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Dermatology > Clinical: Melanoma, Non Melanoma and Benign Skin Lesions > Flashcards

Clinical: Melanoma, Non Melanoma and Benign Skin Lesions Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the most common non-melanoma skin cancer?

A

Basal Cell Carcinoma

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2
Q

What are the 3 types of basal cell carcinomas?

A

Superficial, Nodular and Infiltrative

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3
Q

How does BCC arise?

A

Derived from immature pluripotent epidermal cells and is composed of cells with similarities to basal cell layer of epidermis and appendages

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4
Q

Who does BCC commonly affect?

A

Middle aged, sun exposed patients

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5
Q

Is BCC slow/fast growing and locally/widely destructive?

A

Slow growing and locally destructive. May ulcerate.

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6
Q

How can BCC kill?

A

By invading the eye and damaging the brain

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7
Q

What is the typical transformation of BCC from an early lesion to a developed one?

A

Early: pale, translucent papules or nodules with overlying superficial telangiectasis.
Late: ulcerated with raised, rolled edge

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8
Q

What does a superficial BCC look like?

A
  • Brown plaques with raised thread like edge

- Tissue needs to be resected

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9
Q

What does an infiltrative BCC look like?

A
  • Morphoeic causes destruction if neglected
  • Ill defined edge and slow growing
  • May infiltrate tissue widely
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10
Q

What does a nodular BCC look like?

A
  • Well defined nodule, looks stuck on

- Shiny and pearly

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11
Q

What is the best management for BCC?

A
  • Early nodular BCC is best excised
  • At difficult lesions around the eyes- Mohs’ micrographic surgery
  • Clearance of more than 90% of tumours should be achieved
  • Cryotherapy for small, localised, low risk lesions
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12
Q

What does squamous cell carcinoma arise from?

A

Epidermal keratinocytes

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13
Q

Where does a patient typically present with SCC?

A

On sun exposed areas such as bald scalp, tops of ears, face and back of hands

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14
Q

When does SCC behave most aggressively?

A
  • In immunocompromised patients

- On the lips and ears

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15
Q

What is the first choice management for SCC?

A

Complete surgical excision

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16
Q

What is the cure rate for most SCC if the excision is cut with a 3-4mm margin?

A

90-95% for most SCC

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17
Q

What can be given to patients with high risk for further SCCs?

A

Systemic retinoids

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18
Q

What is Actinic Keratosis?

A

Hyperkeratotic Erthythematous lesions arising on chronically sun exposed areas

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19
Q

What is the risk of progression Actinic Keratosis to SCC?

A

0.1%

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20
Q

Does SCC always have to arise from Actinic Keratosis?

A

No, it can arise de-novo

21
Q

What may indicate a transformation of Actinic Keratosis to SCC?

A

Increase in size, ulceration, bleeding, pain or tenderness

22
Q

What is the histology of Actinic Keratosis?

A

Moderate squamous cell dysplasia. Not as dysplastic as Bowen’s disease.

23
Q

What is Bowen’s disease?

A

In situ, SCC on lower leg of elderly woman

24
Q

What can Bowen’s disease mimic?

A

Inflammatory diseases

25
Q

What is the presentation of Bowen’s disease?

A

Slow growing, well demarcated, scaly, erythematous plaque

26
Q

What may be difficult to distinguish Bowen’s from?

A

Superficial BCC

27
Q

What does Bowen’s disease often co-exists with?

A

Venous stasis

28
Q

What is the % chance of Bowen’s disease developing into SCC?

A

3%

29
Q

What is the histology of Bowen’s disease?

A

Crowding, hyperkeratosis, parakeratin

30
Q

How is Bowen’s disease managed?

A

Non surgical procedures are often preferred. Incisional biopsy to confirm diagnosis.

31
Q

What is keratoacanthoma?

A

A benign squamous tumour, difficult to distinguish from SCC as it clinically and histologically similar.

32
Q

How does keratoacanthoma develop?

A

Rapid growth over weeks-moths then spontaneous resolution

33
Q

What does keratoacanthoma look like?

A

Isolated dome shaped nodule with central keratin plug

34
Q

What is the most common type of cutanous T cell lymphoma?

A

Mycosis Fungiodes

35
Q

“scaly rash (like psoriasis) tumour that can on for 20-30 years”

A

Mycosis Fungiodes (cutaneous lymphoma)

36
Q

What is the defective gene copy in freckles?

A

MCIR gene

37
Q

Often referred to “age spots” or “liver spots”, what are they?

A

Actinic Lentigines

38
Q

What is Actinic Lentingines?

A

“Age spots” related to UV exposure
-Increased number of melanocytes along the basement membrane but without the formation of nests that occur in melanocytic naevi

39
Q

How does Seborrheoic Keratosis arise?

A

Benign proliferation of epidermal keratinocytes

40
Q

What do Seborrheoic Keratosis commonly look like and where do they appear?

A
  • Very common in ageing skin, found on face and trunk

- Warty, ‘stuck on’ appearance with a greasy hyperkeratotic surface with a visible pinpoint keratin plug

41
Q

Are Melanocytic naevi most commonly congential or acquired?

A

Acquired before the age of 25

42
Q

What is melanocytic naevi?

A

Localised, benign clonal proliferations of melanocytes

43
Q

What is the % of babies typically born with melanocytic naevi?

A

1%

44
Q

What are the 3 types of acquired naevi and in what stage of life do they develop?

A

1) Junctional naevus in childhood
2) Compound naeves in adolescence/ early adulthood
3) Intradermal naevus in adulthood

45
Q

Describe where Junctional, compound and Intradermal Naevi are found

A

Junctional: clusters of melanocytes found at the DEJ

Compound: clusters of melanocytes found at the DEJ and in dermis

Intradermal: clusters of melanocytes found entirely in the dermis

46
Q

How does the difference in appearance vary between the junctional, compound and intradermal naevi and how do these differences arise?

A

Junctional: macular, circular or oval mid-dark brown appearance

Compound and Intradermal: both seen as nodules due to dermal content. Intradermal is less pigmented than compound.

47
Q

What are the 2 clinical settings of dysplastic naevi?

A
  • Sporadic: not inherited

- Familial: strong FHx of melanoma, autosomal inheritance, high lifetime risk of developing melanoma

48
Q

Give some examples of rarer naevi

A

Blue naevi, Halo naevi, Spitz naevi

49
Q

How does a congenital naevus differ from an acquired naevus in how it looks?

A

Congenital: larger, slightly raised, becomes more rugose and elevated as the child grows older

Dermatology (14 decks)

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