Melanoma

Question 1

what are the two types of melanoma

Answer 1

1. melanoma

2. non-melanoma

Question 2

what does malignant melanoma arise from?

Answer 2

arises from melanocytes

Question 3

genetics of malignant melanoma

Answer 3

CDKN2A (tumour suppressor) and CDK4 (oncogene, cell cycle with Rb)

Question 4

four types of malignant melanoma

Answer 4

1. superficial spreading
2. acral/mucosal lentiginous
3. lentigo maligna
4. nodular

Question 5

sites for superficial spreading melanoma

Answer 5

trunk and limbs

Question 6

sites for lentigo maligna melanoma

Answer 6

sun damaged areas, commonly face, neck, scalp

Question 7

describe nodular melanoma

Answer 7

• commonest cancer
• slow growing nodule
• pearly
• telangiectasia
• excellent prognosis
• surgical excision

Question 8

how does SSM, A/MLM and LMM grow?

Answer 8

• grow as macules either as in-situ or with dermal micro invasion (RGP)
• can invade dermis (VGP)

Question 9

is nodular melanoma a VGP?

Answer 9

yes

Question 10

presentation of melanoma

Answer 10

Asymmetry
ill-defined border
two or more colours
wide diameter, non symmetrical 
speed of change

Question 11

when is speed of change the most important factor in presentation?

Answer 11

atypical mole syndrome

Question 12

spread of malignant melanoma

Answer 12

• dermal lymphatics
• regional lymph nodes
• blood

Question 13

diagnosis of malignant melanoma

Answer 13

• Breslow thickness (deepest part of the tumour from granular layer)
• other prognostic indicators are ulceration, mitotic rate, invasion, lymph node involvement

Question 14

management of malignant melanoma

Answer 14

• targeted therapy e.g. vemurafenib, dabrafenib
• excision of lesions
• sun protection measures
• chemo/radiotherapy

Question 15

example of a benign epidermal tumour

Answer 15

seborrheic keratosis (basal cell papilloma)

Question 16

define seborrheic keratosis

Answer 16

benign proliferation of epidermal keratinocytes

Question 17

sites of seborrheic keratosis

Answer 17

face

trunk

Question 18

presentation of seborrheic keratosis

Answer 18

ageing skin
well-defined
stuck on appearance (greasy hyperkeratotic surface)
acanthosis
sign of Leser-Trelat

Question 19

management of seborrheic keratosis

Answer 19

reassurance

cryotherapy if troublesome

Question 20

what is special about precancerous dysplasias

Answer 20

they show squamous dysplasia

Question 21

examples of precancerous dysplasia

Answer 21

1. Bowen’s disease
2. actinic keratosis
3. viral lesions

Question 22

describe Bowen’s disease

Answer 22

full thickness dysplasia of epidermal keratinocytes (SCC in situ, no dermal invasion)

Question 23

presentation of Bowen’s disease

Answer 23

scaly patch/plaque
irregular border
legs
can mimic inflammatory conditions

Question 24

management of Bowen’s disease

Answer 24

imiquimod cream

surgical management

Question 25

diagnosis of Bowen's disease

Answer 25

diagnostic biopsy

Question 26

define actinic keratosis

Answer 26

common precursor of SCC (low rate of progression)

Question 27

presentation of actinic keratosis

Answer 27

sun-exposed sites scaly patch several atypical lesions- Bowenoid

Question 28

management of actinic keratosis

Answer 28

non-surgical

Question 29

describe precancerous dysplasia viral lesions

Answer 29

associated with HPV 16 | found on anogenital skin

Question 30

list of management options for precancerous dysplasia

Answer 30

- surgery - cryotherapy - 5-fluorouracil cream - imiquimod - PDT

Question 31

examples of invasive malignancies that are non-melanoma

Answer 31

1. basal cell carcinoma | 2. squamous cell carcinoma

Question 32

genetics of BCC

Answer 32

mutations in PTCH1 | hedgehog signalling pathway

Question 33

location of BCC

Answer 33

sun exposed sites

Question 34

presentation of BCC

Answer 34

slow growing painless and often ignored locally destructive no metastasis

Question 35

three types of BCC

Answer 35

nodular superficial infiltrative (morphoeic)

Question 36

management of basal cell carcinoma

Answer 36

``` vismodegib excision imiquimod PDT cryotherapy ```

Question 37

diagnosis of BCC

Answer 37

skin biopsy

Question 38

presentation of nodular BCC

Answer 38

pearly nodule | blood vessels visible

Question 39

presentation of superficial BCC

Answer 39

erythematous, scaly, irregular bordered plaque | pearly whipcord margin

Question 40

presentation of infiltrative BCC

Answer 40

waxy scar-like plaque indistinct border

Question 41

associations of squamous cell carcinoma

Answer 41

``` elderly immunosuppressed chronic leg ulcers chronic lupus vulgaris xeroderma pigmentosum dystrophic variant epidermolysis bullosa ```

Question 42

presentation of SCC

Answer 42

hyperkeratotic wart/ulcer/lump fast growth painful bleeding

Question 43

spread of SCC

Answer 43

can spread locally to bone and lymph nodes

Question 44

management of SCC

Answer 44

excision

Question 45

describe miscellaneous tumours

Answer 45

enormous range that can arise from sweat glands, smooth muscle, arrector pili, lymphatics, Langerhans, Merkel and fat

Question 46

five risk factors for skin cancer development

Answer 46

``` sun exposure genetic predisposition immunosuppression environmental carcinogens phototoxic drugs ```

Question 47

how does sun exposure cause skin damage

Answer 47

multiple p53 mutations UVB direct DNA damage UVA indirect oxidative damage deeper into the skin depletes Langerhans

Question 48

genetic predispositions to skin cancer

Answer 48

- DNA repair syndrome xeroderma pigmentosum - albinism: congenital AR absence of melanin - Gorlin's syndrome: AD condition with multiple BCC - recessive dystrophic epidermolysis bullosa

Question 49

examples of phototoxic drugs

Answer 49

``` voriconazole thiazide diuretics NSAIDS anti-TNF azathioprine ```

Question 50

describe Gorlin's syndrome

Answer 50

naevoid basal cell carcinoma

Question 51

describe albinism

Answer 51

absence or defect of tyrosine | visual problems too due to lack of pigment (photophobia, nystagmus, amblyopia)