Skin Cancer Flashcards

1
Q

what type of sun burn causes the biggest risk of skin cancer?

A

blistering burns

esp during childhood

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2
Q

describe BCC?

A

telangectasia
can have rolled edge
pearlescent
locally invasive but doesnt tend to spread distantly

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3
Q

sub-types of BCC?

A

nodular (raised but well defined)
superficial (flat and well defined)
infiltrative (less well defined)

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4
Q

how is each sub-type of BCC managed?

A
nodular = surgical excision
superficial = topical cream or cryotherapy or photodynamic therapy
infiltrative = mohs surgery
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5
Q

what topical creams can be used in superficial BCC?

A

5-FU

imiquimod

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6
Q

what is Mohs surgery?

A

surgical excision of cancer with small margin, then look at sample under microscope to check youve got all the cancer call (can go back and take more if needed)

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7
Q

how might superficial BCCs appear?

A

red
irregular
can have some crusting and pinpoint bleeding

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8
Q

what is actinic keratosis?

A

partial thickness dysplasia of keratinocytes

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9
Q

what is bowens disease?

A

full thickness dysplasia of keratinocytes

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10
Q

what is SCC?

A

full thickness dysplasia of keratinocytes + invasion of basement membrane

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11
Q

how is actinic keratosis managed?

A

topical creams
photodynamic therapy
cryotherapy (good for solitary lesion)

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12
Q

what does the term field exposure mean?

A

large area of skin all dysplastic from sun exposure

can be a mixture of SCC, actinic keratoses etc

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13
Q

how is field exposure managed?

A

surgical excision of SCCs

topical therapy for actinic keratoses

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14
Q

how is bowens disease managed?

A

topical therapy

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15
Q

where are SCCs likely to occur in smokers?

A

lips

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16
Q

SCCs in which areas are most likely to metastasise?

A

ears and lips

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17
Q

what is a keratoacanthoma?

A

skin lesion which occurs in sun-damaged skin
grows very quick over a few weeks-months then regresses
are typically well defined growths with a central keratin plug (look like a volcano)
can have features of SCC (keratin) and BCC (rolled edges and telangectasia)

18
Q

SCCs can complicate chronic wounds, what might indicate that theres an SCC present?

A
wound not healing
becomes exophytic (growing outwards)
19
Q

immunocompromised people more likely to get SCC or BCC?

A

SCC

20
Q

where do most melanomas occur?

A

back in men

legs in women

21
Q

risk factors for melanoma?

A

same as BCC and SCC

but also having large number of moles increases chances of one becoming malignant

22
Q

major criteria indicating a malignant mole?

A

change in shape
change in size
change in colour

23
Q

minor criteria indicating a malignant mole?

A

diameter >6mm
bleeding
sensory change
inflammation

24
Q

biggest risk of malignant evolution in a mole?

A

changing mole

25
Q

ABCDE of assessing moles?

A
A = asymmetry
B = border
C = colour (Multiple colours)
D = diameter (>6mm)
E = elevation or evolution
26
Q

standard practice if you think its a melanoma?

A

excise with 2mm margins

27
Q

how are people with multiple atypical moles or a family history of atypical moles monitored?

A

initially monitor every 3 months, then 6 monthly, then yearly
always look for the “ugly duckling”

28
Q

types of melanoma?

A
superficial spreading
nodular
lentigo maligna 
acral
amelanotic (dont produce any pigment)
29
Q

which type of melanoma has the worst prognosis?

A

nodular

doesnt have a radial growth phase, just immediately vertical growth

30
Q

melanoma growth phases?

A

radial (in dermis, no metastatic potential, melanoma in situ)
vertical (growing down the way, able to metastasise)

31
Q

what is the best predictor of prognosis in skin cancer?

A

breslow thickness

32
Q

what is breslow thickness?

A

depth from granular layer

33
Q

how does lentigo maligna commonly present?

A

often on the face in elderly people

can look like brown patch in radial phase, only really known as lentigo maligna once in vertical growth phase

34
Q

how is lentigo maligna managed in radial growth phase?

A

can be managed topically with imiquimod
but still need to do punch biopsy of worst looking bit to check its not in vertical growth phase as topical therapy wont work in vertical phase

35
Q

acral melanoma is more common in which skin types?

A

darker skin

36
Q

what signs can indicate active growth?

A

starburst pattern

satellite lesions

37
Q

amelanotic melanomas are more common in which skin types?

A

people who dont produce much eumelanin (brownish one)

ie - celtic skin types (1 and 2)

38
Q

how is malignant melanoma managed?

A

surgical excision +/- sentinel node biopsy
role of chemotherapy, radiotherapy and immunotherapy
advanced malignant melanomas difficult to treat

39
Q

what determines the size of excision?

A

breslow thickness

40
Q

how does breslow thickness affect survival?

A

confined to epidermis (in situ) = 100% 5 year survival
thickness <0.76mm = 90% 5 year survival
thickness >3mm = 60% 5 year survival