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Year 3 Human Disease > Head and neck skin cancer > Flashcards

Head and neck skin cancer Flashcards

1
Q

describe 7 melanoma subtypes

A

MOLASNA

  • superficial spreading (radial growth, can see spread under skin)
  • nodular (vertical growth - more serious)
  • lentigo maligna (diffuse appearance, varied colour/shape)
  • amelanotic (pigmented)
  • acral (in extremities. common in non white people)
  • mucosal eg mouth
  • occular
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2
Q

7 point checklist for suspected malignant melanoma

A

major signs: change in shape/ colour/ size

minor signs: inflammation, crusting/bleeding, sensory change inc itch, diameter >7mm

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3
Q

what is ABCDE of malignant melanomas

A 
Asymmetry
border
colour
diameter
evolution (changed shape/ size/ colour or risen)
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4
Q

clinical stages of melanoma in terms of spread and 10 yr prognosis

A

I: local tumour, 81%
II: involvement of local lymph nodes, 47%
III: disseminated disease, 0%

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5
Q

resection margins for stage I cutaneous melanoma

a. melanoma in situ
b. melanoma 2mm
e. lentigo malignant melanoma
f. acral/ subungal melanoma

A

resection margins for stage I cutaneous melanoma

a. melanoma in situ: 0.5cm
b. melanoma 2mm: not known
e. lentigo malignant melanoma: usually 0.5-1cm, depends on tumour thickness
f. acral/ subungal melanoma: based on tumour thickness. may have to dislocate joint nr tumour

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6
Q

clarke’s level: define and levels

A 
deepest portion of skin invaded by tumour, 5 layers of outermost epidermis under fat
I: preinvasive
II:thinly invasive 
III-IV: moderately invasive
V: deeply invasive
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7
Q

are clarkes levels qualitative or quantitative? explain

A

qualitative

epidermis thickness varies all over body eg thicker on sole of foot

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8
Q

breslow thickness: define and levels

A

mm thickness of melanoma, reflects depth of penetration in to skin
0-0.99mm: lower risk
1-3.99mm: intermediate risk
4mm +: higher risk

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9
Q

7 reasons for urgent referral to LSMDT

A
  • new mole after puberty which is changing shape/ colour/ size
  • long standing mole changing shape/ colour/ size
  • mole with or more colours and lost symmetry
  • mole itching/ bleeding
  • any new persistent skin lesion esp if growing/ pigmented/ vascular and if diagnosis not clear
  • new pigmented damage to nail esp where there is associated damage to nail
  • lesion growing under nail
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10
Q

what to include in HISTORY of malignant melanoma 5

A
  • duration of lesion
  • change in size
  • change in colour
  • change in shape
  • symptoms eg itching, bleeding
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11
Q

what to include in EXAMINATION of malignant melanoma 4

A
  • site
  • size
  • elevation
  • description (margins, pigmentation,ulceration)
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12
Q

what is the least deadly skin cancer

A

basal cell carinoma

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13
Q

describe basal cell carcinoma 4

A
  • slow growing
  • locally invasive
  • malignant
  • epidermal
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14
Q

pattern of bcc tissue infiltration

A

3 dimensional contigious pattern

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15
Q

7 clinical appearances of bcc

A
  • nodular
  • cystic
  • ulcerating
  • superficial
  • morphoeic/ sclerosing: spread out from margins
  • keratotic
  • pigmented
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16
Q

risk factors of bcc 4

A

UV sunlight exposure
inc age
male
gorlins sydrome (multiple keratinous tumours of jaws)

17
Q

most common cancer in USA/ UK

2nd most common

A

basal cell carcinoma

2. squamous cell carcinoma

18
Q

6 factors affecting prognosis of bcc

A
  • tumour size
  • tumour site
  • tumour type/ definition of margins
  • growth pattern
  • recurrent tumours
  • immunocompromised pts
19
Q

6 surgical techniques used for bcc

A

destructive :

  • currettage & cautery/ electrodisection
  • cryosurgery
  • carbondioxide laser

excisional: primary, recurrent, mohs’ micrographic surgery

20
Q

what is mohs micrographic surgery and stages

A

maps tumour so no healthy tissue is removed

  1. saucer shaped patch of tissue removed
  2. removed tissue is cut in to sections, stained and marked on a detailed diagram (Mohs map)
  3. roots of cancer identified on undersurface/ edge of map. if residual cancer is found, mohs map used to guide removal
  4. when this is repeated so no cancer remains, surgical defect is ready for repair
21
Q

bcc surgical margins mm margin and % cure

a. well-defined lesions
b. morphoieic lesions

A

a. 3mm surgical margin 85% cure
- -> 4-5mm surgical margin 95% cure

b. morphoeic lesions:
3mm margin 66%
5mm margin 82%
13-15mm margin >95%

22
Q

7 non surgical techniques for bcc

A
  • radiotherapy
  • chemotherapy
  • topical therapy
  • intralesion interferon
  • photodynamic therapy
  • palliative therapy
  • retinoids
23
Q

causes of squamous cell carcinoma scc 3

A
  1. chronic sun exposure
  2. injuries to skin (burns, sores, chemicals eg arsenic, petroleum
  3. spontaneous on normal, healthy skin
24
Q

people more at risk of scc

A

fair, blue/ green/ grey eye, light hair, spend a lot of time in the sun

25
Q

6 factors affecting metastatic potential of cutaneous scc

A
  • site
  • size (diameter): >2cm more likely to recur locally
  • size (depth/ invasion): >4mm depth or extending in to subcutaneous tissue more likely to recur/ metastasize
  • histological differentiation/ subtype: more serious if poorly differentiated/ perineural involvment/ lymphatic/ vascular invasion
  • host immunosuppression
  • previous tx/ tx modality
26
Q

order of common sites of scc 5

A
  1. sun exposed sites (not lip or ear)
  2. lip
  3. ear
  4. non sun exposed eg perineum, sacrum , sole of foot
  5. areas of radiation/ thermal injury/ chronic draining sinuses/ chronic ulcers/ chronic inflammation/ Bowens disease
27
Q

describe low risk scc 5

A
  • arising at sun exposed sites exluding lip or ear
  • tumours up to 20mm diameter
  • up to 4mm depth, confined to epidermis
  • well-differentiated
  • no evidence of immune dysfunction
28
Q

surgical margins for cutaneous scc

A

2cm tumour/ poorly differentiated/ extending subcutaneous/ ear/ lip/ scalp/ eyelids/ nose: 6mm margin/ mohs micrographic surgery/ examine histologically

29
Q

name and describe 2 pre-malignant conditions

A
  • actinic/ solar keratosis: rough, scaly, slightly raised growths that range in colour brown - red and may be up to 2cm diameter
  • actinic cheilitis: actinic keratosis in lips –> dry, cracked, scaly, pale, white. lower lip (more exposed to sun)
30
Q

treatment of pre malignant conditions 8

A
  • curettage/ electrodesiccation
  • excisional surgery
  • x ray
  • mohs excisional surgery
  • cryosurgery
  • laser surgery
  • photodynamic therapy
  • imiquimod, 5 fluorouracil, topical diclofenac
31
Q

prognosis of pre malignant conditions and issues

A

10% progression to scc (more likely in over 70s)

not cost effective to treat all pre malignant lesions

32
Q

what things about a person increases risk of skin cancer

A

white 80%
freckles
family history
hair and eye colour

Year 3 Human Disease (28 decks)

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