Condition- Skin Cancers

Question 1

What is a basal cell cancer?

Answer 1

Malignant cancer that arises from cells of the stratum basale of the epidermis. It is the most common skin cancer

Question 2

What is the main risk factor for developing skin cancers?

Answer 2

UV exposure

Question 3

List two hereditary/ genetic conditions which predisposes you to BCC

Answer 3

• Xeroderma pigmentosum- defect in DNA repair mechansim
• Gorlin’s syndrome- syndrome of multipls BCCs

Question 4

Which type of cancer is this? State the distinguishing features

Answer 4

(Nodular) Basal Cell Carcinoma- superficial lesion, pearly, rolled edges, telangiectasia, central ulcer, grows slowly

Question 5

Which part of the body are basal cell cancers often found?

Answer 5

Sun-exposed areas- face, periocular, neck, scalp

Question 6

How are basal cell carcinomas investigated?

Answer 6

Clinical diagnosis, rarely required biopsy, routine referral

Question 7

What is a squamous cell carcinoma?

Answer 7

A malignancy of epidermal keratinocytes. It is the second most common type of skin cancer

Question 8

What % of SCCs metastasize?

Answer 8

around 5%

Question 9

What precancerous lesion often preceded SCCs?

Answer 9

Actinic keratosis

Question 10

List some causes and risk factors for SCC

Answer 10

Causes:

• UV raditaion
• HPV infection
• preceding actinic keratosis
• Bowen’s disease

Risk factors:

• immunosupression
• carcinogens (tobacco)
• xeroderma pigmentosum
• fair skin

Question 11

Describe the typical apperance of an SCC lesion

Answer 11

hyperkeratotic (keratin horn), ulcerated, bleeding, crusted/scaly, non-healing

Question 12

Which investigations might you conduct on someone with a s suspected SCC?

Answer 12

Dermatoscopy, excisional biopsy, lymph node aspiration, CT/MRI for staging. Requires urgent referral due to risk of mets

Question 13

What is a melanoma?

Answer 13

A malignant skin cancer arising from melanocytes. Most aggressive and deadly skin cancer due to high metastatic risk

Question 14

Melanocytes may arise from a preceding lesion________

Answer 14

Melanocytic Naevi (mole)- a cell which overproduces melanosomes

Question 15

List the 4 variants of melanomas

Answer 15

• Superficial spreading melanoma
• lentigo maligna
• nodular melanoma
• arcal lentiginous melanoma

Question 16

Which type of melanoma is this?

Answer 16

Superficial spreadling melanoma- arises from a prior melanocytic naevus

Question 17

Which type of melanoma is this?

Answer 17

Nodular Melanoma- red, black lump, arises in sun-exposed parts of the body

Question 18

Which type of skin cancer is this? Describe its distinguishing features? Where on the body does it usually arise?

Answer 18

Lentigo maligna, large, flat, irregular, brown in colour, arises from prior naevus, usually arises on face

Question 19

Which type of melanoma is this? Which part of this body does it usually arise? Which ethnicity is it common in?

Answer 19

Arcal Lentiginous melanoma- common in African and asians. Arises on palms, soles and subungual areas

Question 20

Which type of melanoma is the most aggressive and metastasizes earliest?

Answer 20

Nodular melanomas

Question 21

Rank the different skin cancers in order of metastatic risk

Answer 21

Melanoma => SCC => BCC

Question 22

State two ways in which full-thickness excisional biopsies of melanomas can be categorised

Answer 22

Breslow’s thickness and Clark’s level

Question 23

State the mnemonic which suggest that a melanocytic lesion is malignant

Answer 23

Asymmetry, Border Irregularity, Colour variability, Diameter >6mm, Evolution in size and shape

Question 24

Describe the typical apperance of a melanoma

Answer 24

ABCDE, bleeding, oozing, ulceration, pruritus, FLAWS (suggest mets)

Question 25

What are the most common sites of melanocytic metastasis?

Answer 25

Lymph nodes, lungs, liver and brain