1: Dermatological Malignancies 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
2
Q
What features are suggestive of a malignant mole (A-E)
A
Asymmetry Borders Irregular Colour > 2 Diameter >6mm Evolution of a lesion
3
Q
What is basal cell carcinoma also referred to as
A
Rodent ulcer
4
Q
What is a basal cell carcinoma
A
Malignant proliferation of epidermal keratinocytes in the stratum basal
5
Q
What is the most common malignant tumour of the skin
A
BCC
6
Q
Which gender is BCC more common
A
Male (2:1)
7
Q
What are three ‘causes’ of BCC
A
- Genetic: Skin types I-III
- Gorlin syndrome
- Sun exposure
8
Q
What are 5 risk factors for BCC
A
- Sun exposure
- History sunburn during childhood
- Skin type I
- Age
- Male
- Immunosupressed
9
Q
How will BCC appear clinically
A
pearly-nodule with rolled edges. May be superficial telangiectasia on the surface
10
Q
What is a rodent ulcer
A
necrosis of centre of the lesion
11
Q
In which region are BCCs more common
A
head and neck
12
Q
What does BCC involve
A
proliferation of epidermal keratinocytes in stratum basal
13
Q
How soon should BCC be referred to a dermatologist
A
routine referral
14
Q
When is a BCC referred urgently (within 2W) to dermatology
A
if compressing on structure
15
Q
What investigations are performed for BCC
A
- Dermatoscope
- Excisional biopsy
16
Q
What is first-line for BCC
A
- Surgical excision
17
Q
What is mohs micrographic surgery
A
Lesion and tissue borders are progressively excised until specimens are microscopically tumour free
18
Q
When is mohs micrographic surgery indicated
A
high risk or recurrence
19
Q
When is radiotherapy used for BCC
A
surgery is not appropriate
20
Q
How can small and low risk BCC be managed
A
- Topical flurouracil
- Topical imiquimod
- Cryotherapy
- Curretage
21
Q
Explain progression of BCC
A
Locally invasive
Does NOT metastasise
22
Q
What is squamous cell carcinoma
A
Malignant locally invasive proliferation of epidermal keratinocytes that has the potential to metastasise
23
Q
What is the second most common type of skin cancer
A
SCC
24
Q
In which gender is squamous cell carcinoma more common
A
Female (2:1)
25
How does the incidence of SCC change with age
Increases with age
26
What is SCC
Malignant proliferation of keratinocytes in the stratum spinosum
27
What are 5 risk factors for SCC
- Smoking
- UV
- Marjolin's Ulcer (Formation SCC at chronic wound site)
- Bowen's disease
- Immunosupression (eg. post HIV, Renal transplant)
- Actinic keratosis
28
How will a SCC present
Keratinised, ill-defined nodule that may be ulcerated. Floor of the ulcer can resemble granulation tissue that bleeds easily.
29
What is the stereotypical presentation for SCC
Elderly patients with painless, non-healing, bleeding ulcer
30
Where do SCC tend to occur
Sun-exposed sites such as the face and neck. Or, lower lip
31
What % of SCC may metastasise
2-5
32
What is Marjolins Ulcer
Aggressive form of SCC that forms on site of previous ulcer/scar
33
What is the pre-cancerous lesion of SCC
Actinic keratosis
34
What is actinic keratosis
Dysplasia - proliferation of keratinocytes that do not invade the basement membrane.
35
How soon should SCC be referred to dermatology
2W
36
What is first-line investigation for SCC
Punch Biopsy
37
What is used as an alternative to punch biopsy for larger lesions
Wedge biopsy
38
What is second line investigation for SCC
CT - to stage spread
39
What is third-node investigation for SCC
Lymph node biopsy/FNA
40
What is first-line management of SCC
Surgery
41
If a SCC is less than 20mm diameter, how large should the margins be
If less than 20mm, surgical excisions margins should be 4mm
42
If a SCC is more than 20mm, how large should excision margins be
If more than 20mm, surgical excision margins should be 6mm
43
What is second line for SCC
Mohs micrographic surgery
44
When is mohs micrographic surgery indicated for SCC
- Cosmetic site
| - Large or recurrent tumours
45
What may also be given for SCC
Radiotherapy
46
What are 4 poor prognostic factors
Diameter >20mm
Depth >4mm
Poor differentiation
Immunosupressend
47
What depth of SCC tumour is more likely to metastasise
>4mm
48
What are malignant melanomas
Malignant prolifération of melanocytes with potential to metastasise
49
What are the 4 types of melanoma
1. Superficial spreading
2. Nodular
3. Lentigo
4. Acral lentiginous
50
What type of melanoma are 70% of cases
Superficial spreading
51
What age-group does superficial spreading melanoma typically affect
Younger patients
52
What causes superficial spreading melanoma
UV exposure
53
What area does superficial spreading melanoma tend to present
Legs, Back and Chest
54
How will superficial spreading melanoma present
'Growing Mole'
| A-E of moles approach
55
What is the second most common type of melanoma
Nodular
56
Which age group do nodular melanomas tend to occur
Middle-Aged
57
Where do nodular melanomas typically present
Trunk
58
What causes nodular melanomas
UV exposure
59
How will nodular melanomas present
Red/Black lump - may bleed or ooze
60
In which population do lentigo melanomas tend to occur
Older people
61
Where do lentigo melanomas occur
Sun-exposed sites (eg. face)
62
What causes lentigo melanomas
CUMULATIVE sun exposure (opposed to superficial and nodular which are caused by intermittent sun exposure)
63
How will a lentigo melanoma present
abnormally enlarging mole (ABCDE)
64
What is an acral lentigous melanoma
presence of melanoma under the nail in hands and feet
65
In which population do acral lentigous melanomas occur
Afro-Carribean
| Hispanics
66
How will acral lentigous melanomas present
Brown discolouration under the nail in afro-carribeans and hispanics
67
What sign refers to melanoma under the nail
Hutchinson's sign
68
What are 4 risk factors for melanoma
- UV exposure
- FH melanoma
- Personal history melanoma
- Several moles
- Skin type I
69
How can a melanoma be identified
```
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
How will a superficial spreading melanoma present
flat patch, may have nodular regions, irregular pigmentation
71
How do superficial melanomas grow
horizontal growth
72
How will a nodular melanoma present
either as a smooth nodule or with verrucus/ulcerating portion.
73
How do nodular melanoma's grow and what does this lead to
Grows downwards - meaning more likely to spread and hence has a worse prognosis
74
How will lentigo melanomas present
large, irregular patch with irregular pigmentation
75
How will acral lentigous melanoma appear
hutchinson's sign: linear dark patch under the nail or ulcers of hands + feet.
76
Where may melanoma spread to
| LLLBB
```
Liver
Lung
Lymph nodes
Brain
Bone
```
77
What cell type does melanoma arise from
melanocytes
78
What investigations are ordered for melanoma
1. Dermatoscopy
| 2. Full-thickness excision biopsy
79
What is the BEST diagnostic test for melanoma
Full-thickness excision biopsy
80
What is full-thickness excisional biopsy used to estimate
Breslow Thickness
81
What is used to stage melanoma
1. Sentinel node biopsy
| 2. CT
82
When should a sentinel node biopsy be offered
If above stage II
83
When should a CT be ordered
>IIC
84
What should be used in young adults as an alternative to CT
MRI
85
How are suspicious lesions for melanoma managed
Excision biopsy
86
What determines the margins of surgical excision
Breslow thickness
| Melanoma is excised, analysed for breslow thickness and margins re-excised if required
87
What surgical excision margins should be offered for breslow thickness 0-1mm
1cm
88
What surgical excision margins should be offered for breslow thickness 1-2mm
1-2cm
89
What surgical excision margins should be offered for breslow thickness 2-4mm
2-3cm
90
What surgical excision margins should be offered for breslow thickness >4mm
3cm
91
What is the indications for chemoradiotherapy in melanoma
Metastatic disease
92
What is the most important prognostic factor for melanoma
Breslow stage
93
What is the 5-year survival for breslow thickness <1mm
95-100
94
What is the 5-year survival for breslow thickness 1-2mm
80-95
95
What is the 5-year survival for breslow thickness 2.1-4mm
60-75
96
What is the 5-year survival for breslow thickness >4mm
50
97
What is actinic keratosis
pre-malignant condition to SCC caused by prolonged sun exposure
98
How will actinic keratosis present clinically
red, scaly patch over sun-exposed sites
99
How is actinic keratosis managed
- Prevention: reduce sun exposure
- Topical flurouracil for 2-3W
- Topical diclofenac
- Topical imiquimod
100
what is the problem with flurouracil cream and how is this overcome
Initially causes erythema and oedema of the skin - overcome by giving topical steroids after
101
What is kaposis sarcoma
spindle cell tumour of capillary endothelial cells caused by HHV8
102
In which individuals does epidemic AIDs associated kaposis sarcoma occur
- HIV
103
In which individuals does classic sporadic kaposis sarcoma occur
- Elderly Males
| - Higher in Jewish or Mediterranean populations
104
When does iatrogenic kaposis sarcoma occur
Following solid-organ transplantation
105
In which population does African endemic kaposis sarcoma occur
African Children
106
Which virus may cause kaposis sarcoma
HHV8
107
What are 3 risk factors for kaposis sarcoma
- Immunosupressed
- Male
- Age
108
how does kaposis sarcoma present
- Purple papules or plaques on the skin and MUCOSA (oral lesions)
- Lymphadenopathy
- Constitutional symptoms
109
if affecting the lung, how may kaposis sarcoma present
Hemoptysis
| Pleural Effusion
110
what should all individuals with kaposis sarcoma receive
HIV Test
111
what is used to manage kaposi sarcoma
Radiotherapy
112
What is seborrheic keratosis
Benign growth of immature keratinocytes
113
What is the most benign skin tumour in the elderly
seborrheic keratosis
114
How do seborrheic keratosis present
- Darkly pigmented well-demarcated papule or plaques
- Greasy/Waxy stuck on appearance
- May bleed in response to trauma
115
For cosmetic patients how may patients opt for seborrheic keratosis to be managed
Cryotherapy
116
What are congenital melanocytes naevi
Present at birth (or soon after). Often exceed 1cm
117
What are congenital melanocytes naevi
Present at birth (or soon after). Often exceed 1cm
