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Dermatology > Cancer (Melanoma + non-pigmented) > Flashcards

Cancer (Melanoma + non-pigmented) Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the 2 main skin cancer types?

A

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

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2
Q

BCC arises from which cell and layer?

A

Keratinocytes within basal layer

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3
Q

SCC arises from which layer?

A

Suprabasal layer

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4
Q

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

A

10-40x

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5
Q

Commonest non-melanoma skin cancer in Scotland?

A

BCC

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6
Q

Skin cancers represent which proportion of all cancers in UK?

A

1/3rd

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7
Q

Melanoma is the commonest skin cancer. True/false?

A

False - only around 5%

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8
Q

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

A

Melanoma

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9
Q

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

A

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

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10
Q

ABCDE of skin lesions includes…

A

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

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11
Q

Ugly Duckling SIgn is characteristic of…

A

Melanoma

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12
Q

Blue-white lesions and atypical pigment are features of…

A

Melanoma

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13
Q

Which % of non-melanoma skin cancers are BCCs?

A

75%

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14
Q

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

A

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

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15
Q

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

A

BCC

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16
Q

BCCs frequently metastasise. True/false?

A

False

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17
Q

Morphoeic BCC is non-infiltrative. True/false?

A

False

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18
Q

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

A

True

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19
Q

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

A

Highly

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20
Q

Precusor lesions for SCCs include (2)

A

1) Actinic keratoses 2) Bowen’s disease

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21
Q

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

A

True

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22
Q

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

A

False

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23
Q

Xeroderma pigmentosum is a defect in which system?

A

DNA repair (nucleotide excision repair)

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24
Q

Gorlin’s Syndrome is…

A

An autosomal dominant familial cancer syndrome

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25
Q

Main feature of Gorlin’s Syndrome

A

Multiple BCCs

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26
Q

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

A

Multi-step expansion

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27
Q

Ras and Raf are example of…

A

Oncogenes

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28
Q

Biggest risk factor for melanoma?

A

UV radiation (followed by genetics and age)

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29
Q

Genetic disorders which can predispose to skin cancer (2)

A

1) Albinism 2) Xeroderma pigmentosum

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30
Q

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

A

2000-fold increase <20 years old

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31
Q

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

A

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

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32
Q

UVA causes direct/indirect damage to the cell.

A

INDIRECT OXIDATION damage (320-400nm)

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33
Q

UVB causes direct/indirect damage to the cell

A

DIRECT DNA damage (290-320nm)

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34
Q

What’s the DNA lesion typical to UV damage?

A

Pyrimidine dimers

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35
Q

Mutations in PCTH1 are associated with which skin cancer?

A

BCC

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36
Q

PTCH1 signals through which type of pathway?

A

Hedgehog

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37
Q

Vismodegib is targetted specifically for which mutation & cancer?

A

PCTH1 mutation & BCC

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38
Q

What are the two familial melanoma genes?

A

1) CDK2NA 2) CDK4

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39
Q

Tramentinib is an example of….

A

MEK inhibitor

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40
Q

What’s the melanocyte: basal keratinocyte ratio?

A

1:5 to 1:10

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41
Q

Freckles are AKA…

A

Ephilides

42
Q

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

A

False

43
Q

Actinic lentigines are also known as…

A

Age / liver spots

44
Q

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

A

True

45
Q

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

A

True

46
Q

Types of melanocytic naevi include (4)

A

-Usual -Dysplastic -Spitz -Blue

47
Q

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

A

True - around 10-15% increases

48
Q

Average person has how many naevi?

A

20-30

49
Q

Common naevi have high/low malignant potential?

A

Low

50
Q

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

A

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

51
Q

Characteristic dysplastic naevi features (3)

A

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

52
Q

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

A

100%

53
Q

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

A

False - has both architectural and cellular atypia

54
Q

Dysplastic naevi are associated with inflammation. True/false?

A

True

55
Q

What gives halo naevi their characteristic depigmentation?

A

Lymphocytic infiltration

56
Q

Spitz naevus is generally entirely benign/malignant?

A

Benign

57
Q

Spitz naevus is always benign. True/false?

A

False - there is a malignant variant

58
Q

4 main types of malignant melanoma?

A

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

59
Q

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

A

Macules (RGP)

60
Q

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

A

VGP

61
Q

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

A

VGP, considered more aggressive

62
Q

Nodular melanoma begins as a nodule/macule?

A

Nodule

63
Q

Nodular melanoma is only lately invasive. True/false?

A

False - early invasion (VGP)

64
Q

Breslow Depth is defined as…

A

Deepest tumour from granular layer in mm

65
Q

Breslow depth > 5mm has a what % survival?

A

5%

66
Q

What are bad prognostic indicators? (4)

A

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

67
Q

Common sites of malignant melanoma mets? (6)

A

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

68
Q

Melanoma primary treatment is with?

A

Excision to give clear margins

69
Q

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

A

Regional lymphadenectomy

70
Q

Excisional margins for in-situ melanoma?

A

5mm

71
Q

Excisional margins for invasive but <1mm thick melanoma?

A

1cm

72
Q

Excisional margins for invasive and >1mm thick melanoma?

A

2cm

73
Q

Melanomas are associated with which oncogene mutation?

A

BRAF

74
Q

Dabrafenib and vemurafenib can target what?

A

BRAF

75
Q

Spot diagnosis

A

Lentigo maligna melanoma

76
Q

What is this sign?

A

Ugly Duckling SIgn (sign of melanoma)

77
Q

Spot diagnosis

A

BCC (central ulceration)

78
Q

Spot diagnosis

A

Actinic keratoses (precursor to SCC)

79
Q

Spot diagnosis

A

Bowen’s Disease (carcinoma in situ)

80
Q

Spot diagnosis

A

Cutaneous horn (SCC)

81
Q

SCC metastasises typically to…

A

Lymph nodes & bone

82
Q

Bowen’s Disease is…

A

Carcinoma-in-situ (SCC)

83
Q

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

A

False - associated with risk of SCC and BCC

84
Q

Describe the 4-step approach to skin cancer prevention

A

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

85
Q

PTCH1 “Hedgehog” pathway mutation causes which cancer type?

A

BCC

86
Q

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

A

Vismodegib

87
Q

Can UV damage cause immunosuppression?

A

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

88
Q

UVB DNA damage (direct) is mainly repaired how?

A

NER

89
Q

UVA DNA damage (indirect) is mainly repaired by

A

BER

90
Q

What’s the typical UVA DNA damage sign?

A

C –> A point mutation

91
Q

Spot diagnosis

A

Solar lentinges (liver spots)

92
Q

Spot Diagnosis

A

Spitz Naevus

93
Q

Spot Diagnosis

A

Superficial Spreading Melanoma

94
Q

Spot Diagnosis

A

Acral Melanoma

95
Q

Spot Diagnosis

A

Lentigo Maligna (in situ is the flat area) Melanoma (raised area)

96
Q

Spot Diagnosis (& how are these lesions usually described?)

A

Seborrheoic keratosis. Key is “stuck on appearence” with a greasy, hyperkeratotic surface.

97
Q

Spot Diagnosis

A

Nodular BCC

98
Q

Spot Diagnosis

A

Superficial BCC

99
Q

Spot Diagnosis

A

Bowen’s Disease

100
Q

Spot Diagnosis

A

Actinic Keratosis

101
Q

Spot Diagnosis

A

SCC of lip

102
Q

Spot Diagnosis

A

Dermatofibroma

Dermatology (15 decks)

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