Disease Profiles: Skin Cancer

Question 1

What does the ABCD checklist stand for in assessing a possible melanoma?

Answer 1

Asymmetry, border, colour, diameter

Question 2

Melanomas in intermittently sun-exposed skin may have what mutation?

Answer 2

BRAF

Question 3

Define the vertical growth phase in melanomas

Answer 3

The melanoma cells invade the dermis forming an expansile mass with mitosis

Question 4

Which form of BCC begins as a reddish, dome-shaped nodule with a translucent surface and telangiectasia, and then can expand to appear necrotic and ulcerated in the central area creating a rolled edge?

Answer 4

Nodular BCC

Question 5

How is infiltrative BCC managed?

Answer 5

Resection

Question 6

Where is acral/mucosal lentiginous melanoma found?

Answer 6

Acral regions - hands, feet, ears and nose

Mucosal regions

Question 7

What is xeroderma pigmentosum?

Answer 7

Genetic disorder involving defective nucleotide excision repair, which predisposes to skin cancer

Question 8

Name a treatment which can increase the response time of a BRAF inhibitor

Answer 8

MEK inhibitor

Question 9

Which form of BCC is flatter and expands gradually, appearing red, scaly, and with a slightly raised ‘whipcord’ margin?

Answer 9

Superficial BCC

Question 10

Which skin cancer is associated with severe sunburn in childhood?

Answer 10

Melanoma

Question 11

Which form of BCC infiltrates tissues more widely and has poorly defined margins?

Answer 11

Infiltrative BCC

Question 12

Which is the most common skin cancer in immunosuppressed patients?

Answer 12

Squamous cell carcinoma

Question 13

Where is lentigo maligna melanoma commonly found?

Answer 13

Sun damaged face/neck/scalp

Question 14

What is actinic keratosis?

Answer 14

Partial thickness dysplasia of epidermal keratinocytes

Question 15

Where is Bowen’s disease most commonly found?

Answer 15

Lower leg of older woman (but can occur at any chronically exposed site)

Question 16

What is keratoacanthoma?

Answer 16

Self-resolving SCC

Question 17

Name a genetic therapy for melanomas caused by c-kit mutations

Answer 17

Imatinib

Question 18

Which skin cancer will present as a warty or hyperkeratotic lump or ulcer on sun-damaged skin?

Answer 18

Squamous cell carcinoma

Question 19

What is the first-line treatment for SCC precursor lesions?

Answer 19

Topical therapies - cryotherapy, 5-flurouracil, imiquimod, PDT

Question 20

What is oculocutaneous albinism?

Answer 20

Autosomal recessive absence/defect of tyrosinase resulting in absence of melanin, which predisposes to skin cancers

Question 21

Which skin cancer arises from melanocytes?

Answer 21

Melanoma

Question 22

Define the radical growth phase in melanomas

Answer 22

The phase of growth in which macules expand either entirely in situ or with dermal microinvasion

Question 23

What is the Breslow depth?

Answer 23

Deepest tumour from the granular layer in mm, used to classify melanoma and predict survival

Question 24

Which type of skin cancer is a c-kit mutation sometimes found in?

Answer 24

Acral melanoma

Question 25

Which skin cancer can present as a slow-growing, pearly nodule with superficial telangiectasia, or as a non-healing ulcer, or a scaling plaque?

Answer 25

Basal cell carcinoma

Question 26

Where is superficial spreading melanoma most commonly found?

Answer 26

Trunk and limbs

Question 27

What is Bowen’s disease?

Answer 27

Squamous cell carcinoma in situ - full thickness dysplasia of epidermal keratinocytes

Question 28

What is the first line treatment for melanoma?

Answer 28

Excision, also sentinel node biopsy if tumour >1mm or there is lymph node metastases

Question 29

Name the four types of melanoma

Answer 29

Superficial spreading, acral/mucosal lentiginous, lentigo maligna, nodular

Question 30

How does BRAF act as a proto-oncogene?

Answer 30

If mutated, BRAF drives cell proliferation by up-regulating MEK and ERK

Question 31

Which skin cancer arises from basal keratinocytes?

Answer 31

Basal cell carcinoma

Question 32

Which HPV type is most commonly associated with dysplasia and squamous cell carcinoma?

Answer 32

Type 16

Question 33

Name a genetic therapy for melanomas caused by BRAF mutations

Answer 33

Vemurafenib

Question 34

Which is the most common type of skin cancer?

Answer 34

Basal cell carcinoma

Question 35

Which type of BCC is shown in the picture?

Answer 35

Pigmented BCC

Question 36

What is a ‘rodent ulcer’?

Answer 36

Basal cell carcinoma with central ulceration

Question 37

Which form of melanoma does not have a radical growth phase?

Answer 37

Nodular melanoma

Question 38

Why are melanomas more likely to metastasize than keratinocyte skin cancers?

Answer 38

Melanocytes are motile cells that move around

Question 39

How is superficial BCC managed?

Answer 39

Topical therapies - cryotherapy, 5-flurouracil, imiquimod, PDT

Question 40

How is BCC usually managed?

Answer 40

Excision

Question 41

What is the first line treatment for SCC?

Answer 41

Usually excision, some may be treated topically (not invasive, smaller)

Question 42

Which type of skin cancer can present as superficial, nodular or infiltrative?

Answer 42

Basal cell carcinoma

Question 43

Where is nodular melanoma most commonly found?

Answer 43

Trunk, sites are varied

Question 44

Why is ulceration of a melanoma a strong adverse indicator?

Answer 44

Higher risk of metastasis