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Dermatology Malignancies Flashcards

1
Q

Is papilloma benign or malignant?

A

benign

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2
Q

is Bowens disease benign or malignant?

A

malignant

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3
Q

is senile keratosis benign or malignant?

A

Benign

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4
Q

is seborrhoeic keratosis benign or malignant?

A

benign

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5
Q

is Squamous cell carcinoma benign or malignant?

A

malignant

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6
Q

is basal cell carcinoma benign or malignant?

A

malignant

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7
Q

are melanomas benign or malignant?

A

can be benign melanomas or malignant melanomas

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8
Q

What is this?

A

Mycosis fungoides

cutaneous T-cell lymphoma

usually confined to skin.

Causes itchy, red plaques (Sézary syndrome-variant also associated with erythroderma)

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9
Q

What is this?

A

Leucoplakia -

white patches (which may fissure) on oral or genital mucosa (where it may itch).

Frank carcinomatous change may occur

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10
Q

What is this?

A
  • Leprosy
  • Suspect in any esthetic hypopigmented lesion
  • NB: Leprosy is a chronic infectious disease that is caused by Mycobacterium leprae and affects the skin and nerves
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11
Q

What is this?

A

Syphilis

  • Any genital ulcer is syphilis until proved otherwise
  • Secondary syphilis:
    • papular rash
      • (papule = raised, <1cm)
    • —including, unusually, on the palms
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12
Q

What benign condition does this describe:

  • a common
  • benign
  • pedunculated tumour
  • often pigmented with melanin
A
  • papilloma

keratinised papillary tumour of squamous epithalium (the layer above the basal e.g. stratum spinosum/prickle)

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13
Q

What is a seborrhoeic keratosis?

A
  • A basal cell papilloma
  • benign
    • (e.g. from the basal layer not prickle/stratum spinosum where papilloma is)
  • you get hyperkeratosis and proliferation of the basal cell layer and melanin pigmentation
    • (- because the basal layer contains the melanocytes:basal cells in 1:10)
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14
Q

these are common over >40 years old

they are a yellowish or brown raised lesion

often multiple

greasy and cryptic surface(/fissure)

What are these?

A

Seborrhoeic keratosis aka basal cell papilloma

greasy = kyperkeratosis

look like melanomas / yellowish or brown raised lesion = proliferation of basal cell layer & melanin pigmentation

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15
Q
  • Solar / actinic keratosis
  • Marjolins ulcer
  • bowens disease

are all what?

A

pre-malignant tumours

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16
Q

What are the pre-malignant forms of SCC?

A

Solar (actinic) keratosis has risk of transforming into SCC

Actinic keratosis (partial damage) –> bowens disease (full thickness damage) –> SCC

& marjolins ulcer and bowens disease

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17
Q

What are the hyperkeratotic atypical dividing cells in the prickle cell layer (stratum spinosum)?

& how are they managed?

A

Solar / actinic keratosis

Rx: cryotherapy, curettage,

topical chemo = 5% flurouracil cream or 5% imiquimod of diclofenac gel

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18
Q

Describe this and when it occurs?

A

small, hard, yellow-brown, scaly tumour

on sun-exposed areas of the elderly

(solar/actinic keratosis)

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19
Q

What is this?

A

bowens disease

Slow-growing red/brown scaly plaque,

HPV (16 & 2) found in some lesions

Full-thickness dysplasia - SCC in situ (CIS) -

has atypical keratinocytes with vacuoliszation, mitoses & multinucleated giant cells are prominent in epidermis

but basal layer is intact

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20
Q

What is Queyrat’s erythroplasia?

A

Penile Bowen’s disease

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21
Q

How do you manage bowens disease?

A

Rx: excision, cryotherapy,

topical fluorouracil

or photodynamic therapy

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22
Q

What makes an ulcer a marjolins ulcer?

A

: malignant change in a scar, ulcer of sinus e.g. chronic venous ulcer

  • is premalignant –> pre-SCC

Slow growing (usually relatively avascular), painless, lymphatic spread is late

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23
Q

Where can marjolins ulcers be found?

A

Smokers lips or

in long-standing ulcers

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24
Q

What is pagets disese of the breast?

A

breast DCIS in the skin

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25
Which is the most common and 2nd common skin cancer?
1 = basal cell carcinoma 2= squamous cell carcinoma
26
which grow faster out of SCC or BCC?
SCC
27
What skin cancer lesion does this describe: * ulcerated lesion * hard, raised edges * sun exposed areas
SCC they are irregular keratotomy ("fleshy") tumours which underrate and crust
28
what skin cancer lesion does this describe: * nodule with pearly appearance * telangiectatic edge * may have central ulcer/can ulcerate * sun exposed site * - mostly on head and face
Basal cell carcinoma
29
which skin cancer types is being fair, sun beds and IV exposure a risk for?
melanoma & BCC & SCC
30
both SCC and BCC rarely metastasise. Which causes local destruction?
SCC can cause extensive local destruction - they tend to grow faster than BCC BCC has slow local destruction
31
Which CC is linked to HPV6,11,16,18 and IMMUNOSUPRESSION e.g. post renal cell transplant?
SCC
32
What is the staging, grading and Rx of BCC?
* TNM staging * not graded as by definition they are low grade * Rx: excision, cryotherapy, * topical flurouracil or imiquimod for superficial BCCs
33
What is the staging, grading and Rx of SCC? (keratinocyte cancer)
* TMN * \>2cm in size = hgiher mets rate - \>4mm = bad * ear, lip have 30% metastatic rate * graded: well, moderately or poorly differentiated * * excision + radiotherapy * MOHs micrographic surgery - more controlled tumour removal inc microscopic exam
34
are the pre-cancer conditions of SCC?
* Actinic keratosis * bowens * marjolins ulcers
35
What are the chances of SCC metastasising?
higher than BCC but still only 1-2%
36
What do you call a BCC that is showing aggressive local spread?
A rodent ulcer NB: even with rodent BCC ulcers distant metastasis is very rare
37
Where are melanocytes situated in the epidermis?
in the basal layer of the epidermis (from neuroectoderm of embryonic neural crest)
38
Melanocytes are always pigmented true or false?
False they are mostly pigmented but not always
39
What reaction is always positive in melanocytes?
melanocytes always have a positive DOPA reaction (DOPA = dihydroxyphenyl alanine) **as they convert DOPA --\> melanin**
40
What are the 2 types of naevus (birthmark/mole)? e.g. benign?
* intradermal melanoma (naevus) * junctional melanoma (naevus)
41
What is an intradermal melanoma? | (naevus)
* the commonest variety of mole * NB: a _hairy_ mole is always _intradermal_ intradermal melanoma = nest of melanocytes entirely within the dermis formin a non-capsulated mass they **never** undergo malignant change & need **no treatment** unless diagnosis is uncertain
42
What is a junctional melanoma? | (naevus)
* pigmented, flat, smooth and hairless * it is a naevus seen in the basal layers of the epidermis from which cells --\> surface * only a small % undergo malignant change
43
What is a juvenile melanoma?
* melanoma before puberty * ~unusual * they fortunately pursue a completely benign course BUT microscopically are indistinguishable from malignant melanoma
44
What is a melanocyte in situ?
* abnormal melanocytes spreading along basal layer of epidermis * but have not yet invaded though the basement membrane * TF = PRE-CANCER
45
What are the suspicious features of a malignant melanoma?
ABCDE & ugly duckling * Asymmetry, * Border (irregular, ragged), * Colour (varied), * Diameter (\>6mm) Ugly duckling sign - identify skin lesions that look different to others (useful if someone has many moles etc)
46
What is a malignant melanoma and why is it vital to have early diagnosis?
* MM = malignant tumour arises from melanocytes which live at bottom of epidermis (basal layer) just above the basement membrane * mostly in skin and rarely in other sites e.g. oral cavity, eye * most are DE-NOVO * but may occur IN pre-existing moles * most are highly aggressive tumours that dont respond well to chemo or radiotherapy --\> need early Dx * 5th most common cancer in the UK * #2 in adults 25-49yrs though = *yonger patients*
47
What scale is used as criteria for melanoma referral to derm?
Glasgow Scale if 3 or \>3 then refer
48
What are the major (2pt) criteria for melanoma referral on the glasgow scale?
**_Change_** in: * shape * colour * size
49
What are the minor 1pt criteria for melanoma referral on the glasgow scale?
50
What are the less helpful signs for melanoma on glasgow scale (they are not worth points)?
as
51
What is the staging and grading of melanoma?
Staging: TMN Grading = NOT graded as by definition melanoma are high grade NB: so this means only SCC are actually graded as BCC = by def low grade and Melanoma = by def are high grade
52
What are worse superficial spreading melanomas or nodular melanomas?
Superfical spreading melanomas are better - these are 70% of melanoma dx, they are: * slow growing * metastasise late * good prognosis Vs nodular melanomas = 10-15% of dx * invade deeply * metastasise early * LESIONS MAYBE AMELANOTIC e.g. flesh coloured (in ~5%)
53
What are acral melanomas?
Acral melanomas -are nasty brown colour & occur on: * palms * soles * subungual (under nails) in _equal frequency in black:white patients_ however it is the _most common melanoma in asian and black ethnic groups_ as... * doesnt appear to be related to sun exposure
54
what are lentigo maligna melanoma?
* evolution from a pre-existing _lentigo maligna_ * lentigo maligna (epidermis dysplasi)--\> malignant melanoma * which is a brown pigmented patch with an irregular outline * found on the cheeks of elderly women (Hutchinson freckle)
55
What is a mucosal melanoma?
found on mucosa of nose, mouth, anus, intestine
56
What is a choroid melanoma?
a melanoma from the pigment layer of the retina renowned for presenting many years after enucleation (surgery) with hepatic mets --\> gives: large liver & glass eye
57
What are the prognostic factors for melanoma?
* Breslow thickness - thickness of tumour in millimetres, measured down microscopy, very important prognostic factor (part of TMN staging) * Tumour stage * LN mets * Presence of ulceration = much worse
58
What is the Rx for melanoma?
* wide local excision * SLB indicated if breslow thickness is \>0.8mm [need to see if need regional node exicion, hot and blue etc] * immunotherapy with high dose interferon A2B * chemotherapy if metastatic disease -- 10-30% response rate
59
What are: capillary haemangioma, cavernous haemangioma, sclerosis angioma, glomus tumour, haemangiosarcoma and kaposi's sarcoma all?
Blood vessel tumours
60
what lesion does this describe: congenital, capillary malformations in the skin usually found at birth?
capillary haemangioma
61
what lesion does this describe? large blood spaces lined with endothelium
cavernous haemangioma | (BV tumours)
62
What lesion does this describe? * pigmented tumour of skin, * hard consistency due to dense fibrous stroma, * fibrosis of capillary haemangioma
Sclerosing angioma | (fibrous histiocytoma)
63
What lesion does this describe? painful, convoluted AV anastomoses found in arterial portion of nail bed
Glomus tumour painful due to abundant nerve fibres
64
What are these types of? salmon pink patch strawberry naevus port-wine stain campbell de Morgan spots spider naevi
Capillary haemangioma haemangioma = benign tumour of BV often forming a red birth mark
65
Which capillary haemangioma is common in new borns and spontaneously it will rapidly disappear?
Salmon pink patch
66
Which capillary haemangioma is this? Bright red & raised disappears during the first few years of life
Strawberry naevus
67
Which capillary haemangioma is this? * present from birth & shows no tendency to regress with age * may be associated with angiomas of the cerebral pia-arachnoid * (inner 2 brain coverings) * which may manifest by focal epileptic attacks * (Sturge-Weber syndrome)
Port wine stain
68
Which capillary haemangioma is most seen in ageing patients?
Campbell de Morgan spots
69
When are spider naevi seen?
(benign BV tumours e.g. swelling) * normal * pregnancy * chronic liver disease
70
What lesion does this describe? * blue-red nodules scattered over the extremities of 1 or \>1 of the limbs, * may ulcerate * can metastasize to the liver & LUNGS
Kaposi's sarcoma * an AIDs defining illness * HHV8 Histology shows vessels and fibroblasts --\> the fibroblasts show malignant features
71
What is the Rx of Kaposi's sarcoma?
* highly active anti-retroviral therapy (HART) * or reduction of immunosuppression in transplant recipients, * local radiotherapy or cytotoxic drugs
72
What are lymphangiomas?
tumours lines by endothelium & contain lymph rare
73
What are schwannoma and neurofibromas?
nerve tumours benign (schwannomas = rare to be cancerous) NB: the genetic condition neurofibromatosis - 3 x types
74
What is the name for benign and malignant fatty tumours?
lipoma = benign fatty tumour liposarcoma = malignant fatty tumour

Skin - Derm/Plastics (5 decks)

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