1b Group Teaching - Management of Skin Cancer Flashcards

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1
Q

Which of the following is false regarding melanoma?
* It can arise in eyes
* Red hair is a risk factor
* Pre-existing nevi are a risk factor
* Causes > 75% of skin cancer deaths

A

Pre-existing nevi are a risk factor
* > 50% of melanomas arise without a pre-existing nevus
* Atypical nevi and > 100 nevi are considered a risk facotr

It can arise in eyes:
* It can arise in skin, mucosal surfaces and uveal tract

Red hair is a risk factor:
* Fair complexion is a risk factor

Causes > 75% of skin cancer deaths:
* True

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2
Q

Which of the following is true regarding the pathogenesis of melanoma?
* Wild type BRAF causes activation of the MAPK (RAS-RAF-MEK-ERK) pathway in MM
* CDKN2A mutations cause inactivation of the MAPK pathway
* CDKN2A encodes p16, a tumour suppressor
* CD8+ T-cell recognise melanoma-specific antigens but cannot kill melanoma cells

A

CDKN2A encodes p16, a tumour suppressor

Wild type BRAF causes activation of the MAPK (RAS-RAF-MEK-ERK) pathway in MM:
* BRAF mutations (not wild-Type) activate the MAPK pathway in MM

CDKN2A mutations cause inactivation of the MAPK pathway:
* CDKN2A mutations cause activation of the MAPK pathway

CD8+ T-cell recognise melanoma-specific antigens but cannot kill melanoma cells:
* CD8+ T-cell are capable of killing melanoma cells by recognizing melanoma specific antigens, if activated appropriately

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3
Q

Which of the following statements is true?
* Acral lentiginous melanoma is more common in darker skin types
* Melanoma incidence is decreasing
* Superficial spreading melanoma is most common variant in pale skin types
* Nodular melanoma has a rapid radial growth phase

A

Superficial spreading melanoma is most common variant in pale skin types

Acral lentiginous melanoma is more common in darker skin types:
* Acral lentiginous melanoma affects all skin-types equally

Melanoma incidence is decreasing:
* Melanoma incidence is increasing

Nodular melanoma has a rapid radial growth phase:
* Nodular melanoma lacks a radial growth phase

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4
Q

Which of the following is true regarding melanoma detection?
* ABCDE rule is helpful for early detection of nodular melanoma
* The advent of dermoscopy has rendered history-taking obsolete in MM screening
* Melanoma and basal cell carcinoma may appear grossly similar
* The ‘black swan’ rule may facilitate detection of melanoma

A

Melanoma and basal cell carcinoma may appear grossly similar

ABCDE rule is helpful for early detection of nodular melanoma:
* Asymmetry, border irregularity, colour variation and diameter >5-6mm are products of the radial growth phase, absent in nodular MM

The advent of dermoscopy has rendered history-taking obsolete in MM screening:
* Dermoscopy is an adjunctive tool in clinical assessment, and findings must be considered alongside other aspects of clinical assessment

The ‘black swan’ rule may facilitate detection of melanoma:
* The ugly ducking sign – a mole that does not resemble other nevi - may indicate an MM

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5
Q

Which of the following investigation of melanoma is correct?
* Suspected melanoma should undergo punch biopsy
* Confirmed melanoma should undergo sentinel lymph node biopsy
* BRAF mutation status can inform prognosis and treatment decisions
* LDH is relevant in haematological malignancy but not helpful in melanoma

A

BRAF mutation status can inform prognosis and treatment decisions

Suspected melanoma should undergo punch biopsy:
* Suspected melanoma should undergo complete excision for diagnosis

Confirmed melanoma should undergo sentinel lymph node biopsy:
* Sentinel lymph node is currently offered for pT1b melanomas

LDH is relevant in haematological malignancy but not helpful in melanoma:
* LDH is a major prognostic factor in metastatic melanoma

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6
Q

Which of the following is true regarding keratinocyte carcinoma / dysplasia?
* Actinic keratoses typically evolve into squamous cell carcinoma
* Basal cell carcinoma is more likely than squamous cell carcinoma to metastasise
* Squamous cell carcinoma is three times more common than basal cell carcinoma
* Keratinocyte carcinomas are more common in men than in women

A

Keratinocyte carcinomas are more common in men than in women

Actinic keratoses typically evolve into squamous cell carcinoma:
* Actinic keratoses may transform to squamous cell carcinoma, but the overall proportional risk is low

Basal cell carcinoma is more likely than squamous cell carcinoma to metastasise:
* Basal cell carcinoma virtually never metastasises

Squamous cell carcinoma is three times more common than basal cell carcinoma:
* Basal cell carcinoma is more common than SCC 4:1

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7
Q

Which of the following is false about Basal cell carcinoma (BCC)?
* Nodular BCC appears as a ‘pearly’ papule
* Morpheic BCC resembles a scar
* Morpheic, micronodular and infiltrative BCC are aggressive subtypes
* BCC never metastasises, and thus treatment is usually desirable rather than essential

A

BCC never metastasises, and thus treatment is usually desirable rather than essential

  • Untreated basal cell carcinomas may become highly destructive to local structures and if left untreated over many years, may eventually become metastatic
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8
Q

Which of the following is true regarding basal cell carcinoma management?
* Diagnostic biopsies are always required prior to definitive treatment
* Topical treatments should always be offered
* Mohs micrographic surgery has replaced traditional excision in surgical management
* Vismodegib may be used for unresectable BCC

A

Vismodegib may be used for unresectable BCC

Diagnostic biopsies are always required prior to definitive treatment:
* Diagnostic biopsies are not required if clinical features suffice for diagnosis

Topical treatments should always be offered:
* Topical treatments are only suitable for superficial basal cell carcinomas on low-risk sites

Mohs micrographic surgery has replaced traditional excision in surgical management:
* Mohs micrographic surgery is indicated for aggressive subtypes, critical sites and recurrent BCC

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9
Q

Which of the following is correct regarding cutaneous squamous cell carcinoma (SCC)?
* Typical appearance virtually always allows clinical diagnosis
* May be difficult to distinguish from keratoacanthoma
* Cemiplimab represents an alternative to surgical treatment
* Rapid growth is a paradoxically positive prognostic feature

A

May be difficult to distinguish from keratoacanthoma

Typical appearance virtually always allows clinical diagnosis:
* Clinical appearances may vary substantially

Cemiplimab represents an alternative to surgical treatment:
* Cemiplimab is indicated for unresectable or metastatic SCC

Rapid growth is a paradoxically positive prognostic feature:
* Rapid growth is a poor prognostic feature

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10
Q

Which of the following statements is true regarding mycosis fungoides?
* Rapid progression is typical
* Distinct clinicopathological features allow swift diagnosis
* Any pruritus is usually mild
* Pathogenesis now clearly defined

A

Any pruritus is usually mild

Rapid progression is typical:
* Progression may take years or decades

Distinct clinicopathological features allow swift diagnosis:
* Clinicopathological features may remain non-specific / inconclusive for years prior to diagnosis

Pathogenesis now clearly defined:
* Pathogenesis remains poorly understood

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11
Q

Which of the following statements is true regarding Kaposi sarcoma?
* It may appear as a pink patch or a polyp
* HHV6 plays a role in the aetiology
* It signifies a diagnosis of AIDS
* It is typically treated with chemotherapy regimens that include doxorubicin

A

It may appear as a pink patch or a polyp
* Cutaneous lesions can vary from pink patches to dark violet plaques, nodules or polyps

HHV6 plays a role in the aetiology:
* HHV8 plays an aetiological role

It signifies a diagnosis of AIDS:
* It may be endemic or related to immunosuppression

It is typically treated with chemotherapy regimens that include doxorubicin:
* Options include radiotherapy, chemotherapy, excision

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12
Q

Which of the following statements is false regarding Merkel cell carcinoma?
* It is arises from cancerous Merkel cells
* Polyomavirus plays an aetiological role
* It demonstrates more aggressive behaviour than melanoma
* Surgery, radiation and anti-PD1 checkpoint inhibitors are used in treatment

A

It is arises from cancerous Merkel cells

  • MCC shares structural & immunohistochemical features with neuroectodermally derived cells, including Merkel cells
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13
Q

Which of the following is not a treatment option for actinic keratoses?
* Cryotherapy
* Topical 5-Fluorouracil
* Imiquimod
* Radiation therapy

A

Radiation therapy

  • Radiation therapy may be used in treatment of BCC, SCC, MCC but not actinic keartoses
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14
Q

Which of the following represent (relative) low-risk features in squamous cell carcinoma?
* Periorificial zones
* Acantholysis on histology
* Immunosuppression
* Absence of perineural invasion

A

Absence of perineural invasion

High risk features in cutaneous SCC:
* Localisation: Trunk and limbs > 2cm; Head / neck > 1cm; Periorificial zones
* Margins: Ill-defined
* Rapidly growing
* Immunosuppressed patients
* Previous radiotherapy or site of chronic inflammation
* Histology:
* Grade of differentiation: poorly differentiated
* Acantholytic, adenosquamous, demosplastic subtypes
* Tumour thickness - Clark level: > 6mm, Clark IV, V
* Invasion beyond subcutaneous fat
* Perineural, lymphatic or vascular invasion

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15
Q

Which of the following is statements is false regarding cutaneous T-cell lymphoma?
* In mycosis fungoides, early aggressive treatment is indicated to prevent progression
* Active treatment of Sézary syndrome always requires systemic therapy
* Radiation therapy may be utilised in mycosis fungoides
* Mycosis fungoides is the most common primary cutaneous lymphoma

A

In mycosis fungoides, early aggressive treatment is indicated to prevent progression

  • Early aggressive therapy does not improve survival
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