Dermatology - skin cancer

Question 1

What is the most common cancer in Australia?

Answer 1

Pancreatic

Lol Jks - skin cancer (non melenoma)

Question 2

What portion of people will get melanoma in Australia by age 85?

Answer 2

1 in 15 men

1 in 25 women

Question 3

What percentage of cancers are melanoma?

Answer 3

10%, 3.6% cancer deaths

Question 4

What portion of non-melenoma skin cancers are due to sun exposure?

Answer 4

99% (mostly immunosuppression for the rest)

Question 5

What are the causes of melenoma?

Answer 5

Sun exposure

Tanning beds

Giant congenital naevi

Genetic (CDK2NA mutations)

Question 6

What are risk factors for melenoma?

Answer 6

 Men (2x women)

 Elderly

 Fair-skinned

 Sun exposure

 Family history (one affected 1 st degree relative=2x risk for melanoma)

 Multiple naevi (>100 naevi = 7x melanoma risk)

 Past skin cancer (melanoma = x10 NMSC = x4)

Question 7

What are the subtypes of BCCs?

Answer 7

Superficial

Nodular

Morpheic

Question 8

Where do superficial BCCs commonly occur?

Answer 8

most common on trunks and limbs

Question 9

Where do nodular BCCs commonly occur?

Answer 9

most common in head and neck?

Question 10

How do morphoeic BCCs appear?

Answer 10

pale and scar like

often appear smaller that they are and less invasive

Question 11

How do you make a diagnosis of BCC/ SCC?

Answer 11

clinical + biopsy

Question 12

how do you biopsy a suspected BCC or SCC?

Answer 12

shave or punch biopsy

Question 13

What are the treatment options for BCCs/ SCCs?

Answer 13

Surgery

Radiotherapy

Cryotherapy (only for certain ones)

Topical creams (only for certain ones)

Phototherapy (only for certain ones)

Question 14

What are the advantages of surgery as a treatment for skin cancer?

Answer 14

best cure rate (95%)

Histological evaluations of the margins

Good cosmesis and function

Question 15

What margins are needed for SCC/ BCC?

Answer 15

3-4mm

Question 16

What are the reasons you would use radiotherapy for a BCC/ SCC?

Answer 16

older people (>60)

Surgery contraindicated

To avoid keloid scar

To avoid mutilating surgery

Palliation

Question 17

Where do SCCs commonly occur?

Answer 17

Sun exposed skin - hands, face, neck, lower legs

Question 18

What are the subtypes of SCCs? (including precursors)

Answer 18

Solar keratosis

Bowens disease

Keratoacanthoma

Invasive squamous cell carcinoma

High risk SCC

Question 19

What are Solar keratosis?

Answer 19

Pre-runner to SCC

Question 20

What is the other name for solar keratosis?

Answer 20

actinic keratosis

Question 21

What are the clinical features of solar keratosis?

Answer 21

Plaques,
Skin coloured or red/ pigmented
can be tender or itchy, sting when sweaty

Question 22

How are solar keratosis most commonly treated?

Answer 22

cryotherapy (sometimes creams)

Question 23

What is Bowen’s disease?

Answer 23

SCC in situ

confined to epidermis, no potential for metastasis

Question 24

What are the clinical features of Bowen’s disease

Answer 24

irregular scaly plaques of up to several centimetres in diameter. They are most often red but may also be pigmented.
Can grow under the nails
Often confused for psoriasis or eczema

Question 25

What skin cancers is cryotherapy suitable for?

Answer 25

BCC or solar keratosis, bowen’s disease on trunk or limbs

Question 26

What is a keratoacanthoma?

Answer 26

A skin lesion. It has a characteristic morphology with a keratin filled sac/ centre. Some pathologist believe it is a well differentiated SCC

Question 27

What is the natural history of keratoacanthomas?

Answer 27

They grow quite quickly over weeks, and then will regress.

They are difficult to distinguish from more invasive cancers clinically, so are often surgically removed anyway.

Question 28

What skin cancers is 5 flourouracil treatment suitable for?

Answer 28

solar keratosis

Question 29

What skin cancers is imiquimod treatment suitable for?

Answer 29

solar keratosis or superficial BCC

Question 30

What skin cancers is photodynamic therapy treatment suitable for?

Answer 30

solar keratosis or superficial BCC or Bowen’s disease

Question 31

What makes a SCC high risk?

Answer 31

○ >2cm
○ Sites: ears, lips, scalp
○ Retreatment needed
○ Immunosuppressed patient

Question 32

What is the metastatic chance in a high risk SCC?

Answer 32

10-20%

Question 33

What is the metastatic chance in a low risk SCC?

Answer 33

< 1%

Question 34

What is the recommended follow up for someone who has had an SCC or BCC removed?

Answer 34

yearly skin check for BCC

2x yearly for SCC

Question 35

What are the melanoma subtypes?

Answer 35

Superficial spreading
Nodular
Lentigo maligna
Acral lintiginous - hands and feet
Subungual - nail
Amelanotic melanomas

Question 36

What is a lentigo mealigna also known as?

Answer 36

melanoma in situ, or Hutchinson’s melanocytic freckle

Question 37

What are the clinical features that suggest a melanoma?

Answer 37

Asymmetrical shape

Border irregularity

Colour irregularity

Diameter > 7mm

Evolution (change in size ,shape or colour)

Question 38

How should a suspected melanoma be biopsied?

Answer 38

shave or punch biopsy generally
incisional biopsy if large

2mm margins wanted

Question 39

What is the most prognostically/ clinically important histological classification of melanomas?

Answer 39

Breslow thickness

Question 40

What surgical margins should be achieved with a melanoma?

Answer 40

Melanoma in situ: 0.5cm
Breslow thickness < 1mm = 1cm margin
Breslow thickness > 1mm = 2cm margin

Question 41

Should you perform a sentinal lymph node biopsy for melanoma?

Answer 41

controversial

only consider if > 1mm breslow thickness

Question 42

What is the recommended follow up for someone who has had an melanoma removed?

Answer 42

if <2mm thick then 2x/ year for 5 years, then yearly

if thicker or mets then every 3-4 months for 5 years then yearly

Question 43

What is the most common subtype of melanoma?

Answer 43

superficial spreading