Skin cancer Flashcards
ACTINIC KERATOSIS
i) what type of skin cancer is it an early version of? what type of UV causes it?
ii) name three appearances of it
iii) where are two common areas for it to be found?
iv) how commonly does it progress to cancer?
v) how is it usually treated? what is done if it is flat? name two topical treatments
i) early SCC caused by UVB
ii) flat thickened papule, plaque, white/yellow, scaly/horn/warty
iii) commonly found in sun exposed areas eg back of hand or face
iv) rare for a solitary lesion to progress to cancer but if more than 10 lesions there is a 10-15% chance of progression
v) treat by removing it (shave/cutterage and cautery)
topicals - diclofenac, 5FU, imiquimod, photodynamic therapy
BOWENS DISEASE
i) what is it? which area is it confined to?
ii) name four risk factors? what mutational change occurs
iii) name three appearances and where it is commonly found
iv) name three ways to treat
i) intra-epidermal SCC (SCC in situ) confused to the epidermis
ii) RF = sun exposure, arsenic exposure, ionising rad, HPV, imm suppression
UV causes P53 mutation and uncontrolled proliferation of sq cells
iii) irregular, scaly plaques - orange, red, brown
iv) observe, excise (cut out and stitch up), surgery (shave, cut/cautery), cryotherapy, 5FU or imiquimod cream, PDT
BCC
i) what is it? does it grow fast or slow? name another characteristic
ii) how may it appear? how do bv look?
iii) what is the most common type? how does this look? which type is more common in younger adults? how does this look?
iv) what is usual first line tx? what diameter margin should be left?
v) what is MOHS? name an advantage of this?
vi) when may superficial surgery be done? how is the wound left to heal?
i) slow growing plaque or nodule that may have spont bleeding or ulceration
ii) appears pearly edge with central erosion and streaky bv (telengiectasia)
iii) nodular is the most common (pearly edges that look rolled)
superficial is more common in younger adults - scaly and irreg plaque with microerosions
iv) first line is excision biopsy - cut and stich then send to histopath
leave a 3-5mm margin
v) MOHS is micrographic controlled excision - examin excised tissue under microscope layer by layer to make sure its all gone
high cure rates and used on sensitive areas such as face, nose, lips, eyes (ensures all tumour is removed)
vi) do superficial sx for small well defined nodular lesions on trunk/limbs > leave wound open to heal by secondary intention
SCC
i) what type of lesion is it? does it ulcerate? what type of cells proliferate?
ii) what two things does it usually arise within? how quick does it grow? is it often pigmented?
iii) which type of sites is it most common? which type of patients is it ost common?
iv) how does it look on dermoscopy? (3) what makes it high risk? (2)
v) what margin should be left on excision if low risk, high risk or very high risk? what other technique can be used if it is low risk?
i) irregular keritaneous nodule/firm erythematous plaque that ulcerates > prolif of keratinocytes in the dermis
ii) usually arises withien actinic keratosis or intra ep carcinoma > grows over weeks to months and is rarely pigmented
iii) most common in sun exposed sites and in immunocompromised patients (transplant)
iv) on dermos - white circles with surface keratin and looped vessels
v) if low risk - 4mm, high risk 6mm or v high risk 10mm
curette and cautery if low risk
MELANOMA
i) what categorises it as in situ/invasive or metastatic?
ii) name three preventable causes? what % are familial?
iii) what is the ABCDE rule?
iv) what checklist is used to decide whether to refer on 2ww pathway? name two major and minor criteria?
v) name three characteristics of a mole that warrent 2ww referral
vi) what is the most common subtype of melanoma? how does this behave? which type has vertical growth?
i) in situ - confined to epidermis, invasive - dermis and met - other tissues
ii) sunbeds, UV light and severe sun damage - 10% are familial
iii) Assymetry, Border (even or uneven), Colour (one or multiple), Diameter (>6-7mm), Evolving (change in size/shape/colour)
iv) 7 point checklist to refer to 2ww
* major = change in size/shape/colour
* minor = diam >7mm/oozy/change in sensation
v) 2ww refer for mole that is new and fast growing, longstanding but change shape/colour, 3+ colours, assym, new pigmentation under the nail
vi) superficial spreading is most common (60=70%) stays in epidermis for a long time
* nodular has vertical growth and usually asrises de novo
MANAGEMENT OF MELANOMA
i) what type is found mostly in older patients?
ii) what type accounts for the majority of melanoma on dark skin and is found on palms and soles?
iii) what staging system is used?
iv) what is the broad management? (2) what should be done if breslow thickness is >0.8-1mm?
i) lentiga maligna melanoma
ii) acral lentiginous melanoma
iii) AJCC staging
iv) wide local excision and if >0.8mm do LN biopsy
PIGMENTED LESIONS
i) what is sebborhoiec keratosis? is it maligment or benign? what causes it? what red flag symptom can it be linked to?
ii) what is dysplasic naevi? name three characteristics? what may it progress to?
iii) what are solar lentigines?
i) benign warty spot that is a sign of skin ageing
* abrupt onset of SK that rapidly increase in size and number - may be paraneoplastic and assoc with adenocarcinoma or stomach or colon
ii) dysplastic naevi - atypical but benign - diameter >5mm and irregular border/margin
* may progress to melanoma but unlikely
iii) solar lentigines - harmless patch of dark skin
BIOPSY
i) what type of biopsy should be done if lesion is pigmented? why?
ii) what should be done for a large pigmented patch?
iii) which layers does a punch biopsy permeate?
iv) what does an excisional biopsy do? what mm margin must be left around them to give adequate to pathology?
i) do excisional biopsy to get a representative sample (take out whole lesion)
ii) large pig patch - do multiple punch biopsies
iii) punch goes through deep dermis and subcut layer
iv) excisional cuts out an elipse of skin - do for pigmented lesions and leave 2mm margin around
