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DERMATOLOGY > SKIN CANCER > Flashcards

SKIN CANCER Flashcards

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Dermatology Board Prep flashcards
1
Q

Most common type of malignant skin tumour ?

A

BCC

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2
Q

Typical features of a basal cell carcinoma?

A

An ulcer with a raised rolled edge - may leave a central crater
Prominent fine blood vessels around a lesion
Pearly or waxy nodule

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3
Q

Most common type of BCC?

A

Nodular BCC

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4
Q

How are BCCs characterised?

A

Slow growing and locals invasion

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5
Q

Where on the body are BCCs most commonly found?

A

Face, head, neck - most sun exposed

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6
Q

Management of BCCs?

A

Surgical excision
Curettage
Cryotherapy
Topical creams: imiquimod, fluorouracil
Radiotherapy

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7
Q

How does imiquimod work to Tx BCCs?

A

It’s an immune response modifier that works by stimulating the immune system = anti-tumour effects
Thought to act as a toll-like receptor-7 agonist

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8
Q

What layer of the skin do BCCs arise from?

A

The stratum basalt

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9
Q

Which skin cancer is least likely to metastasises?

A

BCC <0.05% risk

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10
Q

Subtypes of BCCs?

A

Nodular
Superficial
Morphoeic
Basosquamous

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11
Q

Investigtaions for BCC?

A

Dermatoscope examination
Diagnosed clinically
Confirmed through excision biopsy

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12
Q

What is Moh’s micrographic surgery?

A

A tissue preserving technique which removes the lesion whilst assessing thr entire excision margins

The tumour is initially debulked, and then saucer-shaped 1mm layers of tissue are excised at a time. Each layer is then immediately checked under a microscope by a trained technician, and the process is continued until the tumour has been fully removed.

Good for areas where it would be cosmetically better to remove as little skin as possible

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13
Q

Risk of developing another skin cancer after A BCC?

A

Patients who have had a BCC have a 35% risk of developing another non-melanoma skin cancer in 3 years and 50% risk in 5 years.

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14
Q

Risk factors for BCC?

A

Intense sun exposure e.g. prior sunburns
Positive FHx
Skin types 1 or 2

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15
Q

What is squamous cell carcinoma?

A

A malignant tumour of keratinocytes arising from the epidermal layer of the skin

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16
Q

How common are SCCs?

A

They are thr second most common form of skin cancer after BCCs

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17
Q

Risk factors for SCCs?

A

excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen’s disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin’s ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

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18
Q

Clinical features of SCCs?

A

Rapidly expanding, painless, raised, ulcerate nodules
May have a cauliflower-like appearance
May be areas of bleeding

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19
Q

Where on the body are SCCs most likely to appear?

A

Sun-exposed sites - head, neck, dorsum of hands and arms, lower limbs

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20
Q

Dermoscopy findings in SCC?

A

White circles or structureless areas
Looped blood vessels
Central keratin plug

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21
Q

Management of SCCs?

A

Surgical excision with 4mm if lesion <20mm diameter. 6mm if >20mm
Moh’s micrographic surgery may be used in high-risk pt or cosmetically-important sites

Radiotherapy may be considered if surgery is not feasible
Chemotherapy is third line

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22
Q

Features of SCC with good prognosis?

A

Well differentiated tumours
<20mm diameter
<2mm deep
No associated diseases

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23
Q

Features of SCC with poor prognosis?

A

Poorly differentiated tumours
>20mm diameter
>4mm deep
Pt has Immunosuppression for whatever reason

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24
Q

Prognosis of SCC?

A

Metastatic potential is 3%
10 year survival for those with metastasis is <10%
High and very high risk SCC have a 80% lifetime risk of further skin cancers

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25
Q

How do nodular BCCs typically present?
What proportion of BCCs do they make up?

A

commonly a pink pearly nodule with telangiectasia, and can become ulcerated or encrusted; subtypes include cystic, pigmented, or keratotic
50-60%

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26
Q

How do superficial BCCs present?
What % of BCCs do they make up?

A

erythematous scaly plaques with a thread-like border, and may bleed or ulcerate
10-15%

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27
Q

How do morphoeic BCCs present?

A

thickened and sclerosing plaques with poorly defined borders; highest risk of incomplete excision and often prone to recurrence after treatment

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28
Q

What is melanoma a cancer of?

A

It’s a malignant tumour of melanocytes
Commonly those in the stratum basale of the epidermis

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29
Q

ABCDE symptoms rule

A

Asymmetrical shape
Border irregularity
Colour irregularity
Diameter >6mm
Evolution of the lesion e.g. change in size/shape
Symptoms e.g. bleed or itch

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30
Q

Risk factors for melanoma?

A

PHx skin cancer, melanoma, atypical naevi
FHx of melanoma
Fitzpatrick skin type 1 + 2
Red/light coloured hair
High freckle density
Light coloured eyes
History of sunburn - particuarly blistering sunburn in childhood
Large number of moles
Intermittent sun exposure
Use of tanning/sun beds (esp if >10 sessions)
Older age
Outdoor occupation
Immunosuppression
Genetic syndromes e.g. xeroderma pigmentosum

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31
Q

Most common age of melanoma?

A

Peak incidence 85-89
25% of cases are diagnosed in people >75

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32
Q

Most important prognostic factors for melanoma?

A

Breslow’s thickness
Lymph node status

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33
Q

Prognosis of melanoma?

A

5 year survival of stage 1 melanoma is 100%
Stage 4 is 30%

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34
Q

Types of melanomas?

A

Superficial spreading
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous
Amelanotic melanoma

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35
Q

Most common type of melanoma?

A

Superficial spreading
60-70% of melanomas

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36
Q

Fitzpatrick type 1 skin?

A

Pale white skin
Blue/green eyes
Blonde/red hair
Always burns and does not tan

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37
Q

Fitzpatrick type 2 skin?

A

Fair skin
Blue eyes
Burns easily and tans poorly

38
Q

Fitzpatrick type 3 skin?

A

Darker white skin
Tans after initial burn

39
Q

Fitzpatrick type 4 skin?

A

Light brown skin
Burns minimally, tans easily

40
Q

Fitzpatrick type 5 skin?

A

Brown skin
Rarely burns, tans dark easily

41
Q

Fitzpatrick type 6 skin?

A

Dark brown or black skin
Always tans darkly and never burns

42
Q

Where on the body do superficial spreading melanomas occur?

A

Most commonly on sun-exposed sites: torso on men and legs in women

43
Q

Average age of incidence with superficial spreading melanoma?

A

Incidence increases with age, peaking in people aged 70-79

44
Q

How do superficial spreading melanomas present? ?

A

A flat pigmented lesion with asymmetrical or irregular borders
Usually spreads horzontally

45
Q

Where do nodular melanomas typically occur?

A

Sun exposed areas - co9mmon on the trunk

46
Q

What age is nodular melanoma most common?

A

50-60 years old

47
Q

How do nodular melanomas present?

A

Rapidly growing, atypical nodule that may ulcerate and bleed easily
May be pigmented

48
Q

What age is lentigo maligna melanoma most common?

A

People aged >60

49
Q

Where does lentigo maligna melanoma most commonly occur?

A

On sun-damaged skin - head and neck

50
Q

How do lentigo maligna melanoma present?

A

Irregularly shaped brown macule that grows slowly and overtime may develop irregular colours
Usually grows horizontally initially

51
Q

Who are acral lentiginous melanomas most common in?

A

Darker skin types and people aged >40

52
Q

Where on the body are acral lentiginous melanomas most common?

A

Soles of feet, palms of hands and nail bed

53
Q

How do acral lentiginous melanomas present?

A

A flat pigmented area, slowly increasing in size.
Smooth at first but later may become thicker with an irregular surface that may be dry/warty
Variable pigmentation- commonly brown, blue-grey, black and red
May be ulceration and bleeding

54
Q

What is Hutchinson’s sign?

A

Periungal band of brown-black pigmentation
A sign of acral lentiginous melanoma

55
Q

Which melanoma type has no clear link to UV exposure?

A

Acral lentiginous melanoma

56
Q

What are amelanotic melanomas?

A

Forms of melanomas with little or no pigment
Any subtype can be amelanotic

57
Q

What are lentigo maligna?

A

A precursor to lentigo maligna melanoma
Presents as a slow-growing or changing patch of discoloured skin - often resembles a freckle in the early stages
They are “in-situ”
Occurs on sun-damage skin particularly nose and cheek
Lesions grow slowly over 5-20 years
Most common in people >40, peaking at 60-80

58
Q

Assessment for melanoma?

A

Med history - how long, changes in shape size + colour, ulceration, itchy, bleeding, cough, weight loss, fatigue, night sweats, PH or FHx, & risk factors
Examine with dermatoscope
Palpate lymph nodes

If suspected to be melanoma then refer urgently 2WW

59
Q

What is the “Ugly Duckling Sign”?

A

When there is an atypical melanocytic lesion that is different from the person;s surrounding moles

60
Q

Diagnostic features/criteria for melanoma?

A

Major criteria:
- change in size
- change in shape
- change in colour

Minor criteria:
- diameter >=7mm
- inflammation
- oozing or bleeding
- altered sensation

61
Q

Diagnosis of melanoma?

A

Suspicious lesions should undergo excision biopsy

62
Q

Breslow thickness of melanoma?

A

This is the distance between the stratum granulosum and the deepest point of the melanoma

63
Q

Margins of excision-Related to Breslow thickness

A

Lesions 0-1mm thick - excise 1cm
Lesions 1-2mm thick - 1-2cm
Lesions 2-4mm thick - 2-3cm
Lesions >4mm thick - 3cm

64
Q

Which patients with melanoma should be offered a sentinel lymph node biopsy?

A

Melanoma with a breslow thickness >1mm

65
Q

What should be done if sentinel lymph node biopsy in a pt with melanoma shows a clinically or radiologically suspicious lymph node?

A

Fine need aspiration cytology

66
Q

Breslow thickness and 5 year survival rates?

A

<0.75mm - 95-100%
0.76-1.5mm - 80-96%
1.51-4mm - 60-75%
>4mm - 50%

67
Q

Investigtaions for staging of a ,drama?

A

CT chest-abdomen-pelvis
MRI brain

68
Q

What staging system is used for melanoma?

A

TNM classification

69
Q

Where does metastatic melanoma typically spread to?

A

Lymph nodes
Brain
Bones
Liver
Lungs

70
Q

What is actinic keratoses?

A

Aka solar keratoses
A common pre malignant skin lesion that develops as a consequence of chronic sun exposure

71
Q

Features of actinic keratoses?

A

small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
Multiple lesions may be present

72
Q

Where are actinic keratoses most commonly found?

A

On sun-exposed areas e.g. temples of head

73
Q

Management of actinic keratoses?

A

Prevention of further risk e.g. sun avoidance and sun cream
Fluorouracil cream - 2-3 week course
Topical imiquimod, topical diclofenac, cryotherapy, curettage and cautery

74
Q

What is Bowen’s disease?

A

A type of precancerous dermatosis that is a precursor to SCC

75
Q

What is the chance of bowen’s disease developing into skin cancer if left untreated?

A

5-10%
1 in 20

76
Q

Features of bowen’s disease?

A

Red scaly patches 10-15mm in size
Slow growing
On sun-exposed areas - head, neck and lower limbs

77
Q

Management of Bowen’s disease?

A

Topical fluorouracil TDS for 4 weeks
Cryotherapy
Excision

78
Q

Topical fluorouracil common SE and how can we manage this?

A

Significant inflammation or erythema
Topical steroids can often be given to control this

79
Q

Counsel pt on appropriate sun protection behaviours?

A

Spend 11am-3pm in the shade
Cover up with clothes, hat and UV protection sunglasses
Sunscreen at least SPF30 or star rating 4/5 - generously, regularly
Dont use sunbeds or sunlamps

80
Q

MDT for skin cancer?

A

Dermatology
Plastic surgery
Clinical oncology
Medical oncology
Consultant radiologist
Skin cancer nurse specialist
Histopathology
Skin cancer pathway co-ordinator

81
Q

Most common malignancy secondary to immunosuppression?

A

Skin cancer - particularly SCC

82
Q

How often do melanomas arise from a pre-existing melanocytic naevi?

A

In about 1/3rd of cases

83
Q

Types of skin biopsy

A

Punch biopsy - removes small core of skin
Shave biopsy - gathers cells from top dermis + epidermis
Curettage - electric needle
Incisional biopsy - removal of a piece of tissue
Excisional biopsy - removes entire area of irregular skin

84
Q

When is a shave/sampling biopsy used instead of an excision/punch biopsy?

A

Superficial lesions e.g. BCC

85
Q

What is a shave biopsy not appropriate for, and why?

A

For suspicious pigmented lesions
E.g. lesions suspicious of melanoma as the biopsy wont provide sufficient depth to accurately determine the stage

86
Q

Most common skin lymphoma?

A

Cutaneous T cell lymphoma

87
Q

Most common types of cutaneous T cell lymphomas?

A

Mycosis fungoides
Sezary syndrome

88
Q

What does cutaneous T cell lymphoma look like?

A

Starts as flat, dry red patches on the skin which can sometimes be itchy
They may develop to become hypo/hyperpigmented, mottled, plaque-like, papules, ulcerations, erythroderma etc

89
Q

Causes of cutaneous metastasis?

A

Melanoma
Breast cancer
Nasal sinus cancers
Larynx cancer
Oral cavity cancer

90
Q

Management of any patients who have recieving organ transplants with new or growing skin lesions?

A

Urgent referral to dermatologist - SCCs are more common

DERMATOLOGY (14 decks)

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