin type I
  • Age
  • Male
  • Immunosupressed
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9
Q

How will BCC appear clinically

A

pearly-nodule with rolled edges. May be superficial telangiectasia on the surface

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10
Q

What is a rodent ulcer

A

necrosis of centre of the lesion

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11
Q

In which region are BCCs more common

A

head and neck

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12
Q

What does BCC involve

A

proliferation of epidermal keratinocytes in stratum basal

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13
Q

How soon should BCC be referred to a dermatologist

A

routine referral

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14
Q

When is a BCC referred urgently (within 2W) to dermatology

A

if compressing on structure

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15
Q

What investigations are performed for BCC

A
  • Dermatoscope

- Excisional biopsy

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16
Q

What is first-line for BCC

A
  • Surgical excision
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17
Q

What is mohs micrographic surgery

A

Lesion and tissue borders are progressively excised until specimens are microscopically tumour free

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18
Q

When is mohs micrographic surgery indicated

A

high risk or recurrence

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19
Q

When is radiotherapy used for BCC

A

surgery is not appropriate

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20
Q

How can small and low risk BCC be managed

A
  • Topical flurouracil
  • Topical imiquimod
  • Cryotherapy
  • Curretage
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21
Q

Explain progression of BCC

A

Locally invasive

Does NOT metastasise

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22
Q

What is squamous cell carcinoma

A

Malignant locally invasive proliferation of epidermal keratinocytes that has the potential to metastasise

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23
Q

What is the second most common type of skin cancer

A

SCC

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24
Q

In which gender is squamous cell carcinoma more common

A

Female (2:1)

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25
Q

How does the incidence of SCC change with age

A

Increases with age

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26
Q

What is SCC

A

Malignant proliferation of keratinocytes in the stratum spinosum

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27
Q

What are 5 risk factors for SCC

A
  • Smoking
  • UV
  • Marjolin’s Ulcer (Formation SCC at chronic wound site)
  • Bowen’s disease
  • Immunosupression (eg. post HIV, Renal transplant)
  • Actinic keratosis
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28
Q

How will a SCC present

A

Keratinised, ill-defined nodule that may be ulcerated. Floor of the ulcer can resemble granulation tissue that bleeds easily.

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29
Q

What is the stereotypical presentation for SCC

A

Elderly patients with painless, non-healing, bleeding ulcer

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30
Q

Where do SCC tend to occur

A

Sun-exposed sites such as the face and neck. Or, lower lip

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31
Q

What % of SCC may metastasise

A

2-5

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32
Q

What is Marjolins Ulcer

A

Aggressive form of SCC that forms on site of previous ulcer/scar

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33
Q

What is the pre-cancerous lesion of SCC

A

Actinic keratosis

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34
Q

What is actinic keratosis

A

Dysplasia - proliferation of keratinocytes that do not invade the basement membrane.

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35
Q

How soon should SCC be referred to dermatology

A

2W

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36
Q

What is first-line investigation for SCC

A

Punch Biopsy

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37
Q

What is used as an alternative to punch biopsy for larger lesions

A

Wedge biopsy

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38
Q

What is second line investigation for SCC

A

CT - to stage spread

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39
Q

What is third-node investigation for SCC

A

Lymph node biopsy/FNA

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40
Q

What is first-line management of SCC

A

Surgery

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41
Q

If a SCC is less than 20mm diameter, how large should the margins be

A

If less than 20mm, surgical excisions margins should be 4mm

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42
Q

If a SCC is more than 20mm, how large should excision margins be

A

If more than 20mm, surgical excision margins should be 6mm

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43
Q

What is second line for SCC

A

Mohs micrographic surgery

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44
Q

When is mohs micrographic surgery indicated for SCC

A
  • Cosmetic site

- Large or recurrent tumours

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45
Q

What may also be given for SCC

A

Radiotherapy

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46
Q

What are 4 poor prognostic factors

A

Diameter >20mm
Depth >4mm
Poor differentiation
Immunosupressend

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47
Q

What depth of SCC tumour is more likely to metastasise

A

> 4mm

48
Q

What are malignant melanomas

A

Malignant prolifération of melanocytes with potential to metastasise

49
Q

What are the 4 types of melanoma

A
  1. Superficial spreading
  2. Nodular
  3. Lentigo
  4. Acral lentiginous
50
Q

What type of melanoma are 70% of cases

A

Superficial spreading

51
Q

What age-group does superficial spreading melanoma typically affect

A

Younger patients

52
Q

What causes superficial spreading melanoma

A

UV exposure

53
Q

What area does superficial spreading melanoma tend to present

A

Legs, Back and Chest

54
Q

How will superficial spreading melanoma present

A

‘Growing Mole’

A-E of moles approach

55
Q

What is the second most common type of melanoma

A

Nodular

56
Q

Which age group do nodular melanomas tend to occur

A

Middle-Aged

57
Q

Where do nodular melanomas typically present

A

Trunk

58
Q

What causes nodular melanomas

A

UV exposure

59
Q

How will nodular melanomas present

A

Red/Black lump - may bleed or ooze

60
Q

In which population do lentigo melanomas tend to occur

A

Older people

61
Q

Where do lentigo melanomas occur

A

Sun-exposed sites (eg. face)

62
Q

What causes lentigo melanomas

A

CUMULATIVE sun exposure (opposed to superficial and nodular which are caused by intermittent sun exposure)

63
Q

How will a lentigo melanoma present

A

abnormally enlarging mole (ABCDE)

64
Q

What is an acral lentigous melanoma

A

presence of melanoma under the nail in hands and feet

65
Q

In which population do acral lentigous melanomas occur

A

Afro-Carribean

Hispanics

66
Q

How will acral lentigous melanomas present

A

Brown discolouration under the nail in afro-carribeans and hispanics

67
Q

What sign refers to melanoma under the nail

A

Hutchinson’s sign

68
Q

What are 4 risk factors for melanoma

A
  • UV exposure
  • FH melanoma
  • Personal history melanoma
  • Several moles
  • Skin type I
69
Q

How can a melanoma be identified

A 
A.B.C.D.E.S
A= asymmetry 
B= irregular borders
C = more than two colours
D = diamete >6mm 
E = evolution - change in mole 
S= symptoms of bleeding or itching
70
Q

How will a superficial spreading melanoma present

A

flat patch, may have nodular regions, irregular pigmentation

71
Q

How do superficial melanomas grow

A

horizontal growth

72
Q

How will a nodular melanoma present

A

either as a smooth nodule or with verrucus/ulcerating portion.

73
Q

How do nodular melanoma’s grow and what does this lead to

A

Grows downwards - meaning more likely to spread and hence has a worse prognosis

74
Q

How will lentigo melanomas present

A

large, irregular patch with irregular pigmentation

75
Q

How will acral lentigous melanoma appear

A

hutchinson’s sign: linear dark patch under the nail or ulcers of hands + feet.

76
Q

Where may melanoma spread to

LLLBB

A 
Liver
Lung
Lymph nodes
Brain 
Bone
77
Q

What cell type does melanoma arise from

A

melanocytes

78
Q

What investigations are ordered for melanoma

A
  1. Dermatoscopy

2. Full-thickness excision biopsy

79
Q

What is the BEST diagnostic test for melanoma

A

Full-thickness excision biopsy

80
Q

What is full-thickness excisional biopsy used to estimate

A

Breslow Thickness

81
Q

What is used to stage melanoma

A
  1. Sentinel node biopsy

2. CT

82
Q

When should a sentinel node biopsy be offered

A

If above stage II

83
Q

When should a CT be ordered

A

> IIC

84
Q

What should be used in young adults as an alternative to CT

A

MRI

85
Q

How are suspicious lesions for melanoma managed

A

Excision biopsy

86
Q

What determines the margins of surgical excision

A

Breslow thickness

Melanoma is excised, analysed for breslow thickness and margins re-excised if required

87
Q

What surgical excision margins should be offered for breslow thickness 0-1mm

A

1cm

88
Q

What surgical excision margins should be offered for breslow thickness 1-2mm

A

1-2cm

89
Q

What surgical excision margins should be offered for breslow thickness 2-4mm

A

2-3cm

90
Q

What surgical excision margins should be offered for breslow thickness >4mm

A

3cm

91
Q

What is the indications for chemoradiotherapy in melanoma

A

Metastatic disease

92
Q

What is the most important prognostic factor for melanoma

A

Breslow stage

93
Q

What is the 5-year survival for breslow thickness <1mm

A

95-100

94
Q

What is the 5-year survival for breslow thickness 1-2mm

A

80-95

95
Q

What is the 5-year survival for breslow thickness 2.1-4mm

A

60-75

96
Q

What is the 5-year survival for breslow thickness >4mm

A

50

97
Q

What is actinic keratosis

A

pre-malignant condition to SCC caused by prolonged sun exposure

98
Q

How will actinic keratosis present clinically

A

red, scaly patch over sun-exposed sites

99
Q

How is actinic keratosis managed

A
  • Prevention: reduce sun exposure
  • Topical flurouracil for 2-3W
  • Topical diclofenac
  • Topical imiquimod
100
Q

what is the problem with flurouracil cream and how is this overcome

A

Initially causes erythema and oedema of the skin - overcome by giving topical steroids after

101
Q

What is kaposis sarcoma

A

spindle cell tumour of capillary endothelial cells caused by HHV8

102
Q

In which individuals does epidemic AIDs associated kaposis sarcoma occur

A
  • HIV
103
Q

In which individuals does classic sporadic kaposis sarcoma occur

A
  • Elderly Males

- Higher in Jewish or Mediterranean populations

104
Q

When does iatrogenic kaposis sarcoma occur

A

Following solid-organ transplantation

105
Q

In which population does African endemic kaposis sarcoma occur

A

African Children

106
Q

Which virus may cause kaposis sarcoma

A

HHV8

107
Q

What are 3 risk factors for kaposis sarcoma

A
  • Immunosupressed
  • Male
  • Age
108
Q

how does kaposis sarcoma present

A
  • Purple papules or plaques on the skin and MUCOSA (oral lesions)
  • Lymphadenopathy
  • Constitutional symptoms
109
Q

if affecting the lung, how may kaposis sarcoma present

A

Hemoptysis

Pleural Effusion

110
Q

what should all individuals with kaposis sarcoma receive

A

HIV Test

111
Q

what is used to manage kaposi sarcoma

A

Radiotherapy

112
Q

What is seborrheic keratosis

A

Benign growth of immature keratinocytes

113
Q

What is the most benign skin tumour in the elderly

A

seborrheic keratosis

114
Q

How do seborrheic keratosis present

A
  • Darkly pigmented well-demarcated papule or plaques
  • Greasy/Waxy stuck on appearance
  • May bleed in response to trauma
115
Q

For cosmetic patients how may patients opt for seborrheic keratosis to be managed

A

Cryotherapy

116
Q

What are congenital melanocytes naevi

A

Present at birth (or soon after). Often exceed 1cm

117
Q

What are congenital melanocytes naevi

A

Present at birth (or soon after). Often exceed 1cm

Dermatology (6 decks)

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