Non Melanoma

Question 1

BCC Lesions are also known as

Answer 1

rodent ulcers

Question 2

BCC are characterised by?

Answer 2

slow-growth and local invasion

Question 3

BCC mets common

Answer 3

false

Metastases are extremely rare.

Question 4

BCC is the most common type of cancer in the Western world.

Answer 4

true

Question 5

many types of BCC are described. The most common type is

Answer 5

nodular BCC

Question 6

Features of BCC?

Answer 6

sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’

Question 7

generally, if a BCC is suspected, a routine referral should be made

Answer 7

true

Question 8

BCC mx?

Answer 8

surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
topical chemotherapy
radiotherapy

Question 9

What is Bowen’s disease?

Answer 9

precancerous dermatosis that is a precursor to squamous cell carcinoma. It is more common in elderly patients.

Question 10

In bowen’s There is around a ?% chance of developing invasive skin cancer if left untreated.

Answer 10

There is around a 5-10% chance of developing invasive skin cancer if left untreated.

Question 11

Features of Bowen’s disease?

Answer 11

red, scaly patches
often 10-15 mm in size
slow-growing
often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs

Question 12

Management of Bowen;s is always in hospital

Answer 12

false

may sometimes be diagnosed and managed in primary care if clear diagnosis or repeat episode

Question 13

Mx bowen’s

Answer 13

topical 5-fluorouracil
typically used twice daily for 4 weeks
often results in significant inflammation/erythema. Topical steroids are often given to control this
cryotherapy
excision

Question 14

Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in ?% of patients.

Answer 14

Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.

Question 15

Risk factors SSC

Answer 15

excessive exposure to sunlight / psoralen UVA therapy
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers
genetic conditions

Question 16

Which conditions are precursors for SCC

Answer 16

actinic keratoses and Bowen’s disease

Question 17

What are long-standing leg ulcers also called?

Answer 17

Marjolin’s ulcer

Question 18

What genetic conditions are associated with SCC?

Answer 18

xeroderma pigmentosum, oculocutaneous albinism

Question 19

What is actinic keratoses?

Answer 19

Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure.

Question 20

Features of actinic keratoses?

Answer 20

small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present

Question 21

for actinic keratoses Management options include

Answer 21

prevention of further risk: e.g. sun avoidance, sun cream

fluorouracil cream
topical diclofenac
topical imiquimod
cryotherapy
curettage and cautery

Question 22

Points for using fluorouracil cream in actinic keratoses?

Answer 22

typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation

Question 23

When is topical diclofenac used in actinic keratoses?

Answer 23

may be used for mild AKs. Moderate efficacy but much fewer side-effects

Question 24

In BCC you don’t need a diagnostic test for surgery

Answer 24

false

As a minimum a diagnostic punch biopsy should be taken if treatment other than standard surgical excision is planned.

Question 25

What is Kaposi Sarcoma?

Answer 25

Tumour of vascular and lymphatic endothelium.
Purple cutaneous nodules.
Associated with immuno supression.

Question 26

Kaposi sarcoma affects who?

Answer 26

Classical form affects elderly males

Question 27

Kaposi sarcoma is slow growing

Answer 27

true

Question 28

Kaposi sarcoma - Immunosupression form is much more aggressive

Answer 28

true

tends to affect those with HIV related disease.

Question 29

The vast majority of NMSC’s are related to UV light exposure.

Answer 29

true

Question 30

Describe pattern of different skin cancer NMSC & sun exposure

Answer 30

or SCC’s the major pattern is chronic long-term exposure.

For BCC’s, the pattern of sporadic exposure with episodes of burning is more important.

Question 31

The incidence of NMSC’s increases with age and whilst there is a female preponderance in those under 40 years of age, in later life the sex incidence is roughly equal.

Answer 31

true

Question 32

Organ transplant recipients have a markedly increased incidence of

Answer 32

SCC
In addition to this increased risk, transplant recipients are also more likely to develop locoregional recurrences following treatment.

Question 33

Which virus DNA is found in the majority of transplant recipient SCC’s.

Answer 33

Human papilloma

Question 34

Actinic keratosis is viewed as a premalignant lesion because?

Answer 34

there are atypical keratinocytes present in the epidermis. In a person with 7 actinic keratosis, the risks of subsequent SCC is of the order of 10% at 10 years. The primary lesion is a rough erythematous papule with a white to yellow scale. Lesions are typically clustered at sites of chronic sun exposure.

Question 35

The commonest clinical presentation of SCC is

Answer 35

an erythematous keratotic papule or nodule on a background of sun exposure. Ulceration may occur and both exophytic and endophytic areas may be seen. Regional lymphadenopathy may be present.

Question 36

Pathology SCC?

Answer 36

Pathologically there is a downward proliferation of malignant cells and invasion of the basement membrane. Poorly differentiated lesions may show perineural invasion and require immunohistochemistry with S100 to distinguish them from melanomas (which stain strongly positive with this marker).

Question 37

Types of BCC?

Answer 37

Nodular BCC
Superficial BCC
Morpheaform BCC
Cystic BCC
Basosquamous carcinoma

Question 38

Describe Nodular BCC?

Answer 38

Raised translucent papule
Usually affect the face
Large nodular BCC’s are locally destructive

Question 39

Describe Superficial BCC?

Answer 39

Usually appears as superficial erythematous macule affecting the trunk
Younger age at presentation (mean 57)
May show areas of spontaneous regression
Horizontal growth patter predominates
High recurrence rate (due to subclinical lateral spread)

Question 40

Describe Morpheaform BCC

Answer 40

Macroscopically resembles flat, slightly atrophic lesion or plaque without well-defined borders
Tumour has sub clinical lateral spread which increases recurrence rates

Question 41

Describe Cystic BCC

Answer 41

Often have clear or blue-grey appearance

Cystic degeneration may not be clinically obvious and tumour may resemble nodular BCC

Question 42

Describe Basosquamous carcinoma?

Answer 42

Atypical BCC
Basaloid histological BCC features with eosinophilic squamoid features of SCC
Biologically more aggressive and are more locally destructive
Rare lesion accounts for 1% of all non-melanoma skin cancers
Metastatic disease may occur in 9-10% of cases and resemble an SCC

Question 43

Keratoacanthoma is usually premalignant

Answer 43

false

They are generally benign lesions although some do view them as precursors of malignancy.

Question 44

Describe keratoacanthoma

Answer 44

Dome-shaped erythematous lesions that develop over a period of days and grow rapidly. They often contain a central pit of keratin. They then begin to necrose and slough off.

Question 45

Mx keratoacanthoma

Answer 45

They may be treated by curettage and cautery. If there is diagnostic doubt (they can mimic malignancy) then formal excision biopsy is warranted.

Question 46

Describe pyogenic granuloma

Answer 46

These present as friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common.

Question 47

Mx pyogenic granuloma

Answer 47

They may be treated with curettage and cautery, formal excision may be used if there is diagnostic doubt.

Question 48

What is Leukoplakia?

Answer 48

Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.

Question 49

Leukoplakia is said to be a diagnosis of exclusion. What should be considered?

Answer 49

Candidiasis and lichen planus should be considered, especially if the lesions can be ‘rubbed off’
Biopsies are usually performed to exclude alternative diagnoses such as squamous cell carcinoma

Question 50

Why is Leukoplakia followed up?

Answer 50

regular follow-up is required to exclude malignant transformation to squamous cell carcinoma, which occurs in around 1% of patients.

Question 51

Skin types may be classified according to Fitzpatrick classification:

Answer 51

I: Never tans, always burns (often red hair, freckles, and blue eyes)
II: Usually tans, always burns
III: Always tans, sometimes burns (usually dark hair and brown eyes)
IV: Always tans, rarely burns (olive skin)
V: Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)
VI: Black skin (e.g. Afro-Caribbean), never tans, never burns