Dermatological Malignancies Flashcards
Risk factors for skin cancer (8)
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)
Features of actinic keratosis; premalignant condition (5)
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
Topical therapy for actinic keratosis
5-FU
diclofenac gel
imiquimod-induces IFN-alpha
Destructive therapy for actinic keratosis (3)
cryotherapy-may cause blistering which can be burst
chemical peeling
Photodynamic therapy-topical sensitiser applied and light shone. reduces risk of progression to SCC.
Features of solar lentigo/liver spots (4)
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.
Management options for solar lentigo (2)
excision is ideal
radiotherapy is an option
In Situ Disease-Bowen’s disease (SCC in situ) features (3)
Well-circumscribed, scaly, erythematous plaque
solitary
symptomatic
Histological features of Bowen’s disease (2)
full thickness dysplasia
carcinoma in situ (hasn’t invaded BM)
DDx of Bowen’s disease (2)
eczema
psoriasis
Management of Bowen’s disease (2)
cryotherapy
5-FU
In situ disease-lentigo maligna: features (2)
melanoma in situ
precursor to invasive lentigo maligna melanoma
Presentation of lentigo maligna (2)
macular
often on FACE of elderly people
Management of lentigo maligna (2)
excision is 1st line
if not possible then topical imiquimod or cryotherapy
Features of lentigo maligna melanoma (4)
invasive malignant melanoma
arises from lentigo maligna
darker nodule +/- ulceration
lentigo>lentigo maligna>lentigo maligna melanoma
Subtypes of BCC (rodent ulcer) (4)
nodular
superficial
morpheic/infiltrative
pigmented
Presentation of BCC (4)
Pearly nodule
Rolled telangiectasic border
usually on face
usually smooth and clean but may become ulcerated
Management of BCC (4)
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)
Presentation of SCC (4)
Ulcerated, keratotic, firm, irregular lesion
grows rapidly
often sun-exposed area
may be painful
RFs for SCC (4)
transplant/immunosuppression
smoking-lower lip
chronic inflammation e.g. venous ulcer
HPV
Management of SCC (3)
SURGERY=GOLD STANDARD
radiotherapy is an alternative
topical imiquimod for superficial lesions
(mets rare but more common in certain areas e.g. ears)
Genetic mutation seen in 66% of melanomas
B-RAF mutation
Presentation of melanomas (6)
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)
DDx for melanomas (2)
benign melanocytic lesion
non-melanocytic pigmented lesion e.g. seborrheic keratosis
surgical management of melanomas
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)
Immunological agents for melanomas
match immunological agents to molecular analysis
ipilimumab: anti CTLA-4
vemurafenib: anti-BRAF
PD-1/PDL-1
Prognostic indicators in melanomas (4)
Breslow thickness
ulceration
sentinel node involvement
mitotic index
