Cancer Flashcards
What cell does malignant melenoma originate form?
Melanocytes
Where are melanocytes found?
Basal layer
What is the correct name for moles?
Melanocytic naevi
Is melenoma is confined to epidermis what is it called?
Melanoma in situ
What is Lenitgo Maligna?
Melanoma is situ that occurs around hair follicles on sun damage skin on face or neck
What is an invasive melanoma?
Melanoma that grows into the dermis
What are the precursor legions for malignant melanoma?
Benign melanocytic naevus (normal mole)
Atypical or dysplastic naevus (funny-looking mole)
Atypical lentiginous junctional naevus (freckle in heavily sun damaged skin)
Congenital melanocytic naevus (brown birthmark)
What is the most common site for melanoma is males?
Back
What is the most common site for melanoma in females?
Legs
What are the two forms of growth for melanoma?
Vertical and horizontal
What is the glasgow 7 point checklist??
Major features:
Change in size
Irregular shape
Irregular colour
Minor features: Diamterer >7mm Inflammation Oozing Change in sensation
What is the ABCDs of melanoma?
A - asymmetry B - Border irregularity C - colour variation D - Diameter over 6 mm E - evolving (enlarging, changing)
What are the 4 horizontal melanomas?
Superficial spreading melanoma (SSM)
Lentigo maligna melanoma (sun damaged skin of face, scalp and neck)
lentiginous melanoma (on trunk and proximal limbs)
Acral lentiginous melanoma (on soles of feet, palms of hands or under the nails – the subungual melanoma)
What are the 5 vertical melanomas?
Nodular melanoma (presenting as a rapidly enlarging lump) Spitzoid melanoma (a nodule that resembles a Spitz naevus) Mucosal melanoma (arising on lips, eyelids, vulva, penis, anus) Neurotropic and desmoplastic melanoma (fibrous tumour with a tendency to grow down nerves) Ocular melanoma
What is the Breslow Thickness used for?
To measure the thickness of INVASIVE melanomas - from top of granular layer to the bottom of the tumour. The thicker, the more likely there will be mets.
What is the Clark Level of Invasion?
Indicated anatomical plane of invasion. Level 1-5, the deeper the level the more likely there will be mets
How are melanomas removed?
Surgically with a margin
If lymph nodes in involved they should be removed too
What are benign skin lesions?
Ephilides (freckles)
Lentigines
Naevi
How do melanocytic naevi occur?
Melanocytes that have failed to mature or migrate in utero
What is the most common subtype of melanoma and who does it affect?
Superifical spreading melanoms
Affects young/middle ages adults
What kind of melanoma is more common in elderly patients?
Nodular melanoma
What is Hutchinson sign and what does it indicate?
Pigmented extension into the nail fold
Acral Lentiginous
Brown/ black greasy lesion
Seborhoeic Keratoses
“Stuck on” appearance and regular border
Seborhoeic Keratoses
How do you treat Seborhoeic Keratoses ?
Reassurance, freezing, curette or shaving it off
may fall off spontaneously on its own
When surgically removed a melanoma, how big should the borders be?
1cm lateral margin for every 1mm depth invasion
Definition of Carcinogenesis?
The process by which a normal cell becomes a malignant cancer cell
UVA
Indirect skin damage
Much more prevalent
Penetrates more deeply into skin
UVB
Direct DNA damage
1000 more times damaging than UVA
Only when sun is directly over head
How many types of skin type are there?
5
What protects the skin from sunlight?
Melanin, absorbs UV
Sunbun and solar lentigo are due to which form of sunlight?
UVB
Solar ageing is due to which form of sunlight?
UVA
What is solar lentigo a precursor for?
Seborhoeic Keratoses
What is sunburn?
A protective mechanism where badly uv damaged keratinocytes apoptosis or programmed cell death
Which type of sunlight doe vitamin come from?
UVB
What type of sunlight is used to tanning bed?
UVA
What factors increase your risk of sunburn?
Fair skin Genetics DNA repair syndromes Albinism Naevoic basal cell carcinoma syndrome Immunosuppresion Age Medications
Where do tumours in the skin arise from?
Any where in the skin
What tumours originate form the epidermis?
Benign Seborrhoeic Keratosis
Precancerous dyplasias e.g. Bowens disease, actinic keratosis and viral lesions
BCC
SCC
What is Seborrhoeic Keratosis ?
Benign proliferation of epidermal keratinocytes
Where does Seborrhoeic Keratosis occur?
Face
Trunk
What is Leser trelet sign?
Explosive onset of Seborrhoeic Keratosis, can be a sign on internal malignancy as part of a paraneoplastic syndrome
What are the three main subtypes of BCC?
Nodular
Superficial
Infiltrative
Where do BCC’s usually occur?
Sun exposed areas e.g. face, back of hands etc.
Do BCCs metastasise?
V v rarely
What are the main precursors for SCC?
Bowen’s disease
Actinic Keratosis
Viral Lesions
Showing sqaumous DYSPLASIA
What is Bowen’s Disease?
Squamous carcinoma in situ. s a neoplastic skin disease; it can be considered as an early stage or intraepidermal form of squamous cell carcinoma.
Where does Bowen’s disease usually occur?
Legs
Appearance of Bowen’s disease?
Scaly patchy/plaque, irregular border and no dermal invasion
Where do Actinic Keratosis usually occur?
Sun exposed areas e.g. scalp, face, hands
Who does SCC most commonly affect?
Elderly sun exposed individuals
Occasionally where can SCC’s come from?
Chronic leg ulcer
Burns
Chronic lupus vulagris
ESP SUN DAMAGED SKIN
Which 4 specific sites are involved in SCC with poor prognosis?
Scalp
Ear
Nose
Lip
In embryological terms where do melanocytes come from?
Neural crest
What is the scientific name for freckles?
Ephilides
What do defects of the MC1R gene cause?
1 defect = freckles
2 defects = freckles and red hair
What are the 6 main factors that point you towards and malignant melanoma diagnosis?
Irregular pigmentation Change is shape New pigmented lesion develops in adulthood Ulceration Development of satellite nodules Bleeding
What are the two non-melanoma cancers?
BCC
SCC
What is the melanoma cancer?
Malignancy melanoma
What layer does BCC originate from?
Basal alyer
What layer does SCC originate from?
Suprabasal layer
What is the commonest human cancer?
BCC
Which gender is malignant melanoma more common in?
Female
What is the ugly ducking sign?
Mole that looks different from all the other moles, male need be checked out
What is a Keratoacanthoma?
is a low-grade skin cancer tumor that is similar to squamous cell carcinoma (SCC). It originates in the skin’s pilosebaceous glands, or hair follicles. This skin cancer tumor grows rapidly, in just a few weeks to a few months
Why is there an increase risk of cancer in people who have had previous hand transplants?
Due to immunosuppression so the body will “accept” the hands
Name new treatment for largely superficial BCC?
Photodynamic therapy
Name new treatment for Nodular BCC?
5% imiquimod cream
before skin surgery, how long should a patient stop smoking?
3 weeks
Treatment for melanoma?
Initially surgery
Further surgery, radio or chemotherapy may be needed if mets
What are the 5 layers of the scalp?
Skin Connective tissue Aponeurosis Loose connective tissue Periosteum
(backwards spells PLACS)
4 methods of local anaesthesia?
Topical
Local infiltration
Nerve block
Field block
Why is adrenaline good to give during anaesthesia?
Prolongs anaesthesia and decreases bleeding
In what structures should adrenaline not be given in?
Fingers and toes
In which patients should adrenaline be avoided in ?
Cardiac disease
Pychotropic drugs
When is Electrosurgery used?
Skin lesions e.g. skin tags
What is Curettage and Cautery?
Abnormality on skin scraped like with a spoon like instrument. After lesion scooped out blood vessels are seared off to prevent bleeding.
What patients get Curettage?
Old frail patients who had said no to standard surgery
Disadvantages of Curettage?
Does not provide a good pathology specimen
Does not accurately record the margins of the tumour
What is shave excision surgery?
simple procedure done to remove growths such as lesions, tumors, and moles on the skin. The growth is removed with a sharp razor and soothed with antibiotic ointment to encourage healing
What is a punch biopsy?
V sharp round ended instrument used to remove skin abnormalities
Advantages of punch biopsy?
Quick
Produces good wound edges
Disadvantages of punch biopsy?
Difficult to judge depth
Round holes do not heal very well
Pathology sample may be too small