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Year 4: DERM > Cancer > Flashcards

Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

Which type of UVA is most associated with NMSC? [1]

UVA
UVB
UVC

A

UVB

UVA -> Aging + also skin cancer
UVB -> Burning + NMSC

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2
Q

What are risk factors for malignant melanoma? [5]

A

UV Radiation
- UVB causes direct DNA damage

Skin Type
- (Fitzpatrick Skin types I & II)

Melanocytic naevi
- multiple (>100) or giant (>20 cm) naevi
- Congenital melanocytic naevi (moles present from birth, or that develop within the first few months after birth, are called congenital melanocytic nevi)
- Atypical mole syndrome (AMS): >1 pigmented lesions on the iris; >1 naevi on buttocks or instep naevi on anterior scalp; ≥2 atypical naevi; >100 naevi

Genetics
- CDK4, xeroderma pigmentosum, melanocortin 1 receptor

Previous skin cancer
- Previous melanoma

Immunosuppression
- HIV/AIDS
- Organ transplant recipient
- Lymphoproliferative disease
- Anti-TNF treatment

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3
Q

FYI

Fitzpatrick Skin types

A
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4
Q

If you have over [] moles, you are more likely to get melanoma skin cancer [1]

A

100

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5
Q

Describe the basic pathophysiology of MM

A

Melanoma originates from uncontrolled proliferation of melanocytes in the basal epidermis.

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6
Q

Describe how Congenital Melanocytic Naevi (moles) are classified based on size. Describe the clinical implications of the different sizes [3]

A

CMNs: Present at birth or develop shortly after birth.

Small and medium sized CMNS pose little risk

Large / giant sized CMNS have up to 10% lifetime risk of becoming MM.

NB: if multiple; add up total size

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7
Q

§

Describe why CMNs turning into MMS are often difficult to detect [1]

Which age group is predominately affected? [1]

A

2/3 are sub-epidermal and 31% in CNS

70% MM occur before age of 10 years

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8
Q

Which is the most common place to get MM in men?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

A

Which is the most common place to get MM in men?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

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9
Q

Which is the most common place to get MM in women?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

A

Which is the most common place to get MM in women?

Skin of lower limb
Skin of trunk
Skin of upper limb
Head or neck

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10
Q

Histologically, melanomas are divided into five major subtypes.

What are they? [5]

A

Superficial spreading (70%)
Nodular (15%)
Lentigo maligna (10%)
Acral lentiginous (< 5%)
Desmoplastic melanoma (< 1%)

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11
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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12
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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13
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Lentigo maligna
- Lentigo maligna is an early form of melanoma in which the malignant cells are confined to the tissue of origin, the epidermis
, hence it is often reported as ‘in situ’ melanoma. It occurs in sun damaged skin so is generally found on the face or neck, particularly the nose and cheek. It grows slowly in diameter over 5 to 20 years or longer.

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14
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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15
Q

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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16
Q

Which of the following are typically more seen at a more advanced stage.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

Which of the following are typically more seen at a more advanced stage.

They transition immediately into the vertical growth phase. Because of this, it is usually diagnosed at a more advanced stage.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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17
Q

[] occurs in the elderly on chronically sun-exposed sites.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

A

[] occurs in the elderly on chronically sun-exposed sites.

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Desmoplastic melanoma

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18
Q

What is the most common manifestation of melanoma? [1]

A

Superficial Spreading Melanoma (70%)

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19
Q

Name this type of melanoma [1]
Which population are most likely in? [1]

A

Nodular Melanoma (10-25%)
Met. early; older populations

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20
Q

Acral Lentiginous Melanoma (5%)

A
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21
Q

Name this type of melanoma [1]
What sign is shown here? [1]

A

Subungual melanoma

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22
Q

Name this type of melanoma [1]

Characteristics? [+]

A

Amelanotic Melanoma
- no melanin
- firm
- grow fast
- look harmless

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23
Q

Describe A-E of suspecting melanoma [5]

A
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24
Q
A
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25
Q

Describe what is meant by dermoscopy [1]

A

Use polarised and non-polarised light:
- look at demoscopic features to recognise melanomas

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26
Q

How do you investigate for MM? [1]

A

All patients require a careful skin and lymph node examination.
- ALWAYS send for histology
- Suspicious lesions should be excised with a narrow (2mm) margin
- NEVER shave or curette a suspected melanoma

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27
Q

Management is complex and guided by the Melanoma Multidisciplinary Team (MDT).

Describe the different treatment options

A

Surgical:
- WLE represents the standard treatment for primary melanoma. Involves removal of the biopsy scar with a surrounding margin of ‘healthy’ skin, with fat, down to muscular fascia. This margin is determined by the Breslow thickness.
- Sentinel Lymph Node Biopsy (SLNB)
- Electrochemotherapy is a relatively new therapy for patients with locally advanced melanoma.

Medical (typically adjuvant therapy)
- Chemotherapy
- Radiotherapy
- Immunotherapy

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28
Q

What does the Breslow thickness (mm) of a MM mean? [1]

What does the Clark level (I-V) refer to? [1]

What thickness inidcates a thin [1] and thick melanoma [1]

A

Breslow thickness (BT) is based on the vertical thickness of the tumour in millimetres.

Clark level (I-V) is a histological classification with estimated prognosis based upon the anatomical level of invasion into the skin.

Breslow Thickness and Clark level
Thin melanoma: < 0.8mm
Thick melanoma: >0.8mm

29
Q

Which factors determine if a MM prognosis? [5]

A

Breslow thickness
Clark level
Ulceration - . It is suggestive of an aggressive tumour phenotype with greater likelihood for invasion and metastasis.
Mitotic index (an indicator of cell turnover) is also an important histological finding.

30
Q

What are the two types of Non-Melanoma Skin Cancer? [2]

A

Basal Cell Carcinoma (BCC)
Squamous Cell Carcinoma (SCC

31
Q

Dx? [1]

Slow growing
Solitary nodule
Central ulceration
Rolled pearly edges
Telangiectasia

A

Basal Cell Carcinoma (BCC)

32
Q

What are the two types of NMSC? [2]

A

Basal Cell Carcinoma (BCC)
Squamous Cell Carcinoma (SCC)

33
Q

Describe the characteristics of Basal Cell Carcinoma (BCC)

A
  • Shiny pink/red lump
  • Slow growing, over months to years
  • Sometimes red flat patches
  • Form a recurrent crust that doesn’t heal
  • Over time bleed/ulcerate in the middle, but may not be painful
  • Usually sun-exposed sites: face, ears, scalp, hands, upper trunk
  • Rarely metastasise

TURP: Telangiectasia Ulceration Rolled edges Pearly edges

34
Q

Which type of skin cancer is most common? [1]

A

Basal Cell Carcinoma (BCC) (75%)

35
Q

Risk Factors for BCC? [7]

A
  • Fair skin: blue eyes, red/blonde hair
  • UV exposure
  • Previous skin cancer
  • Previous radiotherapy
  • Arsenic ingestion
  • Immunosuppression
  • Genetic disease: Gorlin syndrome & Xeroderma pigmentosum
36
Q

Which genetic conditions are a risk factor for BCC? [2]

A

Genetic disease:
* Gorlin syndrome
* Xeroderma pigmentosum

37
Q

Describe what is meant by Gorlin syndrome [1]

A

A rare autosomal dominant condition that occurs as a result of gene mutation, specifically the PTCH1 gene. Individuals with Gorlin syndrome typically begin to develop BCCs during adolescence or early adulthood.

38
Q

Describe test often perform in clinic to test for BCC [1]

A
39
Q

What are the clinical sub-types of BCC? [5]

Describe how the present

A

There are several clinical sub-types of BCC, including:
nodular
- red / flesh-coloured and have well-defined borders with overlying telangiectasias. As they grow, they may develop central ulceration (Rodent ulcer).

superficial
- slow-growing erythematous plaques that may be dry or crusted or have a slight bluish tinge

morphoeic
- scar-like lesion or indentation; they commonly occur on the upper trunk or face.

pigmented
- Pigmented BCCs may be difficult to distinguish from melanoma.

basosquamous:
- A rare, but aggressive form of BCC with increased risk of recurrance and even metastasis.

40
Q

Describe this type of BCC [1]

A

Morphoeic BCC
- sclerotic (scarred)

41
Q

Describe this type of BCC [1]

A

Pigmented BCC

42
Q

Types of BCC:

[] and [] BCCs are considered low-risk, whereas [] is high-risk due to their extensive local spread and high recurrence rate.

A

Nodular and superficial BCCs are considered low-risk, whereas morpheaform is high-risk due to their extensive local spread and high recurrence rate.

43
Q

Describe the Dx [2] and Mx [3] of BCC

A

Diagnosis
History
Skin biopsy from ulcer edge

Management
Excision
Radiotherapy
Superficial BCCs – 5-flourouracil or imiquimod cream

44
Q

Describe the different treatment options for low and high risk BCC [+]

A

The main goal of treatment is the complete removal of the tumour with preservation of the function and cosmesis of the affected area.

The type of treatment depends on whether the BCC is low or high risk

Low risk:
- complete surgical removal or electrodesiccation and curettage (ED&C)
- Superficial BCCs – 5-flourouracil or imiquimod cream

High risk
- Mohs micrographic surgery is a specialist removal method for non-melanoma skin cancers with high recurrence risk
- As an alternative for high-risk lesions, simple resection with adjunct radiotherapy has been recommended

45
Q

Dx? [1]

A

Squamous cell carcinoma

46
Q

Describe the characteristics of SCC [+]

A
  • Enlarging scaly/crusted lumps
  • Grow rapidly over weeks
  • May ulcerate
  • Often tender/painful/bleed (except in IC ptx)
  • Usually arise within pre-existing actinic keratosis or intraepidermal carcinoma
  • Commonly face, lips, ears, hands and limps
  • Rarely metastasises
  • Often have hyperkerotic horn / no rolled border
47
Q

Dx? [1]
Describe this [1]

A

Actinic Keratoses
- hyperkeratotic papules on a background of sun-damaged skin
- Actinic keratosis involves the formation of precancerous scaly lesions on the skin
- Actinic keratoses have around a 10% risk of developing into an SCC, therefore monitoring and treatment are important

48
Q

Describe the management options for Actinic Keratoses [4]

A

Management options include:
- prevention of further risk: e.g. sun avoidance, sun cream
- fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
- topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
- Imiquimod can be used for lesions on the face and scalp when cryotherapy or other topical treatments cannot be used.

49
Q

Superficial form of SSC = ? [1]

A

Bowens Disease

50
Q

Describe what is meant by Bowen’s disease [1]

A

Bowen’s disease (also known as SCC in situ) occurs when the cancerous cells are confined to the epidermis.15 It can also progress into invasive SCC, so it is important to monitor and treat Bowen’s disease promptly.

51
Q

Describe the management of squamous cell skin cancer [3]

A

Surgical excision with 4mm margins if lesion < 20mm in diameter.

If tumour >20mm then margins should be 6mm.

Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

52
Q

Squamous skin cell cancer commonly mets to…[3]

A

The most commonly affected sites are lungs, liver and brain.

53
Q

Describe the differences in a good and bad prognosis for squamous skin cell cancer [4]

A

High-risk features include:

Size: >2mm deep or >20mm wide
Site: face, ear, genitals, hands, feet
Recurrence
Immunosuppressed individual
Poor differentiation (histologically)
Perineural invasion (histologically)
High tumour budding

Geeky medics^

54
Q

For Bowen’s disease, therapies such as [] or therapies like [] are first-line management

A

For Bowen’s disease, destructive therapies such as cryotherapy or topical therapies like 5-fluorouracil are first-line management.8

55
Q

Dx? [1]

A

Seborrheic Keratoses

56
Q

How do you differentiate Seborrheic Keratoses between melanoma? [2]

A

SK:
- well-demarcated, waxy, ‘stuck-on’ appearing papules or plaques with a greasy surface
- usually asymptomatic, although they may become irritated or itchy.

Melanoma:
- asymmetrical lesion with irregular borders and varied colours within one lesion
- It tends to evolve over time - a key feature that distinguishes it from SK.

However, definitive diagnosis for both conditions should ideally be made through biopsy followed by histological examination.

Melanoma on the left; SK on the right

57
Q

H

Describe the characteristics of Seborrheic Keratoses [+]

A
  • Very common
  • Present in >90% of people over 60
  • Increase in number with time
  • Often develop in middle aged
  • Waxy or warty surface
  • Flat or plaques
  • Stuck on appearance
58
Q

Tx for serborrheic keratoses? [2]

A
  • reassurance about the benign nature of the lesion is an option
  • options for removal include curettage, cryosurgery and shave biopsy
59
Q

Name and describe this type of skin condition [3]

A

Junctional Naevi
* Mole
* Flat
* Pigmented
* Regular, symmetrical, static appearance

GO over

60
Q

What are solar lentigo?

A

Solar lentigo
- is a harmless patch of darkened skin. It results from exposure to ultraviolet (UV) radiation, which causes local proliferation of melanocytes and accumulation of melanin within the skin cells (keratinocytes)
- aka sun spots

61
Q

Name and describe this type of skin condition [3]

A
  • Compound Naevi
    Mole
    Central raised area
    Surrounded by flat pigmentation
62
Q

Name and describe this type of skin condition [3]

A

Junctional Naevi
Flat
Pigmented
Regular, symmetrical, static appearance

63
Q

Name and describe this type of skin condition [3]

A

Intradermal Naevi
* Protrude from the skin surface
* Pigmented or flesh coloured

64
Q

Name and describe this type of skin condition [1]

A

Blue Naevi
- solitary, bluish, smooth surfaced macule, papule or plaque. They are generally round or oval in shape.

65
Q

On palm of hands or feet

Dx? [1]

A

Acral Naevi

66
Q

Name and describe this type of skin condition [1]

A

Naevus Spilus
- Nevus spilus, also known as speckled lentiginous nevus, is a light brown or tan birth mark, speckled with small, dark spots or small bumps.
- Malignant change very rare

67
Q

Name and describe this type of skin condition [1]

A

Dermatofibroma
- common benign fibrous skin lesions. They are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury

68
Q

https://www.passmedicine.com/menu.php#

A

Year 4: DERM (20 decks)

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