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Dermatology > Dermatological Malignancies > Flashcards

Dermatological Malignancies Flashcards

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Dermatology Board Prep flashcards
1
Q

Risk factors for skin cancer (8)

A 
Sun exposure
FHx
Fair skin
Actinic keratosis & Bowen's disease
radio/phototherapy
smoking
immunosuppression
long-standing leg ulcers
(other diseases e.g. atypical mole syndrome, Gorlin's syndrome)
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2
Q

Features of actinic keratosis; premalignant condition (5)

A 
crumbly yellow-white scales 
can be brown or skin coloured
MAY HAVE CUTANEOUS HORN
commonly found on scalp/forehead
occurs in sun-exposed skin due to dyplastic intra-epidermal proliferation of atypical keratinocytes
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3
Q

Topical therapy for actinic keratosis

A

5-FU
diclofenac gel
imiquimod-induces IFN-alpha

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4
Q

Destructive therapy for actinic keratosis (3)

A

cryotherapy-may cause blistering which can be burst
chemical peeling
Photodynamic therapy-topical sensitiser applied and light shone. reduces risk of progression to SCC.

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5
Q

Features of solar lentigo/liver spots (4)

A

brown patches/macules
flat, irregular, variable pigment
due to collection of melanocytes (freckles due to excess melanin)
typically affects caucasians >40yrs with sun-damaged skin.

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6
Q

Management options for solar lentigo (2)

A

excision is ideal

radiotherapy is an option

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7
Q

In Situ Disease-Bowen’s disease (SCC in situ) features (3)

A

Well-circumscribed, scaly, erythematous plaque
solitary
symptomatic

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8
Q

Histological features of Bowen’s disease (2)

A

full thickness dysplasia

carcinoma in situ (hasn’t invaded BM)

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9
Q

DDx of Bowen’s disease (2)

A

eczema

psoriasis

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10
Q

Management of Bowen’s disease (2)

A

cryotherapy

5-FU

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11
Q

In situ disease-lentigo maligna: features (2)

A

melanoma in situ

precursor to invasive lentigo maligna melanoma

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12
Q

Presentation of lentigo maligna (2)

A

macular

often on FACE of elderly people

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13
Q

Management of lentigo maligna (2)

A

excision is 1st line

if not possible then topical imiquimod or cryotherapy

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14
Q

Features of lentigo maligna melanoma (4)

A

invasive malignant melanoma
arises from lentigo maligna
darker nodule +/- ulceration
lentigo>lentigo maligna>lentigo maligna melanoma

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15
Q

Subtypes of BCC (rodent ulcer) (4)

A

nodular
superficial
morpheic/infiltrative
pigmented

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16
Q

Presentation of BCC (4)

A

Pearly nodule
Rolled telangiectasic border
usually on face
usually smooth and clean but may become ulcerated

17
Q

Management of BCC (4)

A

Excision=cure; no further Rx needed
Mohs surgery-layers of skin removed and examined under microscope until normal skin remains
Radiotherapy-for large lesions, avoided in <65 since increased risk of further skin ca.
imiquimod/5-FU for superficial lesion/surgery inappropriate
(mets rare)

18
Q

Presentation of SCC (4)

A

Ulcerated, keratotic, firm, irregular lesion
grows rapidly
often sun-exposed area
may be painful

19
Q

RFs for SCC (4)

A

transplant/immunosuppression
smoking-lower lip
chronic inflammation e.g. venous ulcer
HPV

20
Q

Management of SCC (3)

A

SURGERY=GOLD STANDARD
radiotherapy is an alternative
topical imiquimod for superficial lesions
(mets rare but more common in certain areas e.g. ears)

21
Q

Genetic mutation seen in 66% of melanomas

A

B-RAF mutation

22
Q

Presentation of melanomas (6)

A

most arise from normal skin (few from dysplastic nevi)
nodular
scalloped border
grow rapidly
may ulcerate
skin markings lost
(EXCISE ALL NEW BLACK, IRREGULAR LESIONS)

23
Q

DDx for melanomas (2)

A

benign melanocytic lesion

non-melanocytic pigmented lesion e.g. seborrheic keratosis

24
Q

surgical management of melanomas

A

All lesions need narrow excision to assess BRESLOW THICKNESS
if <1mm: wide local excision
if >1mm: wide local excision(2cm margin)+sentinel node biopsy (if LN+ve then stage 3)

25
Q

Immunological agents for melanomas

A

match immunological agents to molecular analysis
ipilimumab: anti CTLA-4
vemurafenib: anti-BRAF
PD-1/PDL-1

26
Q

Prognostic indicators in melanomas (4)

A

Breslow thickness
ulceration
sentinel node involvement
mitotic index

Dermatology (6 decks)

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