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DERMATOLOGY > SKIN CANCER > Flashcards

SKIN CANCER 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
How do nodular BCCs typically present? What proportion of BCCs do they make up?
commonly a pink pearly nodule with telangiectasia, and can become ulcerated or encrusted; subtypes include cystic, pigmented, or keratotic 50-60%
26
How do superficial BCCs present? What % of BCCs do they make up?
erythematous scaly plaques with a thread-like border, and may bleed or ulcerate 10-15%
27
How do morphoeic BCCs present?
thickened and sclerosing plaques with poorly defined borders; highest risk of incomplete excision and often prone to recurrence after treatment
28
What is melanoma a cancer of?
It’s a malignant tumour of melanocytes Commonly those in the stratum basale of the epidermis
29
ABCDE symptoms rule
Asymmetrical shape Border irregularity Colour irregularity Diameter >6mm Evolution of the lesion e.g. change in size/shape Symptoms e.g. bleed or itch
30
Risk factors for melanoma?
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
31
Most common age of melanoma?
Peak incidence 85-89 25% of cases are diagnosed in people >75
32
Most important prognostic factors for melanoma?
Breslow’s thickness Lymph node status
33
Prognosis of melanoma?
5 year survival of stage 1 melanoma is 100% Stage 4 is 30%
34
Types of melanomas?
Superficial spreading Nodular melanoma Lentigo maligna melanoma Acral lentiginous Amelanotic melanoma
35
Most common type of melanoma?
Superficial spreading 60-70% of melanomas
36
Fitzpatrick type 1 skin?
Pale white skin Blue/green eyes Blonde/red hair Always burns and does not tan
37
Fitzpatrick type 2 skin?
Fair skin Blue eyes Burns easily and tans poorly
38
Fitzpatrick type 3 skin?
Darker white skin Tans after initial burn
39
Fitzpatrick type 4 skin?
Light brown skin Burns minimally, tans easily
40
Fitzpatrick type 5 skin?
Brown skin Rarely burns, tans dark easily
41
Fitzpatrick type 6 skin?
Dark brown or black skin Always tans darkly and never burns
42
Where on the body do superficial spreading melanomas occur?
Most commonly on sun-exposed sites: torso on men and legs in women
43
Average age of incidence with superficial spreading melanoma?
Incidence increases with age, peaking in people aged 70-79
44
How do superficial spreading melanomas present? ?
A flat pigmented lesion with asymmetrical or irregular borders Usually spreads horzontally
45
Where do nodular melanomas typically occur?
Sun exposed areas - co9mmon on the trunk
46
What age is nodular melanoma most common?
50-60 years old
47
How do nodular melanomas present?
Rapidly growing, atypical nodule that may ulcerate and bleed easily May be pigmented
48
What age is lentigo maligna melanoma most common?
People aged >60
49
Where does lentigo maligna melanoma most commonly occur?
On sun-damaged skin - head and neck
50
How do lentigo maligna melanoma present?
Irregularly shaped brown macule that grows slowly and overtime may develop irregular colours Usually grows horizontally initially
51
Who are acral lentiginous melanomas most common in?
Darker skin types and people aged >40
52
Where on the body are acral lentiginous melanomas most common?
Soles of feet, palms of hands and nail bed
53
How do acral lentiginous melanomas present?
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
What is Hutchinson’s sign?
Periungal band of brown-black pigmentation A sign of acral lentiginous melanoma
55
Which melanoma type has no clear link to UV exposure?
Acral lentiginous melanoma
56
What are amelanotic melanomas?
Forms of melanomas with little or no pigment Any subtype can be amelanotic
57
What are lentigo maligna?
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
Assessment for melanoma?
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
What is the “Ugly Duckling Sign”?
When there is an atypical melanocytic lesion that is different from the person;s surrounding moles
60
Diagnostic features/criteria for melanoma?
Major criteria: - change in size - change in shape - change in colour Minor criteria: - diameter >=7mm - inflammation - oozing or bleeding - altered sensation
61
Diagnosis of melanoma?
Suspicious lesions should undergo excision biopsy
62
Breslow thickness of melanoma?
This is the distance between the stratum granulosum and the deepest point of the melanoma
63
Margins of excision-Related to Breslow thickness
Lesions 0-1mm thick - excise 1cm Lesions 1-2mm thick - 1-2cm Lesions 2-4mm thick - 2-3cm Lesions >4mm thick - 3cm
64
Which patients with melanoma should be offered a sentinel lymph node biopsy?
Melanoma with a breslow thickness >1mm
65
What should be done if sentinel lymph node biopsy in a pt with melanoma shows a clinically or radiologically suspicious lymph node?
Fine need aspiration cytology
66
Breslow thickness and 5 year survival rates?
<0.75mm - 95-100% 0.76-1.5mm - 80-96% 1.51-4mm - 60-75% >4mm - 50%
67
Investigtaions for staging of a ,drama?
CT chest-abdomen-pelvis MRI brain
68
What staging system is used for melanoma?
TNM classification
69
Where does metastatic melanoma typically spread to?
Lymph nodes Brain Bones Liver Lungs
70
What is actinic keratoses?
Aka solar keratoses A common pre malignant skin lesion that develops as a consequence of chronic sun exposure
71
Features of actinic keratoses?
small, crusty or scaly, lesions may be pink, red, brown or the same colour as the skin Multiple lesions may be present
72
Where are actinic keratoses most commonly found?
On sun-exposed areas e.g. temples of head
73
Management of actinic keratoses?
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
What is Bowen’s disease?
A type of precancerous dermatosis that is a precursor to SCC
75
What is the chance of bowen’s disease developing into skin cancer if left untreated?
5-10% 1 in 20
76
Features of bowen’s disease?
Red scaly patches 10-15mm in size Slow growing On sun-exposed areas - head, neck and lower limbs
77
Management of Bowen’s disease?
Topical fluorouracil TDS for 4 weeks Cryotherapy Excision
78
Topical fluorouracil common SE and how can we manage this?
Significant inflammation or erythema Topical steroids can often be given to control this
79
Counsel pt on appropriate sun protection behaviours?
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
MDT for skin cancer?
Dermatology Plastic surgery Clinical oncology Medical oncology Consultant radiologist Skin cancer nurse specialist Histopathology Skin cancer pathway co-ordinator
81
Most common malignancy secondary to immunosuppression?
Skin cancer - particularly SCC
82
How often do melanomas arise from a pre-existing melanocytic naevi?
In about 1/3rd of cases
83
Types of skin biopsy
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
When is a shave/sampling biopsy used instead of an excision/punch biopsy?
Superficial lesions e.g. BCC
85
What is a shave biopsy not appropriate for, and why?
For suspicious pigmented lesions E.g. lesions suspicious of melanoma as the biopsy wont provide sufficient depth to accurately determine the stage
86
Most common skin lymphoma?
Cutaneous T cell lymphoma
87
Most common types of cutaneous T cell lymphomas?
Mycosis fungoides Sezary syndrome
88
What does cutaneous T cell lymphoma look like?
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
Causes of cutaneous metastasis?
Melanoma Breast cancer Nasal sinus cancers Larynx cancer Oral cavity cancer
90
Management of any patients who have recieving organ transplants with new or growing skin lesions?
Urgent referral to dermatologist - SCCs are more common

DERMATOLOGY (14 decks)

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