Skin Cancer Flashcards
What the risk factors for malignant melanoma?
Family history,
Genetic syndromes eg, familial atypical multiple mole melanoma syndrome,
Skin type prone to burning and not tanning,
Immunosuppression
High levels of UV exposure
Presence of atypical melanocytic naevi
Smoking
Advanced age and male sex,
What are the different types of malignant melanoma?
Superficial spreading,
Nodular,
Lentigo Maligna melanoma,
Acral lentigoinous
Amelanotic
Describe features of superficial spreading melanoma?
Most common. Occurs in young people
Typically occurs on arms, legs, and trunk
Describe features of nodular melanoma
Second most common cause. Occurs in sun exposed sites in middle aged people. Presents with a red/black lump which bleeds and oozes
Describe featurs of lentigo maligna and acral lentiginous
Lentigo maligna - Less common. Occurs in chronic sun exposed sights. Presents as growing mole
Acral - Rare. occurs on nails, palms or soles and people with darker pigmentation.
What are the major diagnostic criteriafor skin cancer?
- Change in size
- Change in shape,
- Change in colour,
ABCD
Asymmetrical, Boarder irregularity, Colour variation, Diameter >6mm
Evolution over time
What are the minor diagnostic criteria?
Diameter >7mm,
Inflammation,
Oozing or bleeding
Altered sensation
What are the investigations for malignant melanoma?
Excisional biopsy and send to pathology to determine whether re-excision of margins is required
What are the pre-malignant melanoma conditions?
Lentigo maligna
Melanoma in situ
What are the margins of excision related to the brewslow thickness?
Lesions <1mm need 1cm excisional margins.
Lesions 1-2mm need 1-2cm margins
Lesions 2-4mm need 2-3cm margins
Lesions >4mm need 3cm margins
When is a sentinal node biopsy required for melanoma?
When brewslow thickness >1mm
What are pharmacological management of melanoma?
Adjuvant chemotherapy/immunotherapy (nivolumab, pembrolizumab or debrafinib if BRAF mutation)
What does the following images show?
Seborrhoeic keratosis - benign warty lesions which have a well defined edge and are normally cauliflower in appearance. Common with increasing age.
What is the name for skin tags?
Fibro-epithelial polyps
Explain how UV light can cause cancer
UV light can act on keratinocytes directly causing DNA damage which causes p53 mutations. This results in abnormal cell proliferation
UV light can also cause immunosupression
What does the following show?
Nodular BCC. It has a shiny, pearly appearence with a rolled shoulder edge, telangectasia (lightening bolt blood vessels) and often ulceration centrally.
Commonly occur on sun exposed sites, especially on head and neck.
What does the following image show?
Superficial BCC. It is shiny with a slightly rolled surface. It has threadlike vessels and ulceration
What does the following image show?
A pigmented BCC. It can look similar to a melanoma. It tends to have a rolled, shiny margin and ulceration.
What does the following image show?
A Morphoeic BCC. These are very subtle. May have a shiny area and tend to be much larger than they look
What does the following show and what are its features?
An SCC with a heavily keratinized Centre. May occur on normal skin or chronically inflamed/sun exposed. Expand rapidly
More likely to metastasis
