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Question 1

Risk factors for squamous cell carcinoma of skin:

Answer 1

Sunlight exposure
Psoralen UVA therapy
Actinic keratoses and Bowen’s Disease (premalignant)
Immunosuppression
Smoking
Long standing leg ulcers
Genetic conditions e.g. xeroderma pigmentosum

Question 2

What is the most common type of cancer in the western world?

Answer 2

Basal cell carcinoma

Question 3

Top 3 types of skin cancer:

Answer 3

Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma

Question 4

4 types of basal cell carcinoma:

Answer 4

Nodular
Superficial
Pigmented
Morphoiec / sclerotic

Question 5

Pathophysiology of basal cell carcinoma:

Answer 5

Basal cell’s DNA controls new creation of skin cells.
Mutation in the DNA causes basal cell to multiple rapidly, and continue to when it would normally die.
Accumulation of cells form a tumour.

(Rarely a PCTH gene is involved)

Question 6

Where are most of the basal cell carcinomas found?

Answer 6

Head, neck, sun exposed areas.

Question 7

Features of a nodular bcc:

Answer 7

Most common type of facial bcc
Shiny pearly lesion
Nodule >0.5cm raised
Telangiectasia
Rolled edge
Centrally ulcerated
Non painful

Question 8

Features of a superficial bcc:

Answer 8

Slightly scaly irregular plaque
Thin rolled edges
Dermascopic investigation needed

Question 9

Features of pigmented bcc:

Answer 9

Similar to nodular, shiny, rolled edges and blood vessels, pigmented so it is darker.

Question 10

Features of morphoiec / sclerotic bcc:

Answer 10

Very shiny compared to other skin, margins often unclear.
Wxy, scar like plaque with indistinct borders.

Wide and deep subclinical extension.
Can infiltrate cutaneous nerves.

Question 11

Which is the second most common skin cancer?

Answer 11

Squamous cell carcinoma

Question 12

Where are high-risk sites for scc?

Answer 12

Ears, lips –> risk of mets is 10-30%

Question 13

Risk factors for development of melanoma:

Answer 13

MAINLY UV, rarely genetic.

UV
Sunburn during childhood
Number and size of melanocytic nevi
Hx of melanoma
High socioeconomic status
Equatorial latitude
DNA repair defects - xeroderma pigmentosum
Immunosuppression

Question 14

What is a melanoma?

Answer 14

Malignant tumour of melanocytes, most common in skin but can be found in bowel and eye as well.
Begins as uncontrolled proliferation of melanocytic stem cells that have undergone acquired or inherited genetic mutations.

Question 15

What determines the prognosis of melanoma?

Answer 15

DEPTH at presentation - BRESLOW depth; 5 year survival is based on this.

Non-ulcerated 5 year survival = 97%, reduces to 70% if >4mm.

Radial growth first, and then vertical in timeline.

Question 16

Subtypes of melanoma:

Answer 16

Superficial spreading - most common
Nodular - pigmented and black
Acral - hands, feet or nails, type IV skin
Subungual - under nails
Amelanotic - no pigment
Lentigo maligna - precursor, usually on face with sun damaged skin
Melanoma in situ - precursor, anywhere but the face

Question 17

Surgical excision of melanoma margins:

Answer 17

Breslow <1mm = 1 cm margin

Breslow >1mm = 2cm margin

Question 18

Referral of suspected skin cancer:

Answer 18

Basal cell carcinomas progress slowly, rarely metastasis and therefore do not require an urgent referral.

Can mostly refer to local outpatient dermatology clinic for triage.

Question 19

Features of squamous cell carcinoma (skin):

Answer 19

Hyperkeratotic, crusty and inflamed, with thick scales.
Often on face / sun exposed sites.

Grow over weeks to months, are often painful and they may ulcerate.

Question 20

What is alopecia areata?

Answer 20

A presumed autoimmune condition affecting hair follicles causing hair loss. Typically presents with discrete bald pathces on scalp but can cause hair loss all over the body.

Question 21

Features of alopecia areata:

Answer 21

Slow progression
Isolated patches of hair loss, well circumscribed
Stubble regrowth / exclamation
Occasional itching / burning
Loss of eyebrows, eyelashes
Loss of body hair?
Hx of other autoimmune conditions.

Question 22

Pathophysiology of alopecia:

Answer 22

Autoimmune disorder characterised by t cells around the follicles.
These CD8+ release pro inflammatory cytokines and chemokines that reject the hair.
‘Antibodies against hair follicle’.

Question 23

Triggers / causes of alopecia:

Answer 23

Family history?
Trauma
Triggered viral infection
Hormonal change
Emotional / physical stress

Question 24

5 different types of alopecia:

Answer 24

1. Patchy - scalp, eyebrows, eyelashes, beard. Localised areas.
2. Alopecia totalis - all scalp hair is lost
3. Alopecia universalis - all body hair is lost
4. Alopecia ophiasis - localised to sides and lower back of the scalp
5. Diffuse - ‘overnight graying’, sudden thinning of scalp hair, and persisting hair goes white/grey
6. Nails - affects 10-50% of those with alopecia. Pitting and ridging, koilonychia and onycholysis

Question 25

Classification of a squamous cell tumour:

Answer 25

Well differentiated / moderately well / poorly / anaplastic

Question 26

Features of high risk squamous cell carcinoma:

Answer 26

Diameter 2 or more cm.
Ear, lip, central face, hands, feet or genitalia.
Elderly or immunosuppressed patient.
Histological thickness >2mm, poorly differentiated histology or subcut tissue, nerve, blood vessel invasion.

Metastatic scc is found in lymph nodes (80%), lungs, liver, brain, bones and skin.

Question 27

Which type of skin cancer is Parkinson’s disease associated with?

Answer 27

Melanoma

Question 28

Glasgow 7 point check list for melanoma:

Answer 28

Describes features of a melanoma.

Major:
change in size
irregular shape
irregular colour

Minor:
diameter >7mm
inflammation
oozing
change in sensation

Question 29

ABCDEFG of melanoma:

Answer 29

Asymmetry
Border irregularity
Colour variation and change
Different
Evolving

Nodular melanomas may also have:

Elevated
Firm to touch
Growing