1b Group Teaching - Management of Skin Cancer Flashcards
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
It is arises from cancerous Merkel cells
- MCC shares structural & immunohistochemical features with neuroectodermally derived cells, including Merkel cells
Which of the following is not a treatment option for actinic keratoses?
* Cryotherapy
* Topical 5-Fluorouracil
* Imiquimod
* Radiation therapy
Radiation therapy
- Radiation therapy may be used in treatment of BCC, SCC, MCC but not actinic keartoses
Which of the following represent (relative) low-risk features in squamous cell carcinoma?
* Periorificial zones
* Acantholysis on histology
* Immunosuppression
* Absence of perineural invasion
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
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
In mycosis fungoides, early aggressive treatment is indicated to prevent progression
- Early aggressive therapy does not improve survival
