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Year 4 - Cancer Care > 1.03 - Skin Cancer > Flashcards

1.03 - Skin Cancer Flashcards

1
Q

What are the layers of the skin?

A
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2
Q

Location of melanocytes.

A

Stratum basale of the epidermis.

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3
Q

Spread of melanoma.

A
  • superficial horizontal spread
  • vertical spread
  • lymphatic spread
  • haematogenous spread
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4
Q

Risk factors for melanoma.

A
  • UV radiation
  • moles
  • lentigo maligna
  • CDKN2A genetic mutation
  • personal history of melanoma
  • immunosuppression
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5
Q

What is lentigo meligna?

A

Melanoma in situ that consists of malignant cells but is not invasive. Increases the risk of malignant melanoma.

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6
Q

Patient education for malignant melanoma.

A
  • UV protection (ie. avoid direct sunlight, avoid indoor tanning, wear suncream)
  • skin-self examination
  • ABCDEs of melanoma
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7
Q

ABCDEs of melanoma.

A

Asymmetry
Border irregular
Color variegation
Diameter >6mm
Evolving lesion

Patients should be advised to book urgent GP appointment if any mole shows any signs of the above.

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8
Q

What are the subtypes of melanoma?

A
  • superficial spreading
  • nodular melanoma
  • lentigo malignant melanoma
  • acral lengtiginous
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9
Q

Features of superficial spreading melanoma.

A
  • most common melanoma (~65%)
  • fits ABCDE criteria for diagnosis
  • slow changes over years
  • flat
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10
Q

Features of nodular melanoma.

A
  • ~30% of all melanoma
  • often found on back, check, head or neck
  • raised or dome shaped
  • darkly pigmented
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11
Q

British Association of Dermatologist suggest the following indications for referral.

A
  • new mole appearing after the onset of puberty
  • longstanding mole changing in shape, colour or size
  • any mole with three or more colours
  • any mole itching or bleeding
  • new persistent skin lesion
  • new pigmented line in nail
  • lesion growing under the nail
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12
Q

Evaluation of skin lesions in clinic.

A
  • dermoscopy
  • biopsy
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13
Q

Laboratory tests for melanoma.

A

Lactate dehydrogenase indicates a worse prognosis if the cancer has metastasised.

Insensitive as a marker for metastatic disease and not usually clinically useful.

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14
Q

Imaging of melanoma.

A
  • ultrasound (?lymph node mets)
  • CXR (?baseline for future comparison)
  • CT CAP (?staging)
  • MRI (?spinal / brain mets)
  • PET (?lymph node mets)
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15
Q

Factors that affect prognosis of melanoma.

A

Worse prognosis with:

  • depth
  • ulceration
  • lymph node involvement
  • haematogenous metastasis
  • male sex
  • young age
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16
Q

Treatment of melanoma.

A
  • surgical excision with a wide margin
  • immunotherapy
  • targeted therapy
  • radiotherapy
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17
Q

What is the role of melanin?

A

Produced in response to UV radiation exposure to protect against DNA damage.

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18
Q

Which parts of the body do melanomas most commonly affect?

A

Trunk or legs

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19
Q

Why do melanomas tend to metastasise earlier than other skin cancer types?

A

Vertical growth more common.

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20
Q

Genetic mutations associated with melanoma?

A

MAPK pathway
CDKN2A pathway

Increase the susceptibility to carcinogenic effects of UV radiation.

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21
Q

When does NICE recommend offering SLNB to patients with melanoma.

A

Breslow thickness >1mm without clinically apparent nodule of metastatic disease.

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22
Q

Staging of melanoma.

A

TNM

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23
Q

Genetic syndromes that predispose melanoma.

A
  • familial atypical multiple mole melanoma syndrome (FAMMM)
24
Q

What is the best prognostic factor for melanoma?

A

Breslow thickness at time of excision

25
Q

What is basal cell carcinoma?

A

Locally invasive skin cancer arising from pluripotent cells of the stratum basal layer of the epidermis.

26
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

27
Q

BCC risk factors.

A
  • UV exposure
  • PUVA therapy
  • type 1 skin
  • immunosuppression
  • genetic syndromes
28
Q

Where do the majority of BCCs present?

A

Sun-exposed areas of the head and neck.

29
Q

Features of BCC.

A
30
Q

Management of BCC.

A

Surgical excision: wide-local excision.

Surgical destruction: curettage and cautery, cryotherapy.

31
Q

High risk BCC determined by presence of which features?

A

Any of the below:
- size >2cm
- site (face)
- poorly-defined margins
- histological features
- previous treatment failure
- immunosuppression

32
Q

Treatment selection for BCC.

A

Consider:

  • patient (choice, comorbidities, anticoagulants)
  • tumour (high vs low risk)
  • practitioner (preference, experience, availability)
33
Q

What is a squamous cell carcinoma?

A

Malignant tumour of keratinocytes, arising from the epidermal layer of the skin.

34
Q

What percentage of skin malignancies are SCC?

A

20%

35
Q

What causes most SCCs?

A

Cumulative prolonged exposure to UVB radiation.

36
Q

Premalignant conditions which SCC can arise from.

A
  • Bowen’s disease
  • leukoplakia
37
Q

What is Bowen’s disease?

A

A growth of cancerous cells confined to the outer layer of the skin.

AKA SCC in-situ.

38
Q

Features of SCC on dermoscopy.

A
  • white circles
  • looped blood vessels
  • central keratin plug
39
Q

Methods of skin biopsy.

A
  • excisional biopsy
  • incisional biopsy
  • punch biopsy
  • shave biopsy
40
Q

How is SCC graded?

A

Broder’s grade:

Ratio of differentiated to undifferentiated cells on histology.

41
Q

What is xeroderma pigmentosa?

A

Rare skin condition where the skin is unable to repair DNA damage caused by UV light.

Results in extreme photosensitivity, abnormal pigmentation and HUGE increased risk of skin cancers.

42
Q

SMART ways to avoid excessive sun exposure.

A

Spend time in the shade between 11am-3pm

Make sure you never burn

Aim to cover up with a t-shirt, wide-brimmed had and sunglasses

Remember to take extra care with children

Then use SPF 30+ sunscreen

43
Q

What are the premalignant skin conditions?

A
  • actinic keratosis
  • Bowen’s disease
44
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ - premalignant condition for squamous cell carcinoma.

45
Q

Pathophysiology of Bowen’s disease.

A

UV radiation damages DNA of cells, resulting in damage to p53 tumour suppressor gene.

This allows for unchecked proliferation of skin cells.

NB: Oncogenic forms of HPV may also trigger Bowen’s disease.

46
Q

Clinical features of Bowen’s disease.

A

Irregular scaly plaques on sun-exposed sites.

47
Q

Risk of progression - Bowen’s disease to SCC.

A

5%

48
Q

How is Bowen’s disease diagnosed?

A
  • dermatoscopy
  • biopsy
49
Q

Treatment of Bowen’s disease.

A
  • observation
  • excision
  • cryotherapy
  • chemotherapy cream
50
Q

What is actinic keratosis?

A

A precancerous scaly spot found on sun-damaged skin.

AKA solar keratosis

51
Q

What causes actinic keratoses?

A

Result of abnormal skin development due to DNA damage by UVB.

They are more likely to appear if the immune function is poor or due to ageing.

52
Q

What are the clinical features of actinic keratosis.

A
  • flat or thickening plaque
  • white or yellow scale
  • skin coloured, red or pigmented
  • tender or asymptomatic

Often found in sun-exposed areas.

53
Q

Risk of progression - actinic keratoses to SCC.

A

10%

54
Q

How is actinic keratosis diagnosed?

A
  • dermoscopy
  • biopsy
55
Q

Treatment of actinic keratoses.

A
  • excision
  • observation
  • cryotherapy

NB: The number and severity can be reduced by taking vitamin B3 twice daily.

Year 4 - Cancer Care (13 decks)

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