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Phase 1b - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the 6 layers of skin?

Come Learn Good Skin Bitches

A
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2
Q

What are 5 points of self detection for skin lesions that may turn cancerous?

ABCDE

A
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3
Q

What is a malignant melanoma?

A
  • Malignant tumour arising from melanocytes
    • Leads to > 75% of skin cancer deaths

Can arise on mucosal surfaces (e.g. oral, conjunctival, vaginal) and within uveal tract of eye

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4
Q

Outline the epidemiology of malignant melanomas.

A
  • Rising incidence rates observed worldwide
  • Develops predominantly in Caucasian populations
    • Incidence low amongst darkly pigmented populations
  • 10-19/100,000 per year in Europe, 60/100,000 per year in Australia / NZ (Sunny locations)
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5
Q

What are the risk factors of malignant melanomas (Genetic 3 / Environmental 3 / Phenotypic 2)?

A

Genetic factors:
* Family history (CNKN2A mutations), MC1R variants
* Lightly pigmented skin, red hair
* DNA repair defects (e.g. xeroderma pigmentosum)

Environmental factors:
* Intense intermittent sun exposure, chronic sun exposure, residence in equatorial latitudes
* Sunbeds
* Immunosuppression

Phenotypic:
* Patient who has more than 100 melanocytic nevi on the whole body
* Patient who has atypical melanocytic nevi

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6
Q

What are the main different subtypes of malignant melanoma (5)?

A
  • Superficial spreading (Horizontal growth then Vertical growth)
  • Nodular (Only vertical growth)
  • Lentigo maligna
  • Acral lentiginous
  • Unclassifiable
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7
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Superficially spreading malignant melanoma

Epidemiology:
* 60-70% of all melanomas
* Most common type in fair-skinned individuals
* Most frequently seen on trunk of men and legs of women

Pathogenesis:
* Can arise de novo or in pre-existing nevus
* In up to 2/3 of tumours, regression (visible as grey, hypo-or depigmentation), due to host immune system reacting to tumour

Pathophysiology:
* After a slow horizontal (radial) growth phase, limited to epidermis, a more rapid vertically oriented growth phase: development of nodule

Differential diagnosis:
* Dermatofibroma

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8
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Nodular malignant melanoma

Epidemiology:
* 2nd most common type of melanoma in fair skinned individuals
* 15-30% of all melanomas
* Most commonly trunk, head and neck, M>F

Pathogenesis:
* Usually dark nodule -but can be pink or red, may be ulcerated, bleeding
* Develops rapidly

Pathophysiology:
* De novo vertical growth phase without the horizontal growth phase. Present more advanced stage, with poorer prognosis.

Differential diagnosis:
* Basal cell carcinoma

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9
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Lentigo maligna (malignant melanoma)

Epidemiology:
* 5% progress to invasive melanoma
* > 60 yo chronically sun damaged skin

Pathophysiology:
* Slow growing macule
* It is an in-situ melanoma

Differential diagnosis:
* Seborrhoeic keratosis

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10
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Acral lentiginous (malignant melanoma)

Epidemiology:
* Uncommon: ~5% of all melanomas
* Most frequently 70yo
* Incidence similar across all age groups

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11
Q

What investigations are suggested in suspected malignant melanomas (2)?

A
  • Examination with a dermatoscope
  • Excision biopsy for histological assessment
    • Measure Breslow thickness: prognosis worse if >1mm
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12
Q

What is the management of malignant melanomas (Surgery 2 / Imaging 1 / Immunotherapy 2)?

A

Surgery:
* Wide local excision
* Margin depends on Breslow thickness
* Sentinel lymph node biopsy - lymph node dissection

Imaging:
* TNM staging

Immunotherapy:
* CTLA-4 inhibition (Ipilimumab)
* PD-L1 (Programmed cell death ligand) inhibitors
* (Nivolumab)

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13
Q

What are the 3 stages of keratinocyte dysplasia?

A

Actinic keratoses
* Dysplastic keratinocytes

Bowen’s disease
* Squamous cell carcinoma in situ

Squamous cell carcinoma
* Invasive cancer
* Potential for metastasis/ death

Predominantly pale skin types
Solar induced UV damage

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14
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A

Actinic keratoses
* Dysplastic keratinocytes

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15
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A

Bowen’s disease
* Squamous cell carcinoma in situ

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16
Q

What is the management of actinic keratosis and bowen’s disease (6)?

A
  • 5-fluorouracil cream
  • Cryotherapy
  • Imiquimod cream
  • Photodynamic therapy
  • Curettage and cautery
  • Excision
17
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Squamous Cell Carcinoma (SCC)

Pathophysiology:
* Can have different appearances
* Erythematous to skin coloured
* Papule
* Plaque-like
* Exophytic
* Hyperkeratotic
* Ulceration
* Arises within background of sun-damaged skin
* Rapidly growing

Differential diagnosis:
* Basal cell carcinoma
* Viral wart
* Merkel cell carcinoma

18
Q

What investigations are recommended for suspected squamous cell carcinoma (SCC) (2)?

Often clinical diagnosis sufficient

A
  • Diagnostic biopsy may be taken if diagnostic uncertainty
  • Ultrasound of regional lymph nodes ± FNA if concerns regarding regional lymph node metastasis
19
Q

What is the management of squamous cell carcinoma (SCC) (5)?

A
  • Examination of rest of skin and regional lymph nodes
  • Excision
  • Radiotherapy
    • Unresectable
    • High risk features e.g. perineural invasion
  • Cemiplimab for metastatic SCC
  • Secondary prevention
    • Skin monitoring advice
    • Sun protection advice
20
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Keratoacanthoma
    • Pseudo-malignancy VS Variant of SCC (still unclear)

  • Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core
  • Resolves slowly over months to leave atrophic scar
  • Most occur on head or neck / sun exposed areas
  • Difficult to distinguish clinically and histologically from squamous cell carcinoma, so often excision
21
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Basal Cell Carcinoma (BCC)

Main subtypes: Nodular- Superficial
* Nodular:
* Most common subtype
* Approximately 50% of all BCCs
* Typically: shiny, pearly papule or nodule
* Superficial:
* Well-circumscribed, erythematous, macule/plaque

Differential diagnosis:
* Squamous cell carcinoma
* Adnexal (Sebaceous) carcinoma
* Merkel cell carcinoma

22
Q

What investigations are recommended for suspected basal cell carcinoma (BCC) (1)?

Often clinical diagnosis sufficient

A
  • Diagnostic biopsy may be taken if diagnostic uncertainty
23
Q

What is the management of basal cell carcinoma (BCC) (1)?

A
  • Standard surgical excision
24
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Mycosis fungoides (sub-type of cutaneous T-cell lymphoma)

Epidemiology:
* 75% of cutaneous lymphomas are T-cell
* MF is most common variant of primary CTCL: 50% of all primary cutaneous lymphoma, 0.4/100,000 (so quite rare)

Pathogenesis:
* Heterogenous group of neoplasms! Considerable variation in clinical presentation, histological appearance, immunophenotype and prognosis

Pathophysiology:
* Patients progress from patch stage -> plaque stage -› (finally) tumour stage disease

Diagnosis:
* Diagnosis requires skin biopsy
* Diagnosis may take years as skin lesions may be present that are neither clinically nor histologically diagnostic for many years

Differential diagnosis:
* Psoriasis
* Eczema (discoid)
* Parapsoriasis

25
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Sézary syndrome (sub-type of cutaneous T-cell lymphoma)
  • Triad of:
    • Erythroderma
    • Generalised lymphadenopathy
    • Presence of neoplastic T-cells (Sézary cells) in the skin, lymph nodes and peripheral blood

Epidemiology:
* 75% of cutaneous lymphomas are T-cell
* Sézary syndrome is rare - < 5% of all CTCL

Pathogenesis:
* Heterogenous group of neoplasms! Considerable variation in clinical presentation, histological appearance, immunophenotype and prognosis

26
Q

A patient present with the following symptoms:

What is the most likely diagnosis?

A
  • Merkel Cell Carcinoma
27
Q

A patient present with the following symptoms:
* PMx of HIV

What is the most likely diagnosis?

A
  • Kaposi Sarcoma

Phase 1b - Dermatology (6 decks)

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