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Skin - Derm/Plastics > Dermatology Malignancies > Flashcards

Dermatology Malignancies Flashcards

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Dermatology Board Prep 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
Q

Which is the most common and 2nd common skin cancer?

A

1 = basal cell carcinoma

2= squamous cell carcinoma

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26
Q

which grow faster out of SCC or BCC?

A

SCC

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27
Q

What skin cancer lesion does this describe:

  • ulcerated lesion
  • hard, raised edges
  • sun exposed areas
A

SCC

they are irregular keratotomy (“fleshy”) tumours which underrate and crust

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28
Q

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
A

Basal cell carcinoma

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29
Q

which skin cancer types is being fair, sun beds and IV exposure a risk for?

A

melanoma

&

BCC

&

SCC

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30
Q

both SCC and BCC rarely metastasise.

Which causes local destruction?

A

SCC can cause extensive local destruction - they tend to grow faster than BCC

BCC has slow local destruction

31
Q

Which CC is linked to HPV6,11,16,18 and IMMUNOSUPRESSION e.g. post renal cell transplant?

A

SCC

32
Q

What is the staging, grading and Rx of BCC?

A
  • TNM staging
  • not graded as by definition they are low grade
  • Rx: excision, cryotherapy,
    • topical flurouracil or imiquimod for superficial BCCs
33
Q

What is the staging, grading and Rx of SCC?

(keratinocyte cancer)

A
  • 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
Q

are the pre-cancer conditions of SCC?

A
  • Actinic keratosis
  • bowens
  • marjolins ulcers
35
Q

What are the chances of SCC metastasising?

A

higher than BCC but still only 1-2%

36
Q

What do you call a BCC that is showing aggressive local spread?

A

A rodent ulcer

NB: even with rodent BCC ulcers distant metastasis is very rare

37
Q

Where are melanocytes situated in the epidermis?

A

in the basal layer of the epidermis

(from neuroectoderm of embryonic neural crest)

38
Q

Melanocytes are always pigmented

true or false?

A

False

they are mostly pigmented but not always

39
Q

What reaction is always positive in melanocytes?

A

melanocytes always have a positive DOPA reaction

(DOPA = dihydroxyphenyl alanine)

as they convert DOPA –> melanin

40
Q

What are the 2 types of naevus (birthmark/mole)? e.g. benign?

A
  • intradermal melanoma (naevus)
  • junctional melanoma (naevus)
41
Q

What is an intradermal melanoma?

(naevus)

A
  • 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
Q

What is a junctional melanoma?

(naevus)

A
  • 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
Q

What is a juvenile melanoma?

A
  • melanoma before puberty
  • ~unusual
  • they fortunately pursue a completely benign course BUT microscopically are indistinguishable from malignant melanoma
44
Q

What is a melanocyte in situ?

A
  • abnormal melanocytes spreading along basal layer of epidermis
  • but have not yet invaded though the basement membrane
  • TF = PRE-CANCER
45
Q

What are the suspicious features of a malignant melanoma?

A

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
Q

What is a malignant melanoma and why is it vital to have early diagnosis?

A
  • 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
Q

What scale is used as criteria for melanoma referral to derm?

A

Glasgow Scale

if 3 or >3 then refer

48
Q

What are the major (2pt) criteria for melanoma referral on the glasgow scale?

A

Change in:

  • shape
  • colour
  • size
49
Q

What are the minor 1pt criteria for melanoma referral on the glasgow scale?

A
50
Q

What are the less helpful signs for melanoma on glasgow scale (they are not worth points)?

A

as

51
Q

What is the staging and grading of melanoma?

A

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
Q

What are worse superficial spreading melanomas or nodular melanomas?

A

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
Q

What are acral melanomas?

A

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
Q

what are lentigo maligna melanoma?

A
  • 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
Q

What is a mucosal melanoma?

A

found on mucosa of nose, mouth, anus, intestine

56
Q

What is a choroid melanoma?

A

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
Q

What are the prognostic factors for melanoma?

A
  • 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
Q

What is the Rx for melanoma?

A
  • 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
Q

What are:

capillary haemangioma, cavernous haemangioma, sclerosis angioma, glomus tumour, haemangiosarcoma and kaposi’s sarcoma

all?

A

Blood vessel tumours

60
Q

what lesion does this describe:

congenital, capillary malformations in the skin usually found at birth?

A

capillary haemangioma

61
Q

what lesion does this describe?

large blood spaces lined with endothelium

A

cavernous haemangioma

(BV tumours)

62
Q

What lesion does this describe?

  • pigmented tumour of skin,
  • hard consistency due to dense fibrous stroma,
  • fibrosis of capillary haemangioma
A

Sclerosing angioma

(fibrous histiocytoma)

63
Q

What lesion does this describe?

painful, convoluted AV anastomoses found in arterial portion of nail bed

A

Glomus tumour

painful due to abundant nerve fibres

64
Q

What are these types of?

salmon pink patch

strawberry naevus

port-wine stain

campbell de Morgan spots

spider naevi

A

Capillary haemangioma

haemangioma = benign tumour of BV often forming a red birth mark

65
Q

Which capillary haemangioma is common in new borns

and spontaneously it will rapidly disappear?

A

Salmon pink patch

66
Q

Which capillary haemangioma is this?

Bright red & raised

disappears during the first few years of life

A

Strawberry naevus

67
Q

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)
A

Port wine stain

68
Q

Which capillary haemangioma is most seen in ageing patients?

A

Campbell de Morgan spots

69
Q

When are spider naevi seen?

A

(benign BV tumours e.g. swelling)

  • normal
  • pregnancy
  • chronic liver disease
70
Q

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
A

Kaposi’s sarcoma

  • an AIDs defining illness
  • HHV8

Histology shows vessels and fibroblasts –> the fibroblasts show malignant features

71
Q

What is the Rx of Kaposi’s sarcoma?

A
  • highly active anti-retroviral therapy (HART)
  • or reduction of immunosuppression in transplant recipients,
  • local radiotherapy or cytotoxic drugs
72
Q

What are lymphangiomas?

A

tumours lines by endothelium & contain lymph

rare

73
Q

What are schwannoma and neurofibromas?

A

nerve tumours

benign

(schwannomas = rare to be cancerous)

NB: the genetic condition neurofibromatosis - 3 x types

74
Q

What is the name for benign and malignant fatty tumours?

A

lipoma = benign fatty tumour

liposarcoma = malignant fatty tumour

Skin - Derm/Plastics (5 decks)

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