Skin Cancer

Question 1

Most common skin cancer

Answer 1

BCC

Question 2

3 characteristics of BCC

Answer 2

Slow growing
Locally invasive
Rarely metastasise

Question 3

Ix for BCC?

Answer 3

Shave/ punch biopsy for histology

Question 4

4 characteristics of appearance of BCC

Answer 4

Pearly white/ pink papule-nodule or firm plaque
Rolled edge
Shiny
Associated telangiectasias

Question 5

3 Tx options for BCC

Answer 5

Surgical excision
Curettage + cautery
Topical Imiquimod/ Fluorouracil 5%

Question 6

Cells involved in SCC

Answer 6

Keratinocytes

Question 7

Cells involved in BCC

Answer 7

Cells in epidermis + follicular epithelium

Question 8

2nd most common skin cancer

Answer 8

SCC

Question 9

List 4 characteristics of SCC

Answer 9

Non-healing ulcerated lesion with hard, raised edges.
Slow-growing ulcer or reddish skin plaque.
May bleed
Metastatic potential

Question 10

Growth rate of SCC and BCC

Answer 10

SCC develop + grow over 3-6 months

BCC are slower

Question 11

What are Actinic Keratoses?

Answer 11

Dry, rough, adherent scaly lesions
Pink/ skin coloured/ red
Non-malignant (low risk transformation to SCC)
AKA Solar keratoses

Question 12

Ix for SCC

Answer 12

Biopsy

Question 13

3 Tx options for SCC

Answer 13

Excisional biopsy
+/- Radiotherapy if metastatic/ invasive
Cryotherapy or Fluorouracil 5% (Bowens/ AK)

Question 14

What is Bowens disease?

Answer 14

Red scaly patches
Intraepidermal (in situ SCC)
Arises in the outer layers of the epidermis
Pre-cancerous: 3% risk of progression to invasive SCC

Question 15

HPV is a risk factor for which skin carcinoma

Answer 15

SCC

Question 16

What are the 4 types of melanoma?

Answer 16

Lentigo maligna (Elderly)
Superficial (60%)
Nodular (>50s)
Acral lentiginous malignant (dark skinned)

Question 17

Which skin cancer most commonly leads to death?

Answer 17

Malignant melanoma

Question 18

Which melanoma is the most aggressive?

Answer 18

Nodular melanoma

Rapidly growing pigmented nodule which bleeds or ulcerates.

Question 19

2 features of superficial melanoma

Answer 19

Large flat irregularly pigmented lesion which grows laterally before vertical invasion develops.
Arises in a pre-existing naevus

Question 20

5 signs of malignant melanoma

Answer 20

A; asymmetrical
B; irregular border
C; >1 colour
D; diameter >6mm
E; Evolving/ elevating

Question 21

6 risk factors for malignant melanoma

Answer 21

MMRISK
Moles- atypical >5
Moles- common >50
Red hair
Inability to tan
Sunburn
Kindred

Question 22

Ix for melanoma

Answer 22

full-thickness excisional biopsy

Question 23

What is used to stage melanoma?

Answer 23

Clark Scale + Breslow thickness

TNM

Question 24

What is used to check for melanoma metastasis?

Answer 24

Sentinel lymph node biopsy
CXR
Liver US + LFTs (liver common site for mets)
CT head, abdo, pelvis

Question 25

Tx for melanoma

Answer 25

Surgical excision
Nivolumab/ Pembrolizumab
Sentinel lymph node biopsy

Question 26

What is a melanocytic naevus?

Answer 26

Mole

Benign proliferation of pigmented melanocytes

Question 27

Ix for melanocytic naevus

Answer 27

Excision biopsy if suspicious

Question 28

4 Tx options for melanocytic naevus

Answer 28

Excision biopsy: flat
Shave biopsy: protruding
Electrosurgical destruction
Laser: lessen pigment or remove coarse hair.