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Dermatology > Non-Melanoma skin cancers and benign skin tumours > Flashcards

Non-Melanoma skin cancers and benign skin tumours Flashcards

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Dermatology Board Prep flashcards
1
Q

What are some examples of premalignant lesions

A

actinic keratosis

intraepidermal carcinoma /bowens/SCC in-situ

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2
Q

whats another name for actinic keratosis

A

solar keratosis

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3
Q

what % of people are affected by actinic keratosis

A

20%

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4
Q

what is the risk of progression to SCC for actinic keratosis

A

<1:1000 p/y

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5
Q

what are features of actinic keratosis

A

single or multiple lesions, macular/patches of scaling skin with erythema, usually in sun exposed areas in older people

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6
Q

what symptoms to actinic keratosis have

A

usually asymptomatic

may be sore/itch

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7
Q

what are the treatment options for AK

A 
do nothing - 25% resolve spontaneously 
cryotherapy - 95-100% cure rate
5FU cream 
curettage and cautery 
PDT
diclofenac gel
imiquimod
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8
Q

how do you choose first line treatment for AK

A

discrete lesions = cryotherapy

5-FU for diffuse lesions

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9
Q

what is intraepidermal carcinoma

A

dysplasia extending through the full thickness of the epidermis

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10
Q

where is IEC/Bowens usually found

A

lower legs of elderly women

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11
Q

whats the risk of malignant transformation for IEC/Bowens

A

3-5%

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12
Q

whats the treatment option for IEC/Bowens

A 
5-FU cream
cryotherapy
curettage/cryotherapy
excision
PDT
imiquimod
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13
Q

when is cryotherapy avoided for IEC/Bowens

A

if on lower legs to avoid ulceration

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14
Q

what is preferred when treating Bowens/IEC if ulceration is particularly risky (IE cryotherapy is contraindicated)

A

PDT (photodynamic Therapy)

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15
Q

what are some examples of non-melanocytic malignant lesions

A

BCC

SCC

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16
Q

what proportion of non-melanocytic malignant lesions are BCCs

A

80%

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17
Q

what are features of BCCs

A

slow growing, asymptomatic lesion with a rolled/pearled edge , usually on sun exposed areas

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18
Q

what are the subtypes of BCCs

A

nodular
superficial
morpheic/sclerosis
pigmented

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19
Q

what are most common areas for BCCs to be on

A

trunk

face

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20
Q

what are features of BCCs at high risk of recurrence

A 
increased size 
central face
poorly defined margins 
morpheic-subtype
histological invasion
previous treatment failure
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21
Q

whats the first line treatment for BCC

A

surgical excision with 5mm margins

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22
Q

whats the treatment success for first-line intervention for BCC + whats the recurrence rate

A

95% , 2%

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23
Q

what is done for BCCs with high risk of recurrence + whats the success rate of that surgery

A

moh’s micrography, 99% BCC, 95% for high risk recurrence BCCs

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24
Q

what is moh’s micrography surgery

A

bulk of tumour is excised
margins removed carefully with a biopsy punch and each punch is quickly examined with reports giving histological analysis in 4 directions (e.g. 12 clear, 3,6,9 tumour)

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25
Q

what are risks of radiotherapy for BCC

A

radionecrosis and possible SCC at the site

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26
Q

what is imiquimod - + how useful is it

A

topical immune modulator, good for low risk tumours, increased recurrence rates compared to surgery but decreased cosmetic damage

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27
Q

what should always be done if a BCC is suspected

A

confirm with biopsy

28
Q

which non-melanocytic malignant lesion has the highest risk for metastasis

A

SCC

29
Q

whats the 5 year survival for SCC

A

75-90%

30
Q

what factors increase the risk for mets for SCCs

A 
ear/lip SCC
>2cm 
increased depth 
non sun exposed areas
poor differentiation 
immunosuppresion 
mucosal subtype
perineural invasion
31
Q

what are features of SCCs

A

much shorter timeframe (weeks) , firm skin coloured nodule with keratinised surface/soft fleshy nodule with eroded surface and a non healing wound

32
Q

what is the best treatment for SCCs +whats its success

A

Excision with a 4mm margin, 95%

33
Q

what can be used for small primary SCC

A

curettage and cautery

34
Q

what are some examples of non-melanocytic benign lesions

A 
dermatofibroma 
neurofibroma 
epidermoid and pilary cysts 
keratocanthoma
strawberry naevus
cherry angioma
pyogenic granuloma
seborrhoeic keratosis 
viral warts 
cutaneous horn
35
Q

what is a dermatofibroma

A

benign discrete solitary dermal nodules on the extermities of young adults

overlying epidermis pigmented

36
Q

what is the iceberg effect

A

a nodule feels bigger than it is

37
Q

how do you manage a dermatofibroma

A

leave alone unless there is diagnostic doubt

38
Q

what is a neurofibroma

A

PNS neural sheath tumour

39
Q

what is the aetiology of neurofibroma

A

90% stand alone tumours

10% in NF-1

40
Q

what are some features of neurofibromatosis-1

A

cafe au lait patches
axillary freckling
lisch nodules

41
Q

what are epidermoid/pilar cysts

A

common swelling with a central punctum what ruptures with a foul-smelling material

histologically lined with epidermis or outer sheath or hair follicle (hence epidermoid/pilar)

42
Q

how do you treat epidermoid/pilar cysts

A

excision

43
Q

what are keratocanthomoas

A

rapidly enlarging pink papule that then forms a crater in the center, rapidly resolves in 6-12 months but leaves an ugly scar

44
Q

who tends to get a keratocanthoma + where does it tend to be

A

fair individuals, on sun exposed areas

45
Q

what other dermatological lesion does a keratocathoma look like + how is it different

A

an SCC- but its quite symmetrical and faster growing

46
Q

what is a strawberry naevus

A

haemangioma present within a few weeks of birth

raised compressible swelling with bright red surface

47
Q

how is a strawberry naevus managed

A

do nothing as usually spontanteously resolves - 50% by 5, 90% by 9

48
Q

what are complications with strawberry naevus and how do you manage

A

bleed/ulceration following trauma = observe/reassure

functional issues = high dose systemic steroids

plastic surgery rarely done

49
Q

what is a cherry angioma

A

benign red papules seen on the trunks of middle-aged + eldery people

50
Q

what is a pyogenic granuloma

A

common benign acquired haemangioma developing at sites of trauma most commonly in kids-young adults

bright red raised lesions

51
Q

whats an important differential for a pyogenic granuloma

A

amelanotic malignant melanoma

52
Q

how do you remove a pyogenic granuloma

A

curettage and cautery

53
Q

what is seborrhoeic keratosis

A

common benign epidermal tumour found usually in >50s on the face/trunk

looks like ‘stuck on’ yellow/brown macules/plaques +/- scaling

54
Q

what % of schoolchildren have a viral wart at any one time

A

4-5%

55
Q

what virus is most commonly associated with viral warts

A

HPV, (1,2,4)

56
Q

what are the types of viral wart

A 
common
plantar
mosaic 
plane 
facial
anogenital
57
Q

what are the features of a common wart

A

smooth initially, eventually hyperkeratotic
on face/genitals
often multiple
pain is rare

58
Q

what are the features of a plantar wart

A

rough surfaces surrounded bt a horny collar, bleeding capillary loops (black dots) distiguish from corns, usually in multiples and painful

59
Q

what are the features of a mosaic wart

A

rough plawues of individual warts, most commonly on soles, palms and around fingers/

not painful

60
Q

what are features of plane warts

A

smooth flat-topped papules, found on face brow and back of hand, become inflamed then resolve spontaneously, skin coloured/light brown

usually multiple
usually painless

61
Q

what are features of facial warts

A

in breard area of males most commonly
spread by shaving
ugly but painless

62
Q

what are features of anogenital warts

A

papillomatous cauliflower-like lesions with moist macerated vascular surface
they may coalesce to form giant lesions
vaginal/anorectal mucosa may be affected

63
Q

what should be suspected if there is anogenital warts in kids

A

sexual abuse

but usually, it is autoinoculation from other areas

64
Q

what is a cutaneous horn + how should it be managed

A

compacted keratin - always do histology as there may be an AK/IEC/SCC at the base

may also be seborrheic keratosis

65
Q

what are some risk factors for skin cancer

A 
long term UV exposure
fair skin type
increased age
immunosuppression 
genetic 
site of chronic inflammation 
HPV (SCC)
66
Q

what genetic syndromes are higher risk for skin cancer development

A

gorlin’s syndrome for BCC

Xeroderma Pigmentosum

Dermatology (12 decks)

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