Cancer (Melanoma + non-pigmented) Flashcards by Kieran Ruthven

What are the 2 main skin cancer types?

1) Melanoma 2) Non-melanoma (includes BCC, SCC)

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BCC arises from which cell and layer?

Keratinocytes within basal layer

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SCC arises from which layer?

Suprabasal layer

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Australia has what incidence of non-melanoma skin cancer versus the UK?

10-40x

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Commonest non-melanoma skin cancer in Scotland?

BCC

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Skin cancers represent which proportion of all cancers in UK?

1/3rd

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Melanoma is the commonest skin cancer. True/false?

False - only around 5%

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What is the most common cancer for 15-24 year olds?

Melanoma

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What’s the most important prognostic factor for melanoma 5-year survival?

Tumour depth (<1mm excellent, 4mm 50%)

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ABCDE of skin lesions includes…

A = Asymmetry B = Border C = Colour D = Diameter (>0.6cm abnormal) E = Evolution

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Ugly Duckling SIgn is characteristic of…

Melanoma

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Blue-white lesions and atypical pigment are features of…

Melanoma

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Which % of non-melanoma skin cancers are BCCs?

75%

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BCCs are fast growing lumps, often painful in presentation. True/false?

False - they are SLOW growing and often PAINLESS (and ignored)

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Rodent ulcer in the central of a skin lesion is typical of…

BCC

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BCCs frequently metastasise. True/false?

False

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Morphoeic BCC is non-infiltrative. True/false?

False

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SCC tends to grow fast and may be painful. True/false?

True

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The majority of SCCs are highly/moderately/poorly differentiated?

Highly

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Precusor lesions for SCCs include (2)

1) Actinic keratoses 2) Bowen’s disease

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SCC is more associated with sun-damaged skin than BCC. True/false?

True

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Actinic keratoses are only assoicated with SCC. True/false?

False

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Xeroderma pigmentosum is a defect in which system?

DNA repair (nucleotide excision repair)

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Gorlin’s Syndrome is…

An autosomal dominant familial cancer syndrome

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Main feature of Gorlin's Syndrome

Multiple BCCs

Cancer is typically a multi-step/single-step process?

Multi-step expansion

Ras and Raf are example of...

Oncogenes

Biggest risk factor for melanoma?

UV radiation (followed by genetics and age)

Genetic disorders which can predispose to skin cancer (2)

1) Albinism 2) Xeroderma pigmentosum

What degree of increased risk do patients with xeroderma pigmentosum have for developing skin cancer?

2000-fold increase \<20 years old

Which autoimmune conditions are associated with a higher risk of malignant melanoma (2)

1) Ulcerative colitis (23% higher risk) 2) Crohn's Disease (80% higher risk) Possibly due to treatment for these conditions (immunosuppresion)

UVA causes direct/indirect damage to the cell.

INDIRECT OXIDATION damage (320-400nm)

UVB causes direct/indirect damage to the cell

DIRECT DNA damage (290-320nm)

What's the DNA lesion typical to UV damage?

Pyrimidine dimers

Mutations in PCTH1 are associated with which skin cancer?

BCC

PTCH1 signals through which type of pathway?

Hedgehog

Vismodegib is targetted specifically for which mutation & cancer?

PCTH1 mutation & BCC

What are the two familial melanoma genes?

1) CDK2NA 2) CDK4

Tramentinib is an example of....

MEK inhibitor

What's the melanocyte: basal keratinocyte ratio?

1:5 to 1:10

Freckles are AKA...

Ephilides

Freckles are relevant to the diagnostic process. True/false?

False

Actinic lentigines are also known as...

Age / liver spots

Actinic lentigines are related to UV exposure. True/false?

True

Actinic lentigines are assoicated with increased melanin and basal melanocytes. True/false?

True

Types of melanocytic naevi include (4)

-Usual -Dysplastic -Spitz -Blue

Large melanocytic naevi are associated with an increased risk of melanoma. True/false?

True - around 10-15% increases

Average person has how many naevi?

20-30

Common naevi have high/low malignant potential?

Low

Acquired naevi tend to move from superficial to deep. True/false?

True - stages are junctional (at DEJ), compound (some in DEJ + some in dermis) and intradermal (entirely dermal)

Characteristic dysplastic naevi features (3)

1) Generally \>6mm diameter 2) Variegated pigment 3) Border asymmetry

Familial dysplastic naevi confers a lifetime risk of melanoma up to what %?

100%

Dysplastic naevi has ONLY architectural atypia OR cellular atypia. True/false?

False - has both architectural and cellular atypia

Dysplastic naevi are associated with inflammation. True/false?

True

What gives halo naevi their characteristic depigmentation?

Lymphocytic infiltration

Spitz naevus is generally entirely benign/malignant?

Benign

Spitz naevus is always benign. True/false?

False - there is a malignant variant

4 main types of malignant melanoma?

1) Superficial spreading (commonest) 2) Acral / mucosal letiginous (acral = palms, soles of feet) 3) Lentigo maligna (sun-damaged, especially face) 4) Nodular

SSM / A/MLM / LMM all grow as macules/papules when in-situ

Macules (RGP)

SSM / A/MLM / LMM only metastasise at which phase?

VGP

Nodular melanoma only has RGP/VGP and is considered more/less aggressive.

VGP, considered more aggressive

Nodular melanoma begins as a nodule/macule?

Nodule

Nodular melanoma is only lately invasive. True/false?

False - early invasion (VGP)

Breslow Depth is defined as...

Deepest tumour from granular layer in mm

Breslow depth \> 5mm has a what % survival?

What are bad prognostic indicators? (4)

1) Ulceration ("b" suffix) 2) High mitoses 3) Lymphovascular invasion 4) Sentinel node involvement

Common sites of malignant melanoma mets? (6)

Skin, heart, lungs, GI tract, liver, brain

Melanoma primary treatment is with?

Excision to give clear margins

If SN biopsy is positive, what is indicated for melanoma treatment?

Regional lymphadenectomy

Excisional margins for in-situ melanoma?

5mm

Excisional margins for invasive but \<1mm thick melanoma?

1cm

Excisional margins for invasive and \>1mm thick melanoma?

2cm

Melanomas are associated with which oncogene mutation?

BRAF

Dabrafenib and vemurafenib can target what?

BRAF

Spot diagnosis

Lentigo maligna melanoma

What is this sign?

Ugly Duckling SIgn (sign of melanoma)

Spot diagnosis

BCC (central ulceration)

Spot diagnosis

Actinic keratoses (precursor to SCC)

Spot diagnosis

Bowen's Disease (carcinoma in situ)

Spot diagnosis

Cutaneous horn (SCC)

SCC metastasises typically to...

Lymph nodes & bone

Bowen's Disease is...

Carcinoma-in-situ (SCC)

Actinic keratoses are only associated with SCC. True/false?

False - associated with risk of SCC and BCC

Describe the 4-step approach to skin cancer prevention

1) Behaviour modifications (avoid sun at peak hours 11AM-3PM) 2) Clothing (tightly woven, loose fitting dark clothes) 3) Sunscreens (SPF25+) 4) Regular self-surveillance

PTCH1 "Hedgehog" pathway mutation causes which cancer type?

BCC

Which antibody can be used to target the PTCH1 (BCC) pathway?

Vismodegib

Can UV damage cause immunosuppression?

Yes (reduces Langerhans cells and increases regulatory T-cells)

UVB DNA damage (direct) is mainly repaired how?

NER

UVA DNA damage (indirect) is mainly repaired by

BER

What's the typical UVA DNA damage sign?

C --\> A point mutation