Common skin cancers Flashcards
1
Q
Name some common skin cancers
A
- Basal cell carcinoma a
- Squamous cell carcinoma
- Melanocytic tumours
2
Q
Name the different layers of the epidermis
A
- Basil cell layer
- Prickle cell layer
- Granule cell layer
- Keretinsed quakes
3
Q
Name the 3 main parts of the skin
A
- Epidermis
- Dermis
- Subcutaneous layer
4
Q
Name some specialised cells in the epidermis
A
- Melanocytes
- Merkel cell
- Dividing cell
- Langerhan cell (immune cell)
5
Q
What do melanocytes do?
A
They produce melanin
6
Q
Name some cancers that can form in the epidermis of the skin
A
- Squamous cell carcinoma
- Basal cell carcinoma
- Melanoma
- Merkel cell carcinoma (quite rare)
7
Q
What are benign glandular tumours called
A
Adenomas
8
Q
What are malignant glandular tumours called
A
Carcinomas
9
Q
Name some elements of the skin where skin tumours can arise from
A
- Epidermis
- Melanocytes
- Merkel cell tumours (Rare but dangerous)
- Adnexal structures (like sweat glands and hair follicles)
- Nerves and blood vessels
- Connective tissue
10
Q
Where do basal cell carcinomas usually form
A
On EXPOSED hair bearing skin such as on the face and lips (apart from hands)
11
Q
Name the most common malignant tumour humans can develop
A
Basal cell carcinomas (BCC)
12
Q
Define metastases
A
the development of secondary malignant growths at a distance from a primary site of cancer.
13
Q
How often do metastases form in basal cell carcinomas
A
Very rarely (1 in 10,000)
14
Q
Why are basal cell carcinomas problematic?
A
As they can be locally aggressive and spread from the epidermas down to subcutaneous fat and the nerve and bone area
15
Q
List the key risk factors for developing basal cell carcinomas
A
- UV light exposure (especially in pale individuals)
2. Immunocompromised patients
16
Q
Talk through the aetiology of basal cell carcinomas
A
- Prominently form on sun exposed sites, especially the face
- Pale skinned individuals who burn easily are at greater risk
- Immunosuppression
- Rare genetic predisposition (goblin syndrome and bazex)
17
Q
What is gorlins syndrome
A
An autosomal dominant syndrome where the tumour suppressor genes are mutated
18
Q
List some characteristics of goblin syndrome
A
- Palmar pits
- Odontogenic keratocytes
- Skeletal abnormalities
- Mental retardation
- Brain tumours
19
Q
What do early lesions of basal cell carcinomas look like?
A
Nodules on the skin
20
Q
If nodules on the skin (caused by BCCs) are neglected and left untreated what can happen?
A
They can begin to ulcerate with rolled edges
this is called a rodent ulcer
21
Q
Why is the histology of basal cells carcinomas split into different types and name the 2 types of BCC histology
A
They are split as there’s a lot of variants
- Low risk types
- High risk types
22
Q
What are basal cell carcinoma tumours made up of
A
Tumours composed of islands of basaloid cells with peripheral palisade
23
Q
Describe the low risk histology of basal cell carcinomas
A
Superficial and nodular
24
Q
Describe the high risk histology of basal cell carcinomas
A
Infiltrative, micro-nodular and morphoeic
25
Name the second most common skin cancer
Squamous cell carcinoma
26
Which is more aggressive Basal cell carcinomas or squamous cell carcinomas
Basal cell carcinomas
27
Name the high risk sites where squamous cell carcinomas are more likely to form
Lip
Ear
Perineum
28
How often do metastases form in squamous cell carcinomas
0.5-5%
29
List the risk factors associated with developing squamous cell carcinomas
1. UV exposure
2. Immunosuppressed individuals
3. Patients with chronic ulcers
4. Radiation burns
5. Chemotherapy drugs
30
Describe the aetiology of squamous cell carcinomas
1. UV radiation
2. Radiotherapy
3. Chronic scars/ ulcers
4. Immunosuppression
4. Drugs for melanoma
31
Describe the clinical presentation of early squamous cell carcinomas
Nodules ulcerated with a crusty surface
32
Describe how squamous cell carcinomas look under a microscope
They look like invasive islands and trabecular of squamous cells showing cytological atypia
33
What are carcinomas
Malignant glandular tumours
34
What are adenomas
Benign glandular tumours
35
Where do squamous cell carcinomas usually metastasise to?
Lymph nodes first
36
Name the pre invasive stage that occurs before a squamous cell carcinoma forms?
Actinic keratosis
37
What is actinic keratosis
A pre malignant change seen due to prolonged UV exposure
38
Describe actinic keratosis
1. Dysplasia to squamous epithelium
2. Can lead to the formation of a scaly lesion with erythematous base
3. Rarely progresses to invasive disease
39
Where do actinic keratosis usually form?
Very common on chronic sun exposed sites
40
Where are melanocytes derived from
Derived from neural crest cells
41
What is the function of melanocytes?
To form melanin which is transferred to epidermal cells to protect the nucleus from UV radiation
42
Name the tumours melanocytes can give rise to?
Naevi (benign moles)
| Melanoma (malignant)
43
Describe naevi
They are local benign collections of melanocytes
44
Name the different types of naevi
1. Superficial
| 2. Deep blue naevi
45
Name some types of deep blue naevi
1. Mongolion spot
| 2, Naevi of Ota, Ito and Hori
46
How are superficial naevi classified?
By their location
47
Name some different classifications of superficial naevi
1. Junctional naevi
2. Intra dermal naevi
3. Compound naevi
48
Where are junctional naevi found
At the base of the epidermis at the junction
49
Where are intra dermal naevi found?
Found entirely in the dermis
50
Where are compound naevi found
The naevi has nests in both the dermis and the junction
51
How do deep blue naevi form
Melanocytes that have been migrating from the neural crest to the epidermis haven't made it and sometimes form masses Called naevi
52
How do we name deep naevi
By their morphological, macroscopic description
53
In whom might you see deep naevi
Mainly in children but they often resolve over time
54
What are the main problems associated with giant congenital naevi?
Aesthetics is the major problem especially if the naevi covers a large area
(very rarely do these naevi turn malignant)
55
What is atypical mole syndrome
People with a large number of clinically atypical moles
56
Describe atypical moles
Moles with irregular margins and that are greater than 1cm in diameter
Variations in colour
57
What are people with atypical mole syndrome more likely to develop
Increased risk of developing melanomas
58
What can atypical mole syndrome sometimes me caused by?
Due to mutations in gene CDKN21 (p16)
59
What is the significance of the p16 gene
It is a key tumour suppressor gene
60
Which tumour is the rarest:
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Melanomas
Melanomas
61
Why are melanomas dangerous
As they can metastasize widely
62
What are naevi?
Benign moles that arise from melanocytes
63
What are melanomas
Malignant tumours that arise from melanocytes
64
Why are the instances of melanomas rising?
More foreign travel
65
List some the risk factors for melanomas
1. UV exposire
2. Tend to arise in people with pale skin
3. Personal or family history of malignant melanomas
4. Giant congenital naevi
66
Describe the aetiology of melanomas
1. Sun exposure (especially short intermittent severe exposure)
2. Race (fair complexion red hair etc)
3. Family history of atypical mole syndrome and multiple large atypical moles
4. Giant congenital naevi have. small risk in turning malignant (<5%)
67
What is the probability that a giant congenital naevi will turn malignant?
less than 5%
68
In terms of sun exposure and the risk of developing melanomas which is worse:
1. Long periods of exposure
2. Short rare periods of intense sun burn
short intermittent severe exposure especially sun burning
69
Describe a benign naevus
1. Symmetrical
2. Even borders
3. Uniform colour
4. Diameter of less than 6mm
70
Describe a malignant melanoma mole
1. Asymmetrical
2. Borders uneven
3. Colour variation
4. Diameter greater than 6mm
5. Lesion has changed recently
71
Name the most common type of melanoma in Britain
Superficial spreading melanoma
72
Describe early superficial spreading melanoma lesions
Flat macule
73
Describe late superficial spreading melanoma lesions
Blue / black nodules
74
Describe how superficial spreading melanomas look macroscopically
Proliferation of atypical melanocytes which invade epidermis and dermis
75
Describe the genetics of superficial spreading melanomas
Often BRAF mutations occur
76
How do we treat superficial spreading melanomas
By using anticancer agents
77
Name some different subtypes of melanomas
1. Superficial spreading melanomas
2. Nodular melanoma
3. Lentigo maligna
78
What is the difference between a superficial melanoma and a nodular melanoma
In nodular melanomas microscopically you don't see extensions of the tumour within the dermis
79
Describe nodular melanomas
They start as a pigmented nodule that can ulcerate
80
What is the prognosis like for nodular melanomas
Poor prognosis
81
Describe how nodular melanomas look microscopically
Invasive atypical melanocytes invade the dermis to produce nodules of tumour cells
82
Who are more likely to see lentigo malinga on?
Seen on chronically sun exposed sites in ELDERLY patients
| eg face
83
Describe lentigo malinga lesions
They tend to be very big flat pigmented areas of the skin
| They grow via disk adhesive single cells along the dermo epidermis junction
84
Why are lentigo malinga tumours hard to get rid of?
They usually form at difficult to operate sites
| They are ill defined
85
How do we treat lentigo malinga lesions
We can use local therapies such as creams
86
As lentigo malinga lesions progress what happens
Melanocytes may invade the dermis (forming a lentigo malignant melanoma)
This has the potential to metastasise)
87
What are the problems associated with lentigo malinga melanomas
They have the potential to metastasise
88
Which mutations are common in lentigo malingas
KIT mutations are more common
89
Which mutations don't usually occur in lentigo malingas and what problems does this cause
BRAF mutations are less common
| This means the Vemurafenib drug tends not to work
90
Name 2 subtype of lentigo melanomas
1. Acral lentiginous melanoma
| 2. Mucosal melanomas
91
Where are Acral lentiginous melanomas formed
On the palms and soles (occasionally sublingual)
92
In whom are Acral lentiginous melanoma common
Afro carribeans
93
How do Acral lentiginous melanoma look like
They form enlarging pigmented patches
94
What type of mutations do Acral lentiginous melanoma exhibit
KIT mutations
95
How common are mucosal melanomas
Rare and they often have a poor prognosis
96
Where do mucosal melanomas usually form?
Oral cavity
Nasal cavity
Genitourinary
GI tract
97
Describe how mucosal melanomas present clinically
Clinically may be a pigmented patch
98
Describe how mucosal melanomas look under a microscope
They have an early lentiginous growth pattern
99
What causes mucosal membranes
KIT mutation
| GNAQ
100
How do we determine the prognosis of a tumour
1. Breslow thickness
2. Site of tumour
3. If the tumour ulcerates
4. Satellites/ in transit
5. If lymph nodes are affected
101
What is breslows thickness
It is a measure through a microscope from the granular later of the epidermis to the base of the tumour
102
According to breslows thickness if a tumours is less than 1mm what is the 5 year survival percentage of a patient
91-95%
103
According to breslows thickness if a tumours is between 1-2mm what is the 5 year survival percentage of a patient
75-90%
104
According to breslows thickness if a tumours is between 2-4mm what is the 5 year survival percentage of a patient
60-75%
105
According to breslows thickness if a tumours is greater than 4 what is the 5 year survival percentage of a patient
45-60%
106
A tumour on which sites in the body have a poor prognosis
Back
Arms
Neck
Scalp
107
If a tumour ulcerates does that mean it have a poorer or Better prognosis?
If the tumour has ulcerated it has a POORER prognosis
108
What do advanced melanomas sometimes form?
Satellites/ transits
109
What are satellites in terms of tumours
They are cutaneous deposits that occur before lymph nodes are affected
110
In patients with thick or ulcerated tumours what do we usually take
A sentinel node biopsy
111
What is the significance of the sentinel node?
It is the lymph node which drain from melanomas first so if we remove it and it tests positive it indicates that most lilt the rest of the lymph nodes in that anatomic areas are affected
112
If a sentinel node biopsy come back positive what should we do?
Remove all the lymph nodes in that autonomic areas to try and halt disease progression
113
What are the problems associated with removing all the lymph nodes from a certain area?
Can lead to lymphedema which ultimately harms the patent
114
How can we treat melanomas?
1. Surgery
2. BRAF inhibitors
3. Immunotherapy
115
How many melanomas are caused by the BRAF gene?
60%
116
What is immunotherapy
Drugs which prevent tumour cells from deactivating T cells which may kill them
