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cancer Flashcards

1
Q

Skin cancer w worst prognosis

A

Melanoma

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2
Q

2 types of skin cancer

A
  • Non melanoma (Basal Cell Cancer, SCC)
  • Melanoma
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3
Q

Questions asked to patients we suspect have skin cancer

A
  1. HISTORY
    - Duration
    - Change
    - Symptoms
    - Risk factor assessment
    - PMHx, DHx, allergies
  2. EXAMINATION
    - Site, size, flat/raised, borders, surface features
    - Pigmented - ABCDE
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4
Q

ABCDE - skin

A

A- Asymmetry
B- irregular Border
C- Colour variation
D- Diameter >6mm
E- Evolution/Elavation

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5
Q

What time of sun exposure is common in patients with BCC/Melanoma

A

Intense intermittent sun exposure

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6
Q

What time of sun exposure is common in patients with SCC and their precursors

A

Chronic cumulative (eg. live abroad, work outside)

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7
Q

BASAL CELL CARCINOMA
- Originate from?
- Hx
- Prognosis

A
  • Basal keratinocytes
  • Slowly growing, asymptomatic
  • Good as don’t metastasise + are locally invasive
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8
Q

BCC Clinical features

A
  • Rolled, pearly, shiny edge
  • central ulceration
  • telangiectasia
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9
Q

BCC
- 3 subtypes + treatment

A
  1. Nodular: Routine excision (3-4mm round it)
  2. Infiltrative: Mohs surgery/ Wide excision
  3. Superficial:
    - Freeze (liquid nitrogen),
    - Creams (i.e: efudex- cytotoxic cream, imiquimod cream)
    - Photodynamic therapy
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10
Q

Diagnostic tool used to look at skin cancer lesions

A

Dermatascope

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11
Q

what type of bcc

A

Inflitrative
- Wide margin

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12
Q

what type of bcc

A

Nodular
- Golf ball
- Well defined

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13
Q

what type of bcc

A

superficial
- flat

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14
Q

SCC
- Originate from
- Hx
- Prognosis

A
  • Supra-basal keratinocytes
  • Fast growing (changes over 2-3 months), tender
  • Meh, could metastasise - most do not
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15
Q

Most common cancer in immunosuppressed population

A

SCC

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16
Q

Clinical features of SCC

A
  • Depends on how well-differentiated cells are
  • Scaly lumps/ ulcerated lumps
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17
Q

Precursors to SCC + their definitions

A
  • Actinic keratosis (solar keratosis): partial thickness of keratinocyte dysplasia of epidermis
  • Bowens disease: full thickness keratinocyte dysplasia of epidermis
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18
Q

Prognosis/Treatment for actinic keratosis and bowens disease

A
  • Treated non-surgically (eg. liquid nitrogen, effudix + education)
  • Non life-threatening (as superficial)
19
Q

actinic keratosis presentation

A
  • scale
  • common on sun exposed areas
20
Q

Bowens disease presentation

21
Q

What % of:

  1. Actinic
  2. Bowens disease

progress into scc

A
  1. around1%
  2. around 5%
22
Q

risk factors for ssc round mouth

A
  • smoking
  • sun exposure
23
Q

Melanoma
- Arrises from
- Hx
- Prognosis

A
  • Melanocytes
  • Changing pigmented lesion, itchy/bleeding
  • Poor, all invasive melanomas can metastasise
24
Q

Melanoma risk factors

A
  • Multiple atypical moles
25
Q

Multiple atypical moles worrying sign

A

‘Ugly duckling sign’ - one mole different to the rest (probably a melanoma)

26
Q

Major + Minor criteria for analysing moles

A

MAJOR
Change in: shape, size, colour

MINOR
Diameter >6mm, bleeding, sensory change, inflammation

27
Q

Most common type of melanoma

A

Superficial spreading melanoma

28
Q

Walk me thru growth of melanoma

A
  1. Horizontal growth - confined to epidermis (no metastatic potential) - normally flat
  2. Vertical growth (break thru basement membrane + can metastasise) - nb look for lumpy melanoma
29
Q

Types of melanoma

A
  • Superficial spreading melanoma
  • Nodular melanoma
  • Lentigo maligna (melanoma)
  • Acral lentiginous melanoma

NB- All can be amelanotic melanoma (no pigment)

30
Q

what type of melanoma is this

31
Q

Prognosis of nodular melanoma + why

A
  • poor as they grow vertically straight away
32
Q

Lentigo maligna

A
  • horizontal growth phase lasts years
  • Name changes to lentigo malgina once vertical phase is commenced
33
Q

What type of melanoma is this

34
Q

What type of melanoma is this

35
Q

What type of melanoma is this

36
Q

Where is acral MM commonly seen

A

palms
soles
nails

37
Q

Risk factors for acral MM

A

genetic mutation

38
Q

What type of melanoma is this

39
Q

What’s Breslow thickness used for

A

to measure deepest tumour cell from granular layer of epidermis

  • related to tumour prognosis (deeper tumour = poorer prognosis)
40
Q

Breslow thickness >3.00mm survival

A

60% 5 year survival

41
Q

Breslow thickness <0.76 survival

A

90% 5y survival

42
Q

Breslow thickness confined to epidermis survival

A

100% 5y survival

43
Q

Malignant melanoma treatment

A
  1. Surgical excision +/- sentinel node biopsy ( done if Breslow thickness > 0.8)
  2. Advanced MM (difficult to treat):
    - Targeted therapies
    - Immunotherapy (to get immune system to attack cancer more)

Derm (8 decks)

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