Skin Cancer

Question 1

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

Answer 1

blistering burns

esp during childhood

Question 2

describe BCC?

Answer 2

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

Question 3

sub-types of BCC?

Answer 3

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

Question 4

how is each sub-type of BCC managed?

Answer 4

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

Question 5

what topical creams can be used in superficial BCC?

Answer 5

5-FU

imiquimod

Question 6

what is Mohs surgery?

Answer 6

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)

Question 7

how might superficial BCCs appear?

Answer 7

red
irregular
can have some crusting and pinpoint bleeding

Question 8

what is actinic keratosis?

Answer 8

partial thickness dysplasia of keratinocytes

Question 9

what is bowens disease?

Answer 9

full thickness dysplasia of keratinocytes

Question 10

what is SCC?

Answer 10

full thickness dysplasia of keratinocytes + invasion of basement membrane

Question 11

how is actinic keratosis managed?

Answer 11

topical creams
photodynamic therapy
cryotherapy (good for solitary lesion)

Question 12

what does the term field exposure mean?

Answer 12

large area of skin all dysplastic from sun exposure

can be a mixture of SCC, actinic keratoses etc

Question 13

how is field exposure managed?

Answer 13

surgical excision of SCCs

topical therapy for actinic keratoses

Question 14

how is bowens disease managed?

Answer 14

topical therapy

Question 15

where are SCCs likely to occur in smokers?

Answer 15

lips

Question 16

SCCs in which areas are most likely to metastasise?

Answer 16

ears and lips

Question 17

what is a keratoacanthoma?

Answer 17

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)

Question 18

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

Answer 18

wound not healing
becomes exophytic (growing outwards)

Question 19

immunocompromised people more likely to get SCC or BCC?

Answer 19

SCC

Question 20

where do most melanomas occur?

Answer 20

back in men

legs in women

Question 21

risk factors for melanoma?

Answer 21

same as BCC and SCC

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

Question 22

major criteria indicating a malignant mole?

Answer 22

change in shape
change in size
change in colour

Question 23

minor criteria indicating a malignant mole?

Answer 23

diameter >6mm
bleeding
sensory change
inflammation

Question 24

biggest risk of malignant evolution in a mole?

Answer 24

changing mole

Question 25

ABCDE of assessing moles?

Answer 25

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

Question 26

standard practice if you think its a melanoma?

Answer 26

excise with 2mm margins

Question 27

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

Answer 27

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

Question 28

types of melanoma?

Answer 28

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

Question 29

which type of melanoma has the worst prognosis?

Answer 29

nodular

doesnt have a radial growth phase, just immediately vertical growth

Question 30

melanoma growth phases?

Answer 30

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

Question 31

what is the best predictor of prognosis in skin cancer?

Answer 31

breslow thickness

Question 32

what is breslow thickness?

Answer 32

depth from granular layer

Question 33

how does lentigo maligna commonly present?

Answer 33

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

Question 34

how is lentigo maligna managed in radial growth phase?

Answer 34

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

Question 35

acral melanoma is more common in which skin types?

Answer 35

darker skin

Question 36

what signs can indicate active growth?

Answer 36

starburst pattern

satellite lesions

Question 37

amelanotic melanomas are more common in which skin types?

Answer 37

people who dont produce much eumelanin (brownish one)

ie - celtic skin types (1 and 2)

Question 38

how is malignant melanoma managed?

Answer 38

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

Question 39

what determines the size of excision?

Answer 39

breslow thickness

Question 40

how does breslow thickness affect survival?

Answer 40

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