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Week 9 - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

Name and describe two benign skin lesions

A
  • Fibro epithelial polyps “skin tags”

* Seborrhoeic warts/keratoses

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2
Q

What two pathways interact to cause skin cancer?

A
  • Direct action of UV on target cells (keratinocytes) for neoplastic transformation via DNA damage
  • Effects of UV on the host’s immune system
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3
Q

What are the three main skin cancer types?

A
  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Malignant melanoma
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4
Q

What level of infiltration occurs in a squamous cell carcinoma?

A

Epidermis

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5
Q

What layer of infiltration occurs in a basal cell carcinoma?

A

Epidermis and dermis

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6
Q

Explain the pathogenesis of a basal cell carcinoma

A
  • Process of creating new skin cells is controlled by a basal cell’s DNA
  • A mutation in the DNA causes a basal cell to multiply rapidly and continue growing when it would normally die
  • The accumulating abnormal cells may form a tumour
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7
Q

Which gene mutation may predispose to a basal cell carcinoma?

A

PTCH

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8
Q

Where is the common site of basal cell carcinoma?

A

80% found on the head and neck/UV exposed sites

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9
Q

What is the appearance of a nodular basal cell carcinoma?

A
  • Shiny
  • Nodule i.e. raised lesion>0.5cm
  • Telangectasia/blood vessels
  • Often ulcerated centrally
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10
Q

What are the subtypes of basal cell carcinoma?

A
  • Nodular
  • Superficial
  • Pigmented
  • Morphoeic/sclerotic
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11
Q

What is the appearance of a morphoeic/sclerotic basal cell carcinoma?

A
  • Depressed area of skin

* Still shiny with increased blood vessels

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12
Q

What is the gold standard treatment of basal cell carcinoma?

A

Surgical excision with a 3-4mm margin

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13
Q

What are the treatments for basal cell carcinoma?

A
  • Surgical excision 3-4mm margin
  • Curettage and cautery
  • Cyrotherapy
  • Photodynamic therapy
  • Topical imiquimod/ 5- fluorouracil cream
  • Mohs micrographic surgery
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14
Q

What cell do squamous cell carcinomas originate from?

A

Keratinocytes

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15
Q

What are the pre-malignant variants of squamous cell carcinoma?

A
  • Actinic keratoses

* Bowen’s disease

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16
Q

Where do most squamous cell carcinomas present?

A
  • On skin regularly exposed to sunlight or other UV radiation
  • Can occur in normal skin or in skin that has been injured e.g. burns or chronically inflamed
17
Q

What are the risks of metastasis for basal cell carcinomas and squamous cell carcinomas?

A
  • Basal cell carcinoma has a low risk of metastasis

* Squamous cell carcinoma that is a high risk SCC has a 10-30% risk of metastasis (ears and lips are high risk sites)

18
Q

Describe the appearance of squamous cell caricnomas

A
  • Nodule
  • Keratin crust
  • Red background
19
Q

What is the gold standard treatment of squamous cell carcinoma?

A

Surgical excision with a 4mm margin

20
Q

What are the treatments for a pre malignant squamous cell carcinoma?

A
  • Topical imiquimod/ 5-fluorouracil cream
  • Cryotherapy
  • Photodynamic therapy
21
Q

What is a melanoma?

A

Malignant tumour of melanocytes

22
Q

Describe the growth of melanoma

A
  • Radial growth phase

* Then vertical growth

23
Q

How does melanoma spread?

A

Via the lymphatics

24
Q

What determines the prognosis of melanoma?

A

The depth of presentation

25
Q

What are the risk factors for the development of melanoma?

A
  • Genetic markers
  • Family history
  • UV irradiation
  • Congenital or multiple atypical nevi
  • history of previous melanoma
  • Skin type I or II
  • High socioeconomic status
  • DNA repair defects
  • Immunosuppression
26
Q

What are the staging tools for melanoma

A

•Clark’s levels and Breslow depth

27
Q

What is the subtype of melanoma that is on the hands and feet?

A

Acral mealnoma

28
Q

What is the subtype of melanoma that occurs under the nails

A

Subungual melanoma

29
Q

What is the subtype of melanoma that lacks pigment?

A

Amelanotic melanoma

30
Q

What is the precursor of melanoma that tends to present on the head and neck?

A

Lentigo maligna

31
Q

What is the precursor of melanoma that can present anywhere on the body?

A

Melanoma in situ

32
Q

What is the treatment of melanoma in someone with a Breslow <1mm

A

Surgical excision with a 1cm margin

33
Q

What is the treatment of a melanoma with a breslow >1mm?

A

2cm margin surgical excision

34
Q

Aside from excision, what is the treatment of melanoma?

A
  • Immunotherapy (ipilimumab)
  • Immune check point/MEK inhibitors (trametinib)
  • Biologic antibodies e.g. BRAF genetic defects (debrafanib)
35
Q

What further investigations should be carried out in someone with a diagnosed melanoma?

A
  • Imaging/ scanning: MRI, CT or PET
  • Assessment of lymph node/organ spread
  • Genetic testing in families if multiple primary melanomas
  • Long term follow up of 5 years
36
Q

Gorlin’s syndrome

A
  • Multiple basal cell carcinomas
  • Jaw cysts
  • Risk of breast cancer
37
Q

Brook spiegler syndrome

A
  • Multiple basal cell carcinoma

* Trichoepitheliomas

38
Q

Gardner syndrome

A
  • Soft tissue tumours
  • Polyps
  • Bowel cancer
39
Q

Cowden’s syndrome

A
  • Multiple hamartomas

* Thyroid, breast cancer

Week 9 - Dermatology (8 decks)

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