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Yr 3 - Core Conditions > Dermatology - Skin Tumours > Flashcards

Dermatology - Skin Tumours Flashcards

1
Q

What is a melanocytic naevus?

A

A pigmented mole - melanocytic naevus is a type of melanocytic tumour (benign) that contains naevus cells (composed of melanocytes).

It can be a direct precursor lesion of melanoma

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2
Q

What are the 3 types of melanocytic naevi

A

Junctional naevus – Between the epidermis and the dermis, flat, usually mid to dark brown.

Compound naevus – Within the dermis and at the epidermal-dermal junction, raised centre with a flat surrounding area, often hairy.

Intradermal naevus – Within the dermis, raised, often hairy, paler.

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3
Q

What is melanoma?

A

A malignant tumour arising from melanocytes (pigment cells)

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4
Q

What is melanoma?

A

A malignant tumour arising from melanocytes (pigment cells) in the skin.

  • In situ → confined to epidermis
  • Invasive → spread to dermis through basement membrane
  • Metastatic → spread to other tissues via lymphatic system or to organs via bloodstream
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5
Q

How are in situ melanomas cured?

A

With excision

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6
Q

What is the risk of recurrence and/or metastasis of melanomas based on?

A

Breslow thickness

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7
Q

What is Breslow thickness?

A

Breslow thickness is the measurement of the depth of the melanoma from the surface of your skin down through to the deepest point of the tumour.

  • <1mm thick = low risk
  • 1-4mm thick = intermediate risk
  • >4mm thick = high risk
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8
Q

What layer of the epidermis are melanocytes found in?

A

Basal layer

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9
Q

What do melanocytes produce?

A

Melanin

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10
Q

What is melanin?

A

A protein that protects skin cells by absorbing UV.

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11
Q

Are melanocytes found equally in black and white skin?

A

Melanocytes are found in equal numbers in black and white skin, but melanocytes in black skin produce much more melanin (dark brown/black skin less likely to be damaged by UV radiation).

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12
Q

What is the most common type of melanoma?

A

Superficial spreading melanoma

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13
Q

How does superficial spreading melanoma grow?

A

Grows flat and horizontally first (spread within epidermis) and later grows vertically

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14
Q

What is the most aggressive form of melanoma?

A

Nodular

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15
Q

How does nodular melanoma grow?

A

Grows rapidly in the vertical plane

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16
Q

What are the 4 types of melanoma

A
  1. Superficial spreading melanoma (most common)
  2. Nodular melanoma (most aggressive)
  3. Lentigo maligna melanoma
  4. Acral lentiginous melanoma
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17
Q

What type of melanoma occurs on palms/soles and under nails?

A

Acral lentiginous melanoma

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18
Q

What is amelanotic melanoma?

A

melanoma with no pigment

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19
Q

What is the ABCDE of melanoma?

A

The ‘ABCDE’ of melanoma is an acronym designed to help the public and clinicians identify features in a skin lesion that may suggest an early or in situ melanoma

  • Asymmetry
  • Border irregularity (melanoma often has a ‘scalloped’ border)
  • Colour variation (a variegated lesion consists of many colours)
  • Diameter >6mm
  • Evolves over time (size, shape)

Other symptoms: bleeding, itching, pain

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20
Q

What diameter would indicate potential melanoma?

A

>6mm

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21
Q

If a lesion has any of the ABCDE features, what should you do?

A

If a lesion has any of these features, it should be referred urgent under the 2 week wait pathway for suspected malignant melanoma

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22
Q

What is the 7 point check list for melanoma?

A
  • Major signs:
    • Change in size
    • Change in shape
    • Change in colour
  • Minor signs:
    • Diameter >7mm
    • Inflammation
    • Altered sensation
    • Crusting/bleeding/oozing
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23
Q

How is Breslow thickness established?

A

Using histology

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24
Q

What is a strong predictor of outcome in melanoma?

A

Breslow thickness

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25
Q

What Breslow thickness indicates the need for a sentinel node biopsy?

A

>1mm - look for evidence of metastases and stage the cancer

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26
Q

What staging system is used for melanoma?

A

TNM:

  • Stage 0 – In situ melanoma
  • Stage 1 – Think melanoma <2mm in thickness
  • Stage 2 – Thick melanoma >2mm in thickness, or >1mm thickness with ulceration
  • Stage 3 – Melanoma spread to invade local lymph nodes
  • Stage 4 – Distant metastases
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27
Q

What is basal cell carcinoma?

A

A locally invasive tumour of the epidermal (basal) keratinocytes.

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28
Q

Give some risk factors for basal cell carcinoma

A
  • Type I or II skin (fair skin which always burns and never or rarely tans)
  • History of frequent or severe previous sun burn
  • Outdoor occupation or hobbies
  • Personal or FH of skin cancer
  • Immunosuppression
  • Increasing age
  • Male sex
  • Gorlin’s syndrome (rare, hereditary)
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29
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

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30
Q

Prognosis of BCC?

A

Rarely metastasise, very rarely a threat to life.

31
Q

Describe the typical appearance of BCC

A

Nodular (most common):

  • Shiny or pearly nodule with smooth surface
  • Blood vessels cross its surface (telangiectasia)
  • Central depression or ulceration
  • Edges rolled
32
Q

What is a rodent ulcer?

A

BCC lesion where the centre is necrotic or ulcerated (sometimes called a rodent ulcer)

33
Q

Management of BCC?

A

Depends on size, location, type and local guidelines – but majority are managed surgically.

34
Q

What is the most common excision of BCC?

A

Surgical excision with 4mm margin (most common)

35
Q

What is Mohs Micrographic Surgery?

A

Mohs micrographic surgery, or Mohs surgery, is a precise surgical technique in which the complete excision of skin cancer is checked by microscopic margin control. It

36
Q

Purpose of Mohs Micrographic Surgery?

A
  • Use in high-risk areas of face e.g. eyes lips, nose
  • Very good for ill-defined lesions/need for tissue sparing
37
Q

What cells does SCC arise from?

A

epidermal keratinocytes

38
Q

What is the 2nd most common skin cancer?

39
Q

Prognosis of SCC?

A
  • Can metastasise which can be fatal
  • Prognosis favourable (5 year survival of 99%) if SCC is detected early
40
Q

HPV infection can increase your risk of which skin cancer?

41
Q

Describe the precursors to SCC

A

Actinic keratosis → Bowen’s disease → SCC

42
Q

What is Bowen’s disease also known as?

A

SCC in situ

43
Q

What is the most common SCC precursor?

A

Actinic keratosis

44
Q

Painful lesions BCC vs SCC

A

BCC - not painful

SCC - can be painful, tender, bleed

45
Q

Describe the lesion in SCC

A

Irregular, ill-defined red nodule with scale and ulceration or crust (keratotic)

46
Q

What thickness of SCC is associated with greatest risk?

47
Q

What are the 3 main types of SCCs?

A
  1. Cutaneous horn
  2. Keratoacanthoma
  3. Carcinoma cuniculatum
48
Q

Where is carcinoma cuniculatum located?

A

Sole of foot

49
Q

SCC vs BCC:

50
Q

Is seborrhoeic keratosis benign or malignant?

51
Q

What is seborrhoeic keratosis?

A

Benign, warty, epidermal growths which occur commonly with skin ageing.

Despite the name, there is no relation with sebum, sebaceous lands nor a seborrhoeic distribution

52
Q

How common is seborrhoeic keratosis?

A

Very common in older adults (estimated over 90% of adults aged >50 y/o)

53
Q

Describe the dermatological features of seborrhoeic keratosis

A
  • Well-defined borders
  • ‘Stuck on’ warty plaque with a fissure keratin surface (greasy)
  • Colour varies
  • Slow growing
54
Q

Is seborrhoeic keratosis a precursor for skin cancer?

55
Q

What is a lipoma?

A

A non-cancerous tumour made up of fat cells – caused by a proliferation of adipose tissue. It grows slowly under the skin in the subcutaneous tissue.

56
Q

Presentation of lipomas?

A
  • Can be solitary (more common in women) or multiple (more common in men)
  • Asymptomatic
  • Slow rowing (years)
  • Soft, smooth, mobile, subcutaneous nodule
57
Q

What is a rare complication of lipomas?

A

Liposarcoma

58
Q

Treatment of lipomas?

A

Usually no treatment required (may be surgically removed if impacting upon nearby muscles)

59
Q

What is an epidermoid cyst?

A

A benign cyst derived from the infundibulum or upper portion of a hair follicle, encapsulated in a thin layer of epidermis-like epithelium. Typically filled with keratin and lipid-rich debris.

AKA follicular infundibular cyst, epidermal cyst, keratin cyst.

60
Q

What is the cause of an epidermoid cyst?

A

Epidermal cell proliferation

61
Q

Do epidermoid cysts more commonly affect men or women

62
Q

Features lesion in epidermoid cyst?

A
  • Skin-coloured/yellow, firm, round nodules
  • May have a central punctum
  • May have offensive smelling keratinous contents
63
Q

What is a dermatofibroma?

A

A common, benign fibrous nodule usually found on the skin of the lower legs.

64
Q

Who may be affected by eruptions of dermatofibromas?

A

Immunosuppressed people

65
Q

Describe a dermatofibroma

A
  • Firm, fibrous, derma nodules or papules
  • Usually <1cm diameter
  • Skin dimples upon compression (pinch sign)
  • Pale centre
66
Q

Management of a dermatofibroma?

A

Often no treatment required

67
Q

What are Campbell de Morgan spots?

A

Cherry angioma that describes a benign vascular skin lesion.

68
Q

Cause of Campbell de Morgan spots?

A

Proliferating endothelial cells (these are the cells that line the inside of a blood vessel) and subsequent blood vessel overgrowth. Aetiology unknown.

69
Q

Presentation of Campbell de Morgan spots?

A
  • Number of spots increases with age
  • Common on mid-trunk
  • Lesion: Red/purple/black papules or macules
70
Q

Treatment of Campbell de Morgan spots?

A

Usually no treatment required (may be removed for cosmetic reasons).

71
Q

What are fibroepithelial polyps also known as?

72
Q

What are fibroepithelial polyps?

A

A common, soft, harmless lesion that appears to hang off the skin.

73
Q

Which virus may be associated with the development of fibroepithelial polyps?

Yr 3 - Core Conditions (33 decks)

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