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BRS YR2 > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What is melanoma?

A
  • Malignant tumour arising from melanocytes
  • > 75% of skin cancer deaths
  • Can arise on mucosal surfaces (e.g. oral, conjunctival, vaginal) and within uveal tract of eye
  • Rising incidence rates observed worldwide
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2
Q

Which type of skin cancer is this?

A

Melanoma

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3
Q

What are the risk factors for melanoma?

A 
Genetic factors
- Family history (CDKN2A mutations), MC1R variants
- DNA repair defects (e.g. xeroderma pigmentosum)
- Lightly pigmented skin
- Red hair 

Environmental factors
* Sun exposure – intense intermittent or chronic
* Sunbeds 
* Immunosuppression

Phenotypic 
* >100 Melanocytic nevi
* Atypical melanocytic nevi
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4
Q

Who is most likely to get melanoma?

A

Caucasians living with more sun exposure e.g Australians

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5
Q

What are the subtypes of melanoma?

A
  • Superficial spreading
  • Nodular
  • Lentigo maligna
  • Acral lentiginous
  • Unclassifiable
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6
Q

What is superficial spreading melanoma?

A
  • Most common type in fair-skin
  • Trunk of men
  • Legs of women
  • Can arise de novo or in pre-existing nevus
  • Regression in 2/3 (greyness or hypopigmentation) caused by host immunity against tumor cell
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7
Q

What is this type of melanoma?

A

Superficial spreading

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8
Q

What is the growth pattern of superficial spreading melanoma?

A

Horizontal then vertical growth

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9
Q

What is nodular melanoma?

A
  • 2nd most common type of melanoma in fair skinned individuals
  • 15-30% of all melanomas
  • Most commonly trunk, head and neck
  • M>F
  • Blue to black, but sometimes pink to red, nodule – may be ulcerated, bleeding
  • Develops rapidly
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10
Q

What is the growth pattern of nodular melanoma?

A

Only vertical growth

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11
Q

What is this type of melanoma?

A

Nodular melanoma

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12
Q

What is lentigo maligna melanoma?

A
  • 10% (minority) of cutaneous melanomas
  • > 60 years old
  • Occurs in chronically sun-damaged skin
  • Most common on face
  • Slow growing, asymmetric brown / black macule with colour variation and an irregular indented border.
  • In situ – termed ‘Lentigo Maligna’
  • Invasive termed ‘Lentigo Maligna Melanoma’
  • 5% of lentigo maligna progresses to invasive melanoma
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13
Q

What is this type of melanoma?

A

Lentigo maligna

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14
Q

What is acral lentiginous melanoma?

A
  • Relatively uncommon
  • Most frequently in 7th decade of life
  • Typically palms and soles OR in / around nail apparatus
  • Incidence similar across all racial and ethnic groups
  • Disproportionate percentage of melanomas diagnosed in Afro-Caribbean (up to 70%) or Asians (up to 45%)
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15
Q

What is this type of melanoma?

A

Acral letiginous

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16
Q

What is this called?

A

Melanonychia

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17
Q

What is amelanotic melanoma?

A

Melanoma where the malignant cells have little to no pigment

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18
Q

What is the acronym for melanoma awareness?

A

ABCDE
* Asymmetry
* Border irregularity
* Colour variegation
* Diameter greater than 5mm
* Evolving

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19
Q

What is Garbe’s rule?

A

If a patient is worried about a single skin lesion, do not ignore their suspicion and have a low threshold for performing a biopsy

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20
Q

What are the differential diagnoses for melanoma?

A
  • basal cell carcinoma
  • seborrhoeic keratosis
  • dermatofibroma
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21
Q

What is this?

A

Seborrhoeic keratosis

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22
Q

What is this?

A

Dermatofibroma

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23
Q

What are the poor prognostic features of melanoma?

A
  • Increased Breslow thickness >1mm
  • Ulceration
  • Age
  • Male gender
  • Anatomical site – trunk, nhead, neck
  • Lymph node involvement
24
Q

What is Breslow thickness?

A

Measurment from granular layer to the bottom of the tumour

25
Q

Which investigations are done for melanoma?

A

Dermoscopy

26
Q

What is important to know about dermoscopy?

A
  • can improve correct diagnosis of melanoma by nearly 50%
  • should not be considered in isolation
27
Q

What is the managment for melanoma?

A
  • Primary excision down to subcutaneous fat
  • Wide incision
  • Sentinel lymphoma node biopsy
  • Prevents local recurrence or persistent disease
28
Q

What is sentinel lymphoma node biopsy?

A

Biopsy of the sentinel node (inital node of lymphatic drainage for a finite region of skin, most likely node to contain metastses)

29
Q

What imaging is done for melanoma?

A

PET-CT
MRI Brain

30
Q

What is a major prognostic indicator in melanoma?

A

LDH

31
Q

What is the managment of unresectable or metastatic melanoma?

A
  • immunotherapy
  • mutated oncogene target therapy
32
Q

What is keratinocyte dysplasia/carcinoma?

A

Solar induced UV damage

33
Q

What are the four types of keratinocyte dysplasia/carcinoma?

A
  • acitinic keratoses
  • Bowen’s disease
  • squamous cell carcinoma
  • basal cell carcinoma
34
Q

What is the most common skin cancer?

A

Basal cell carcinoma

35
Q

What are the risk factors for keratinocyte carcinomas?

A
  • UV exposure
  • fair skin
  • genetic syndromes
  • nevus sebaceous
  • porokeratosis
  • organ transplantation and immunosuppressive drugs
  • chronic non healing wounds
  • ionising radiation
  • occupational chemical exposure (tar, aromatic hydrocarbons)
36
Q

What are acitinic keratoses?

A
  • Atypical keratinocytes confined to epidermis
  • Develop on sun-damaged skin - usually head, neck, upper trunk and extremities
  • Macules or papules
  • Red or pink
  • Usually some scale – may be thick scale
  • Distinction from squamous cell carcinoma sometimes difficult – requiring biopsy
  • Risk of progression to squamous cell carcinoma
37
Q

What is this?

A

Acitinc keratoses

38
Q

What is Bowen’s disease?

A
  • Squamous cell carcinoma in situ
  • Erythematous scaly patch or slightly elevated plaque
  • May arise de novo or from pre-existing AK
  • May resemble actinic keratoses, psoriasis, chronic eczema
39
Q

What is squamous cell carcinoma?

A

Carcinoma which arises within background of sun-damaged skin

40
Q

What can squamous cell carcinoma look like?

A
  • Erythematous to skin coloured
  • Papule
  • Plaque-like
  • Exophytic
  • Hyperkeratotic
  • Ulceration
41
Q

What is this?

A

Squamous cell carcinoma

41
Q

What is this?

A

Squamous cell carcinoma

42
Q

What is keratocanthoma?

A
  • rapidly growing papule with keratotic core
  • resolves slowly over months
  • mostly occur on sun exposed areas
  • difficult to distinguish from squamous cell carcinoma
43
Q

What is this?

A

Keratocanthoma

44
Q

What investigations are done for squamous cell carcinoma?

A
  • diagnostic biopsy
  • ultrasound of regional lymphnodes
45
Q

What are the differential diagnoses for squamous cell carcinoma?

A
  • basal cell carcinoma
  • viral wart
  • merkel cell carcinoma
46
Q

What is the treatment for squamous cell carcinoma?

A

Excision

47
Q

What is the treatment for squamous cell carcinoma that is unresectable and has high risk features?

A

Radiotherapy

48
Q

What is the treatment for metastatic squamous cell carcinoma?

A

Cemiplimab

49
Q

What is secondary prevention for squamous cell carcinoma?

A
  • Skin monitoring advice
  • Sun protection advice
50
Q

What are the main subtypes of basal cell carcinoma?

A
  • Nodular
  • Superficial
  • Morpheic
  • Infiltrative
  • Basisquamous
  • Micronodular
51
Q

What is the most common subtype of basal cell carcinoma?

A

Nodular

52
Q

What is the treatment of basal cell carcinoma?

A
  • Standard surgical excision
  • Mohs micrographic surgery
53
Q

What is merkel cell carcinoma?

A
  • highly anaplastic cells which share features with neuroectodermally derived cells, not actually from merkel cells
  • 80% are associated with polyomavirus
  • Aggressive, malignant behaviour
  • > 40% develop advanced disease
54
Q

What is this?

A

Merkel cell carcinoma

BRS YR2 (67 decks)

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