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Y2 Cancer (MCD) > Cancer as a Disease – Skin Cancer > Flashcards

Cancer as a Disease – Skin Cancer Flashcards

1
Q

What are the five layers of the epidermis?

A

Stratum corneum Stracum lucidum Stratum granulosum Stratum spinosum Stratum basale

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2
Q

What are the main cell types in the epidermis?

A

Keratinocytes Melanocyts Langerhans Cells (dendritic cells) Merkel Cells - sensation

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3
Q

State the types of skin cancer that come under each of the following types: a. Keratinocyte derived b. Melanocyte derived c. Vasculature derived d. Lymphocyte derived

A
  1. Keratinocyte derived
  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
  1. Melanocyte derived
    * Malignant Melanoma
  2. Vasculature derived
  • Kaposi Sarcoma – endothelium of lymphatics
  • Angiosarcoma – endothelium of blood vessels
  1. Lymphocyte derived
    * Mycosis fungoides
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4
Q

State two examples of genetic syndromes that massively increase the risk of getting skin cancer.

A
  • Gorlin’s Syndrome – regular BCCs
  • Xeroderma Pigmentosum – increased risk of BCC, SCC and malignant melanoma
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5
Q

Give two examples of viruses and the skin cancer they can lead to

A
  • HHV8 - Karposi’s sarcoma
  • HPV - SCC, especially in genitals and mouth
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6
Q

What is the difference between the depth reached by UVB radiation and UVA radiation?

A

UVB – reaches sea level, reach epidermis

UVA – reaches dead sea level (423m below sea level), reach dermis

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7
Q

How does UVB cause mutations in DNA?

A
  • Induces the formation of photoproducts
  • Particularly affects pyrimidines – causing cross-linkin
  • Formation of cyclobutane pyrimidine dimers (T=T, T=C, C=C)
  • and 6-4 pyrimidine pyrimidone photoproducts
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8
Q

How are UVB mutations usually corrected?

A

Nucleotide excision repair

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9
Q

How can UVA promote skin carcinogenesis?

A
  • Forms cyclobutane pyrimidine dimers (but less effectively than UVB)
  • Also generates free radicals that can damage DNA
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10
Q

Name a condition that is caused by a defect in nucleotide excision repair.

A

Xeroderma pigementosum

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11
Q

What are the features of this condition?

A
  • Increased risk of BCCs, SCCs and melanoma
  • Photosensitivity
  • Dry skin
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12
Q

What happens to keratinocytes in sunburn?

A
  • The UV damage leads to keratinocyte apoptosis
  • The apoptotic cells in UV overexposed skin are called sun burn cells
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13
Q

Describe the immunomodulatory effects of UV light.

A
  • UVA and UVB affect the expression of genes involved in skin immunity
  • It depletes Langerhans cells in the epidermis
  • This reduces skin immunocompetence and immunosurveillance
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14
Q

What are the consequences of UV therapy for psoriasis?

A
  • Increased risk of skin cancer UV can act on keratinocytes and cause DNA damage
  • If the Langerhans cells have been depleted then they will be unable to knock out the damaged cells so they could persist and become cancerous
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15
Q

Which system is used to categorise people based on their skin type and sensitivity to UV?

A

Fitzpatrick Phenotypes

I-VI with I being: always burns never tans, and VI being Afro-Caribbean skin tone

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16
Q

Where are melanocytes found within the epidermis?

A

In the basal layer

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17
Q

What happens to melanin once it is produced by the melanocytes?

A
  • It is packaged into melanosomes and it passes along the dendrites of the melanocytes and is taken up by the keratinocytes
  • The keratinocytes put the melanosomes around their nuclei, which protects the nuclei from DNA damage
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18
Q

What are the two types of melanin?

A
  • Eumelanin – black/brown
  • Phaeomelanin – yellowish or reddish-brown
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19
Q

What is melanin formed from?

A

Tyrosine

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20
Q

What gene regulates the relative amounts of melanin produced?

A
  • MC1R
  • Over 20 polymorphisms that vary in the eumelanin:phaeomelanin production ratio
21
Q

What is Lentigo Maligna?

A
  • Proliferation of malignant melanocytes within the epidermis
  • There is no risk of metastasis
  • This is also called melanoma in situ
22
Q

What is it the name given to a large area of lentigo maligna that has a smaller area within it that has become invasive?

A

Lentigo maligna melanoma

23
Q

What is a superficial spreading malignant melanoma?

A
  • Lateral proliferation of malignant melanocytes
  • They invade the basement membrane so there is a risk of metastasis
24
Q

What is the ABCDE for the diagnosis of superficial spreading malignant melanoma?

A
  • Asymmetry
  • Border irregularity
  • Colour variation
  • Diameter (>0.7 mm and increasing)
  • Erythema - redness indicating loss of differentiation and keratin production
25
What is it called when a pale area appears in the middle of a melanoma?
Area of regression – this is associated with higher risk of metastasis
26
What is it called when you get a vertical proliferation of malignant melanocytes?
Nodular malignant melanoma Associated with high risk of metastasis
27
Describe the pattern of growth when a nodular melanoma arises from a superficial spreading malignant melanoma.
Downward proliferation of malignant melanocytes that is following previous horizontal growth
28
What is the type of melanoma that occurs on the palms and soles?
Acral lentiginous melanoma
29
What type of melanoma produced no melanin?
Amelanotic melanoma
30
What is the prognosis of melanoma based on?
Breslow thickness – thickness from the top of the tumour to the bottom
31
What is a keratoacanthoma?
* It is either a benign lesion or a benign version of an SCC * It grows rapidly but then disappears * There is no risk of metastasis
32
What can squamous cell carcinomas (SCCs) be caused by?
* UV exposure * HPV * Immunosuppression (main cancer in organ transplant patients) * May occur in scars or scarring processes
33
How can you tell whether an SCC is well differentiated?
If the lesion has a keratin horn then it shows that the keratinocytes can still produce keratin and so they are well differentiated
34
What is a basal cell carcinoma (BCC)?
Malignant tumour arising from keratinocytes in the basal layer of the epidermis
35
Describe the appearance of BCCs
* They are pearly * They have a rolled edge * They often have arborising telangiectasia - vessel pattern like a tree
36
Name a cutaneous T cell lymphoma.
Mycosis fungoides Atypical lymphocytes invade the dermis and epidermis Slowly progressive
37
Which viruses are associated with Kaposi sarcoma?
* HHV8 * HIV
38
Name a disease that predisposes to SCCs and HPV induced warts (that can become incredibly keratotic).
Epidermodysplasia Veruciformis
39
What are the most common skin cancers?
Keratinocyte derived BCC - most common SCC - 2nd most common
40
What are the most common causes of skin cancer?
UV light - most common Genetic syndromes Viral infections Immunosupression
41
What areas have high risk of metastasis?
Ears, lips, genitals
42
Which genes does UV damage lead to mutations in
* Cell division * DNA repair * Cell cycle arrest
43
What is UV light immunotherapy used to treat?
Psorasis
44
How is melanin production stimulated?
Keratinocytes release MSH which triggers melanocytes to produce more melanin
45
What are the features of lentigo malign?
* Irregular shape * Light and dark brown colour * Flat * Usually occur on face and head
46
What are the different types of malignant melanoma?
* Superficial spreading * Nodular * Lentigo maligna melanoma * Acral lentiginous * Amelanotic
47
What is a SCC?
Squamous cell carcinoma Risk of metastasis
48
What are the invasive features of BCCs?
* Slow growing * Invade tissue * Never metastesise
49
What are BCCs caused by?
* Sun exposure * Genetics

Y2 Cancer (MCD) (16 decks)

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