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YR2: MCD Cancer > 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 
Stratum lucidum 
Stratum granulosum 
Stratum spinosum 
Stratum basale
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2
Q

What are the 4 main cell types in the epidermis?

A

Keratinocytes
Melanocytes
Langerhans Cells
Merkel Cells

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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

Keratinocyte: Basal + Squamous Cell Carcinoma
Melanocyte: Malignant Melanoma
Vasculature: Kaposi Sarcoma, Angiosarcoma
Lymphocyte: 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 + malignant melanoma

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5
Q

Give two examples of viruses that can lead to skin cancer?

A

HHV8

HPV

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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

UVA – reaches dead sea level

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7
Q

How does UVB cause mutations in DNA?

A

Induces formation of photoproducts (mutations)
Causing cross-linking of pyrimidines
E.g. Cyclobutane pyrimidine dimers (T=T, T=C, C=C)
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 happens to keratinocytes in sunburn?

A

UV induced apoptosis- removes damaged cells with cancerous potential
Apoptotic cells in UV overexposed skin= sun burn cells

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12
Q

Describe the immunomodulatory effects of UV light.

A

UVA + UVB affect expression of genes involved in skin immunity
Deplete Langerhans cells in the epidermis
Reduces skin immunocompetence + immunosurveillance

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13
Q

What are the consequences of UV therapy for psoriasis?

A

Increased risk of skin cancer
UV can act on keratinocytes + cause DNA damage
If Langerhans cells have been depleted, they will be unable to knock out damaged cells so they could persist + become cancerous

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14
Q

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

A

Fitzpatrick Phenotypes (I-VI)

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15
Q

Where are melanocytes found within the epidermis?

A

In the basal layer - Stratum basale

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16
Q

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

A

Packaged into melanosomes, passes along processes of melanocytes + is taken up by keratinocytes
Keratinocytes put melanosomes around their nuclei, which protects the nuclei from DNA damage

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17
Q

What are the two types of melanin?

A

Eumelanin: black/brown
Phaeomelanin: yellowish or reddish-brown

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18
Q

What is melanin formed from?

A

Tyrosine

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19
Q

What gene regulates the relative amounts of melanin produced? What ratio depends on this?

A

MCR1

Eumelanin : Phaemomelanin produced

20
Q

What is Lentigo Maligna?

A

Proliferation of malignant melanocytes within the epidermis
“Pagetoid” spread- melanocytes have spread up
No risk of metastasis
AKA. melanoma in situ

21
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

22
Q

What is a superficial spreading malignant melanoma?

A

Lateral proliferation of malignant melanocytes

Invade the basement membrane so there is a risk of metastasis

23
Q

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

A 
Asymmetry 
Border irregularity  
Colour variation  
Diameter (>0.7 mm + increasing) 
Erythema
24
Q

What is it called when a pale area appears in the middle of a melanoma? What is this associated with?

A

Area of regression: associated with higher risk of metastasis

25
Q

What is it called when you get a vertical proliferation of malignant melanocytes with no previous horizontal growth? What is the consequence of this?

A

Nodular malignant melanoma

Risk of metastasis

26
Q

Describe the pattern of growth when a nodular melanoma arises from a superficial spreading malignant melanoma.

A

Downward proliferation of malignant melanocytes following previous horizontal growth

27
Q

What type of melanoma occurs on the palms and soles?

A

Acral lentiginous melanoma

28
Q

What type of melanoma produced no melanin?

A

Amelanotic melanoma

29
Q

What is the prognosis of melanoma based on?

A

Breslow thickness: thickness from top of tumour to bottom

30
Q

What is a keratoacanthoma?

A

A benign lesion or a benign version of an SCC
Grows rapidly but then disappears
No risk of metastasis

31
Q

What can squamous cell carcinomas (SCCs) be caused by?

A

UV exposure
HPV
Immunosuppression
Scarring process

32
Q

How can you tell whether an SCC is well differentiated?

A

If lesion has a keratin horn, it shows the keratinocytes can still produce keratin , thus are well differentiated

33
Q

What is a basal cell carcinoma (BCC)?

A

Malignant tumour arising from keratinocytes in the basal layer of the epidermis

34
Q

Describe the appearance of BCCs

A

Pearly- greyish, shiny, glistens
Rolled edge
Arborising telangiectasia
Pinky/ red/ grey

35
Q

Name a cutaneous T cell lymphoma.

A

Mycosis fungoides

36
Q

Which viruses are associated with Kaposi sarcoma?

A

HHV8

HIV

37
Q

Name a disease that predisposes to SCCs and HPV induced warts (that can become incredibly keratotic).

A

Epidermodysplasia Veruciformis

38
Q

Describe 4 features of BCC’s

A

Caused by sun exposure + genetics
Slow growing
Invades tissue but doesn’t metastasise
Common on face

39
Q

What is a squamous cell carcinoma (SCC)?

A

Malignant tumour of keratinocytes

Has risk of metastasis (though much smaller risk than melanoma)

40
Q

What are the 4 overarching causes of skin cancer?

A

Genetic syndromes
Viral infections
UV light
Immunosuppression

41
Q

Describe the incidence rates of malignant melanoma and basal cell carcinoma?

A

MM: Increasing, mainly in white skinned people
BCC: Increasing

42
Q

Describe 4 visual characteristics of malignant melanomas

A

Dark
Red border
Lumpy
Abnormal appearance

43
Q

What does skin colour depend on?

A

Amount + type of melanin produced

not the density of melanocytes

44
Q

Describe 3 features of Malignant melanomas

A

Malignant tumour of melanocytes
Caused by UV exposure + genetic factors
Risk of metastasis

45
Q

Describe the appearance of Lentigo Maligna

A

Irregular shape
Light + dark brown
Usually > 2cm

46
Q

List 4 key risk factors for development of melanomas

A

PMH of melanoma
FH of melanoma
Skin type 1 or 2
Sunburns during childhood

47
Q

What is the main approach to treatment in skin cancer?

A

Surgery

YR2: MCD Cancer (18 decks)

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