👍🏻Dermatology👍🏻- Skin Cancer Flashcards
How can skin lesions be categorised?
Pigmented
Non-pigmented
How can pigmented lesions by further subdivided?
Melanocytic and non-melanocytic
What are the melanocytic lesions?
Melanocytic naevi
Solar lentigo
Lentigo maligna
Malignant melanoma
What are the types of malignant melanoma?
Lentigo maligna
Lentigo maligna melanoma
Superficial spreading melanoma
Nodular melanoma
Acral lentiginous melanoma
Subungual melanoma
Amelanotic melanoma
What is a melanoma?
What is a lentigo maligna?
A melanoma in situ
Proliferation of malignant melanocytes within the epidermis
Common Sites: Face, neck, and sun-exposed areas in elderly individuals
What do lentigo malignas look like?
Irregular shape
Light and dark brown colours
Size usually >2.0cm
What is a lentigo maligna melanoma?
Invasive melanoma arising from Lentigo Maligna
Common Sites: Same as LM—primarily face and neck
What are the characteristic features of a LMM?
Expanding pigmented lesion with increasing variation in colour and surface nodularity
What are the two types of melanoma growth?
What is a SSM?
Superficial Spreading Melanoma (SSM)
The most common type of melanoma (~70% of cases)
Common Sites: Men – trunk; Women – lower legs
What is the appearance of an SSM?
Irregularly bordered, asymmetrical macule with multiple colors (brown, black, red, blue, or white)
What is the growth pattern of SSM and how does it link to its prognosis?
Slow radial growth phase, followed by vertical growth
Good prognosis if growth remains horizontal
Vertical growth indicates aggression and ability to metastasis - poor prognosis
What is de-pigmentation?
In up to 2/3 SSMs, regression due to host immune system response
How do you diagnose an SSM?
What occurs after vertical proliferation of malignant melanocytes (if there was no previous horizontal growth)?
Nodular malignant melanoma
What are the key differences between SSM and nodular melanomas?
NM much more aggressive
Early vertical growth - No radial growth phase
NM has a raised nodule, SSM is flat
Much worse prognosis due to early invasion and metastasis risk
What can occur within an SSM?
Nodular melanoma arising within a superficial spreading melanoma
What is an acral lentiginous melanoma?
A rare but most common melanoma in darker-skinned individuals
Irregularly pigmented macule or patch on palms, soles, or under nails
Acral (hand and foot) surfaces
Slow radial growth, later becoming invasive
What is unique to acral lentiginous melanomas?
Tumours always flat on feet due to constant pressure being applied
What is a subungual melanoma?
subtype of Acral Lentiginous Melanoma affecting the nail unit
Thumb and big toe most affected
What is the appearance of a subungual melanoma?
Longitudinal melanonychia (dark stripe on the nail)
Ulceration
Nail dystrophy
Hutchinson’s sign (pigmentation spreading to nail fold/cuticle)
How are dermatological findings investigated?
What is an amelanotic melanoma?
Melanomas do not always have to be pigmented
A nodule on the skin – always alarming
A non-pigmented melanoma, making diagnosis challenging
What are the biggest risk factors for melanoma?
Family history of dysplastic nevi/melanoma
Sunburns during childhood
Intermittent burning exposure in unacclimatized fair skin
Atypical/dysplastic nevi
Personal history of melanoma
What is the management for melanoma?
What further investigations can be taken in melanoma management if disease thickness exceeds 0.8mm or there are sign of later stage disease?
Sentinel lymph node biopsy ( if thickness >0.8mm)
PET-CT (if stage III&IV)
MRI Brain (if stage III&IV)
What is a pyogenic granuloma?
A benign, rapidly growing vascular lesion
Nodulous
Common on fingers, lips, face, and oral mucosa
Caused by trauma, irritation or sometimes pregnancy
Easily bleeds with minor trauma due to high vascularity
Describe the appearance of a pyogenic granuloma
Bright red, dome-shaped lesion, often pedunculated
What are the non-pigmented skin cancers?
Actinic keratosis- precancerous
Bowen’s disease (SCC in situ)
Squamous cell carcinoma
Basal cell carcinoma
What does “in situ” mean in dermatology?
Confined to the epidermis
What is Bowen’s disease?
SCC in situ
What in this image suggests cancer?
Red dots - glomerular vessels
Indicates cancerous histology
What is actinic keratosis?
Dysplastic keratinocytes
Compare actinic keratoses, Bowen’s disease, SCC
What are the treatments for AKs and Bowen’s?
5 fluorouracil cream
Cryotherapy
Imiquimod cream
Photodynamic therapy
Currettage and cautery
Excision
What are the pros and cons of photodynamic therapy?
more expensive and unpleasant
better cosmetic results
(e.g. a lady with a SCC in situ on face may opt for photodynamic therapy)
Outline the AK and Bowen’s treatments
5-fluoracil cream - antimetabolite cream, causes appoptosis in dysplastic cells
Cryotherapy - freezes lesions using liquid nitrogen
Imiquimod cream - Immune response modulator - activates T-cell-mediated clearance of dysplastic cells
Photodynamic therapy - Photosensitizing agent applied, followed by exposure to light - destruction of dysplastic cells
Curettage & cautery - scraping lesion with curette then cauterizing base to destroy remaining cells
Excision - complete surgical removal of lesion
What is the clinical appearance of SCC?
What is a keratoacanthoma?
Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core
Over months, slowly resolves
Difficult to distinguish clinically and histologically from squamous cell carcinoma
Outline BCC
Superficial
Well-focused arborising vessels and the occasional small blue globule
Most common CANCER in the world – not skin cancer, CANCER
How do BCCs usually present?
What is the treatment for BCC or SCC?
Surgery
Mohs surgery at high risk sites
Radiotherapy
What is Mohs surgery?
