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Y3- I & W > common skin cancers > Flashcards

common skin cancers Flashcards

1
Q

describe the outline of the skin layers

A

epidermis
dermis
subcutaneous layer

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2
Q

what does the epidermis layer look like

A 
the epidermis layer looks like:
keratinised cells 
granules cell layer 
prickle cell layers 
basal cell layer 
then the basal lamina 
in between we have langerhans cells and merkel cells for example
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3
Q

where does proliferation of cells occur

A

in the basal lamina

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4
Q

describe prickle cell layers

A

they have intercellular junctions and as they mature they develop keratin granules

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5
Q

what do merkel cells do

A

proprioceptive functions

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6
Q

where do squamous cells and basal cell carcinomas arise from

A

the epidermal layer

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7
Q

where do melanomas arise from

A

melanocytes

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8
Q

describe basal cell carcinomas

A

commonest malignant tumour
occur on sun exposed sites
metastasis is rare
can be locally aggressive- start in the dermis and move down into SC tissue

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9
Q

what is the risk factor for BCC

A

UV light- esp in pale people
immunosuppressed
genetic predisposition eg gorlin syndrome or bazex drupe cristol syndrome

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10
Q

describe gorlin syndrome

A

autosomal dominant
early development occurs of BCC in 20s-30s
1/100000 prevalence

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11
Q

signs and symptoms of gorlin syndrome

A

palmer pits
odontogenic keratocytes
skeletal abnormality
mental retardation

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12
Q

what can we see clinically in relation to gorlin syndrome

A

early lesions

ulceration centrally rodent ulcers-with pale edges

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13
Q

describe the histology of BCC

A

the tumour is composed of islands of basaloid cells with peripheral palisade cells

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14
Q

what do basaxoid cells show up as histologically

A

dark staining with minimal cytoplasm

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15
Q

what do the low risk types of BCC look like histologically

A

superficial and nodular

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16
Q

what do the high risk types of BCC look like histologically

A

infiltrative and micro nodular

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17
Q

describe SCC

A

more aggressive than BCC

h

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18
Q

what are some high risk sites for SCC

A

lip
ear
perineum
can occur in mucosal sites

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19
Q

what is the metastasis rate in SCC

A

0.5-5% rate

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20
Q

where does metastasis of SCC occur first

A

in the lymph nodes

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21
Q

what are some risk factors for SCC

A 
UV exposure high
immunosuppressed 
chronic ulcers 
radiation bands 
immunomodulatory drugs eg BRAF inhibitors
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22
Q

what did percivall pott describe

A

that due to hydrocarbon exposure a lot of chimes sweeps develop SCC

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23
Q

what can SCC look like clinically

A

scaley

nodular and ulcerated

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24
Q

what can we see microscopically from SCC

A

arise from keratinocytes
try to replicate what normal cells look like
spinous processes between cells
invade BV and nerves

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25
Q

why do we see actinic keratosis

A

due to chronic UV exposure

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26
Q

what does acinitic keratosis look like clinically

A

scaley lesion with erythematous base

rarely progresses to an invasive disease

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27
Q

what does acinitic keratosis look like histologically

A

abnormal nuclei which are big

28
Q

where do melanocytes derive from

A

the neural crest

29
Q

what is the function of melanocytes

A

to from melanin which is transferred to epidermal cells to protect the nucleus from radiation

30
Q

what are benign melanocytic tumours called

A

naevi

31
Q

what are malignant melanocytic tumours called

A

melanomas

32
Q

describe naevi

A

local benign collections of melanocytes

33
Q

where are naevi found

A

in the superficial dermis and move down the layers

34
Q

what do naevi look like

A

uniform and well circumscribed

35
Q

what are the different types of naevi

A

superficial

deep

36
Q

what do deep naevi look like

A

deep blue colour

37
Q

describer atypical mole syndrome

A

irregular shaping of moles

usually with families with an increased melanoma risk

38
Q

why might people have atypical mole syndrome

A

due to mutations in the CDKN2A

39
Q

what does mutations in the CDKN2A gene lead to

A

atypical mole syndrome

40
Q

what is a risk factor for atypical mole syndrome

A

UV exposure
pale skin
family history of melanomas

41
Q

describe what a naevi looks like

A 
symmetrical
even borders 
uniform colour
less than 6mm in diameter 
lesion hasn't changed over time
42
Q

what does a melanoma look like

A 
asymmetrical
uneven borders 
different colours
greater than 6mm in diameter
lesion starts to change over time
43
Q

what is the most common melanoma in UK

A

superficial spreading melanoma

44
Q

what does the early stage of a superficial spreading melanoma look like

A

a flat macule

45
Q

what does a late stage of a superficial spreading melanoma look lik

A

blue/black nodule

46
Q

what does the late stage of the superficial spreading melanoma look like microscopically

A

proliferation fo the atypical melanocytes at the dermal epidermal junction which invades the epidermis and then can spread to the BV and nerves

47
Q

what are some genetic reasons for superficial spreading melanoma

A

B-RAF proto oncogene mutations

48
Q

describe nodular melanomas

A

starts off as a pigmented nodule which can be ulcerated

49
Q

where are nodular melanomas found

A

on areas with intermittent sun exposure

50
Q

what do we see in nodular melanomas microscopically

A

invasive atypical melanocytes invading the dermis

51
Q

describe lentigo maligna

A

found on elderly pts
on sun exposed sites
flat pigmented patch

52
Q

how is lentigo maligna formed

A

by disc adhesive single cells and then they go into the dermis

53
Q

what do we see microscopically in lentigo melanoma

A

proliferation of abnormal melanocytes along the basal layer

54
Q

which mutation is commonly seen in letigo maligna

A

KIT mutations

55
Q

where are kit mutations commonly seen

A

lentigo maligna

acral lentiginous melanoma

56
Q

where can acral lentiginous melanoma be seen

A

on palms and soles

or sublingual

57
Q

which group has a predominance to acral lentiginous melanoma

A

afro carribeans

58
Q

what does the microscopy seen in acral lentiginous melanoma show

A

proliferation of abnormal melanocytes along the basal layer

but no marked sun damage

59
Q

where do mucosal melanomas occur

A 
oral 
nasal 
GU
GI 
tract
60
Q

what do we microscopically see in mucous melanomas

A

early lengitinous growth along the border between epithelium and CT

61
Q

which mutations do we see in mucosal melanomas

A

KIT

GNAQ mutations

62
Q

what does mucosal melanomas mimic

A

amalgam pigments

63
Q

what is prognosis of cancers based on

A

breslow thickness

64
Q

where is prognosis works

A

in the BANS area

if ulcerated

65
Q

what treatment can we use

A

surgery removal when small
or if too late
immunotherapy-

66
Q

what does the breslow thickness look at

A

the measure between the granular layer to the base of the epidermis

Y3- I & W (21 decks)

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