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Skin > Dermatological Malignancies > Flashcards

Dermatological Malignancies Flashcards

1
Q

Main diagnostic features of malignant melanoma

A

Change in size

Change in colour

Change in shape

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2
Q

Secondary features of malignant melanoma (minor criteria)

A

Diameter >/=7mm

Inflammation

Oozing or bleeding

Altered sensation

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3
Q

What is the most common form of malignant melanoma?

A

Superficial spreading

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4
Q

Who does superficial spreading malignant melanoma most commonly effect?

A

Arms, legs, back and chest, young people

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5
Q

Who does nodular malignant melanoma most commonly effect?

A

Sun exposed skin, middle-aged people

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6
Q

Who does lentigo maligna melanoma most commonly effect?

A

Chronically sun-exposed skin, older people

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7
Q

Who does acral lentiginous malignant melanoma most commonly effect?

A

Nails, palms or soles, African Americans or Asians

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8
Q

Appearance of superficial spreading malignant melanoma

A

Growing mole with diagnostic features listed

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9
Q

Appearance of nodular malignant melanoma

A

Red or black lump or lump which bleeds/oozes

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10
Q

Appearance of lentigo maligna malignant melanoma

A

Growing mole with diagnostic features listed

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11
Q

Appearance of acral lentiginous malignant melanoma

A

Subungal pigmentation (Hutchinson’s sign) or on palms of feet

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12
Q

Investigations in malignant melanoma

A

If the lesion has any suspicious features it should be referred under 2WW pathway

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13
Q

ABCDE of malignant moles

A

Asymmetry

Border irregularity (melanoma often has a ‘scalloped’ border)

Colour variation (a variegated lesion is one that consists of many colours)

Diameter >6mm

Evolves over time

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14
Q

What is “ugly duckling sign”?

A

Any lesion that sticks out from the others should be suspected for malignancy

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15
Q

What is “Breslow thickness”?

A

Breslow thickness is the depth of the tumour and is a strong predictor of outcome

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16
Q

What is the significance of Breslow thickness <1mm

A

Sentinel node biopsy should be carried out

This looks for evidence of metastases and stage the cancer

17
Q

Management of malignant melanoma

A

Referral to dermatology under 2WW

Suspicious lesions should undergo excision biopsy

Lesion should be removed completely

Sentinel lymph node mapping

Isolated limb perfusion

Block dissection of regional lymph node groups

18
Q

What is the single most important factor in determining malignant melanoma prognosis?

A

Breslow thickness

19
Q

Define basal cell carcinoma

A

Locally invasive tumour of epidermal keratinocytes

20
Q

Risk factors for basal cell carcinoma

A

Type I or II skin

History of frequent or severe previous sun burn

Outdoor occupation or hobbies

Personal or family history of skin cancer

Immunosuppression

Increasing age

Male sex

21
Q

Clinical features of basal cell carcinoma

A

Small, skin-coloured or pink nodule with central depression

Often have pearly rolled edge and surface telangiectasia

In older lesions, centre can become necrotic/ulcerated

Located on sun exposed areas of skin, especially head and neck

Do not cause pain or bleeding

Typically very slow growing

22
Q

Management of basal cell carcinoma

A

Dependent on size, location, type and local guidelines

Majority surgical excision with a 4mm margin

Curettage and cautery

Mohs micrographic surgery if in a cosmetically sensitive area or appears ill-defined

Cryotherapy

Photodynamic therapy

Radiotherapy as adjunct or if surgery inappropriate

Topical therapies such as Imiquimod or 5-Fluorouracil

23
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

24
Q

What does mohs surgery involve?

A

Examining excised tissue under the microscope as it is removed to ensure all the cancerous cells are removed whilst preserving the maximum amount of healthy tissue

25
Q

Define squamous cell carcinoma

A

Locally invasive malignant tumour of epidermal keratinocytes

26
Q

Risk factors for squamous cell carcinoma

A

Type I or II skin

History of frequent or severe previous sun burn

Outdoor occupation or hobbies

Personal or family history of skin cancer

Immunosuppression, especially following organ transplant

Smoking

Premalignant skin conditions such as Actinic Keratosis or Bowen’s Disease

Increasing age

Male sex

27
Q

What is Bowen’s disease?

aka intraepidermal SCC or SCC in situ

A

Pre-malignant

Tumour cells are confined to the epidermis

Appears as an irregular, red, keratinised, scaly plaques classically located on areas of sun exposed skin

28
Q

Clinical features of squamous cell carcinoma

A

Can cause pain, tenderness or bleeding

Grow over weeks or months

Often occur on sun exposed areas of skin e.g. face, scalp, ears, hands and shins

29
Q

Management of squamous cell carcinoma

A

Surgical excision

Curettage and cautery

Mohs micrographic surgery if the SCC is in a cosmetically sensitive area, is ill-defined or recurrent

Cryotherapy

Radiotherapy if surgery is inappropriate

30
Q

What is actinic keratosis?

A

A premalignant skin condition which can precede the development of SCC

31
Q

Risk factors for actinic keratosis

A

Thickened papules or plaques surrounding erythematous skin and a keratotic, rough, warty surface

Commonly found on sun exposed areas of skin e.g. back of hands or face

32
Q

Management of actinic keratosis

A

Managed to prevent development into SCC

Localised lesions are managed suing cryotherapy, curettage or surgical excision

Larger lesions are managed with topical therapies e.g. 5-Fluorouracil (a cytotoxic agent), NSAID or Imiquimod (which modifies immune response)

33
Q

What topical agents are used in dermatological malignancies?

A

5-Fluorouracil (a cytotoxic agent)

Imiquimod (modifies immune response)

34
Q

What is Kaposi sarcoma?

A

A high-grade B cell non-Hodgkin’s lymphoma and invasive cervical cancer

Skin (7 decks)

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