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Week 9 - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

(39 cards)

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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?

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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?

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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

Study These Flashcards
A
  • Nodule
  • Keratin crust
  • Red background
19
Q

What is the gold standard treatment of squamous cell carcinoma?

Study These Flashcards
A

Surgical excision with a 4mm margin

20
Q

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

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

What is a melanoma?

Study These Flashcards
A

Malignant tumour of melanocytes

22
Q

Describe the growth of melanoma

Study These Flashcards
A
  • Radial growth phase

* Then vertical growth

23
Q

How does melanoma spread?

Study These Flashcards
A

Via the lymphatics

24
Q

What determines the prognosis of melanoma?

Study These Flashcards
A

The depth of presentation

25
What are the risk factors for the development of melanoma?
*  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
What are the staging tools for melanoma
• Clark's levels and Breslow depth
27
What is the subtype of melanoma that is on the hands and feet?
Acral mealnoma
28
What is the subtype of melanoma that occurs under the nails
Subungual melanoma
29
What is the subtype of melanoma that lacks pigment?
Amelanotic melanoma
30
What is the precursor of melanoma that tends to present on the head and neck?
Lentigo maligna
31
What is the precursor of melanoma that can present anywhere on the body?
Melanoma in situ
32
What is the treatment of melanoma in someone with a Breslow <1mm
Surgical excision with a 1cm margin
33
What is the treatment of a melanoma with a breslow >1mm?
2cm margin surgical excision
34
Aside from excision, what is the treatment of melanoma?
*  Immunotherapy (ipilimumab) *  Immune check point/MEK inhibitors (trametinib) *  Biologic antibodies e.g. BRAF genetic defects (debrafanib)
35
What further investigations should be carried out in someone with a diagnosed melanoma?
*  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
Gorlin's syndrome
*  Multiple basal cell carcinomas *  Jaw cysts *  Risk of breast cancer
37
Brook spiegler syndrome
*  Multiple basal cell carcinoma | *  Trichoepitheliomas
38
Gardner syndrome
*  Soft tissue tumours *  Polyps *  Bowel cancer
39
Cowden's syndrome
*  Multiple hamartomas | *  Thyroid, breast cancer

Week 9 - Dermatology (8 decks)

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