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Dermatology Year 2 > Cancers > Flashcards

Cancers Flashcards

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Dermatology Board Prep flashcards
1
Q

Melanoma?

A

Malignant tumour arising from melanocytes
Leads to >75% of skin cancer deaths
Can arise on mucosal surfaces (e.g. oral, conjunctival, vaginal) and within uveal tract of eye
Rising incidence rates observed worldwide

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2
Q

Melanoma risk factors?

A

Genetic - FHx, red hair, light skin
Environment - sun exposure, sunbeds, immunosuppression
Phenotypic - >100 melanocytic nevi, atypical melanocytic mevi

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3
Q

Melanoma subtypes?

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous

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4
Q

Superficial spreading melanoma?

A

Most frequently on trunk of men, legs of women
In 2/3 - regression = hypo or depigmented area showing host immunity
Horizontal then vertical growth

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5
Q

Nodular melanoma?

A

Usually blue to black, sometimes pink to red, nodule - may be ulcerated, bleeding
Develops rapidly
Only verticals growth

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6
Q

Lentigo maligna melanoma

A

> 60, chronically sun-damaged skin, most common on face
Slow growing, asymmetric brown black machine with colour variation and an irregular indented border

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7
Q

Acral Lentiginous melanoma?

A

Typically palms and soles OR around nail apparatus
Incidence similar across all racial and ethnic groups - disproportionate percentage in BAME

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8
Q

Melanoma self-detection?

A

ABCDE
Asymmetry
Border irregularity
Colour variation
Diameter greater than 5mm
Evolving

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9
Q

Garbe’s rule?

A

If a patient is worried about a single skin lesion, do not ignore their suspicion and have a low threshold for performing a biopsy

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10
Q

Melanoma poor prognostic factors?

A

Increased Breslow thickness >1mm
Ulceration
Age
Male gender
Anatomical site – trunk, head, neck
Lymph node involvement

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11
Q

Breslow thickness?

A

Measurement from granular layer to bottom of tumour

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12
Q

Dermoscopy?

A

Can improve correct diagnosis of melanoma by nearly 50%

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13
Q

Melanoma management?

A

Primary excision down to subcutaneous fat - 2mm peripheral margin
Wide excision - 5mm for in situ, 10mm for </=1mm

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14
Q

Sentinel lymphoma node biopsy?

A

Lymphatic drainage of finite regions of skin drain specifically to an initial node within a given nodal basin - the ‘sentinel node’
Currently offered for pT1b+

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15
Q

LDH?

A

Major prognostic indicator in melanoma

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16
Q

If melanoma unresectable or metastatic?

A

Immunotherapy or mutated oncogene targeted therapy

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17
Q

Melanoma immunotherapy?

A

CTLA-4 inhibition
PD-L1 inhibitors

18
Q

Mutated oncogene targeted therapy for melanoma?

A

Combination of BRAF inhibitor and MEK inhibitor

19
Q

Keratinocyte dysplasia/carcinoma subtypes?

A

Actinic keratoses
Bowen’s disease
Squamous cell carcinoma
Basal cell carcinoma

20
Q

BCC pathogenesis

A

UV radiation
Has proteolytic activity
Loss of function in chromosome 8a, p53 mutations

21
Q

SCC pathogenesis?

A

UV radiation
p53 alteration
NOTCH1 or NOTCH2 plays role

22
Q

Actinic keratoses?

A

Atypical keratinocytes confined to epidermis
Develop on sundamaged skin
Macules or papules, red or pink, some scale

23
Q

Bowen’s disease?

A

SCC in situ
Erythematosus scaly patch or slightly elevated plaque

24
Q

Actinic keratoses and Bowen’s disease treatment?

A

5-fluorouracil cream
Cryotherapy
Imiquimod cream
Photodynamic therapy
Excision
Curettage and cautery

25
Q

SCC may be?

A

Erythematous to skin
Papule
Plaque-like
Exophytic
Hyperkeratotic
Ulceration

26
Q

SCC clinical features - high risk?

A

Localisation and size - trunk and limbs >2cm, head and neck >1cm
Ill-defined margins
Rapidly growing
Immunosuppressed
Previous radiotherapy or chronic inflammation

27
Q

Keratoacanthoma?

A

Rapidly enlarging papule that evolves into sharply circumscribed, crateriform nodule with keratotic core
Resolves slowly over months
Most on head or neck/sun exposed areas

28
Q

SCC treatment?

A

Excision
Radiotherapy
Cemiplimab for metastatic
Secondary prevention - skin monitoring advice, sun protection

29
Q

BCC subtypes?

A

Nodular
Superficial
Morpheic
Infiltrators
Basisquamous
Micronodular

30
Q

Nodular BCC?

A

Most common, typically presents as shiny, pearly papule or nodule

31
Q

Superficial BCC?

A

Well-circumscribed, erythematous macule/patch or thin papule/plaque

32
Q

Morpheic BCC?

A

Slightly elevated or depressed area of induration, usually light-pink to white in colour
More aggressive behaviour

33
Q

Basisquamous BCC?

A

Histological features of both BCC + SCC

34
Q

Micronodular BCC?

A

Resembles nodular BCC
More destructive - high rates of recurrence and sub clinical spread

35
Q

BCC treatment?

A

Surgical excision
Mohs micrographic surgery
Topical therapy, photodynamic therapy, radiotherapy, vismodegib
Breadloaf method

36
Q

Merkel cell carcinoma?

A

Highly anaplastic cells which share features with neuroectodermally derived cells
Solitary, rapidly growing nodule - pink-red to violaceous, firm, dome shaped
Ulceration can occur
AGGRESSIVE, MALIGNANT BEHAVIOUR

37
Q

Melanoma common mutations and pathway dysregulation?

A

Commonest mutation is BRAF, KIT and NRAS.

MAPK pathway is dysregulated in most melanomas

38
Q

Melanoma risk factors?

A

Intense intermittent sun exposure

Immunosupression

Family history

39
Q

Melanoma thicker than 1mm investigation?

A

Sentinel lymphoma node biopsy

40
Q

Breslow’s depth with stage?

A

I - 0.75mm or less
II - 0.76-1.5mm
III - 1.51-4mm
IV - >4mm

41
Q

Non-metastatic vs metastatic melanoma treatment?

A

Non-metastatic - excision: primary or wide excision, depending on extension
Metastatic - oncogene targeted therapy(kills cancer cells as stops them to grow and survive) or Immunotherapy (boosts immune response)

42
Q
A

Dermatology Year 2 (3 decks)

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