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dermatology yr 2 > skin cancer > Flashcards

skin cancer Flashcards

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1
Q

what is a melanoma

A

Malignant tumour arising from melanocytes

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2
Q

what proportion of skin cancer deaths is melanoma responsible for?

A

75%

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3
Q

where can melanoma arise?

A

on mucosal surfaces (e.g. oral, conjunctival, vaginal) and within uveal tract of eye

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4
Q

how is melanoma incidence changing (incr or decr)

A

increasing

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5
Q

genetic factors For melanoma

A

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

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6
Q

environmental factors for melanoma

A

Sun exposure – intense intermittent or chronic
Sunbeds
Immunosuppression

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7
Q

a risk factor of melanoma related to a skin feature

A

> 100 melanocytic nevi (mole/ spot)
atypical melanocytic nevi

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8
Q

what populations are at greater and lower risk of melanoma

A

predominantly in Caucasian populations
than darkly pigmented populations

more australia and NZ than europe

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9
Q

subtypes of melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Unclassifiable

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10
Q

which subtypes of melanoma are the first and second most common amongst fair skin?

A

superficial spreading, 60-70 of all melanomas

2nd: nodular 15-30% of all melanomas

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11
Q

where is the most common site to get superficial spreading melanoma and nodular melanoma in men and women

A

trunk in men and legs in women

trunk head and neck for nodular both sexes

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12
Q

is nodular melanoma more common in males or females?

A

males

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13
Q

what do nodular melanomas look like?

A

blue to black. but sometimes pink to red
nodule
may be ulcerated or bleeding

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14
Q

what is the growth rate of nodular melanoma (fast or slow)

A

develops rapidly

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15
Q

does superficial spreading melanoma arise on pre existing veni or de novo?

A

can be both

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16
Q

what is something that happens in 2/3 of superficial spreading tumours? which bodily system is responsible for this?

A

In ~2/3 of tumours, regression (visible as grey, hypo-or depigmentation )

a result of host immunity against tumour

(basically immune system fighting it and making it disappear/ fade a bit)

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17
Q

what are the two types of spreading of a melanoma and what melanoma type does each correspond to

A

horizontal (also called radial) growth in superficial spreading melanoma

and

vertical growth in nodular melanoma

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18
Q

which type of growth and by extension: melanoma subtype comes as a first phase and which one is the progressed phase

A

first horizontal growth and superficial spreading melanoma and then if progresses it will be vertical: nodular

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19
Q

what are some features that you (only) see in the superficial spreading melanoma?

A

asymmetry, boarder irregularity, colour variation

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20
Q

what is a sign that melanoma has moved from superficial spreading to nodular?

A

red nodule (san spiraki next to the superficial spreading lesion) see slide 12

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21
Q

what are the less common types of melanomas

A

acral lentiginous melanoma
and
non- classifiable melanomas: nail melanoma and amelanotic melanoma

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22
Q

why are non - classifiable melanomas called “non- classifiable”

A

because they don’t have a typical presentation of that allows them to fit into the other categories

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23
Q

explain the association between acral lentiginous melanoma and race

A

basically because darker skintones hardly ever get the other types of melanoma, 75% of afro caribbean people who have melanomas have this type just because ITS THE ONLY TYPE THEY CAN GET AS EASILY AS CAUCASIANS

similar vibes for asian but % = 45

REMEMBER this is what BOB MARLEY HAD

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24
Q

where does acral melanoma occur

A

in soles and palms ( akra!!)
OR
in/ around nail apparatus

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25
what age group is acral melanoma more common in
7th decade of life
26
nail melanoma what is it
slide didnt have text but basically this black line on usually only one nail starts form cuticle till end of nail
27
what is amelanotic melanoma
when the lesion is pink - not black or blue as typical so can be tricky - (when its pink stop and think)
28
what is the public awareness self detection campaign acronym for melanoma. explain it
ABCDE asymmetry (two halves dont match) border: uneven borders color: variety of color in the spot diameter: bigger than pencil eraser (1/4") Evolution: change in size shape colour ect.
29
what is Garbe's rule (concerning presentation of worried patient with skin lesion)
If a patient is worried about a single skin lesion, do not ignore their suspicion and have a low threshold for performing a biopsy
30
what are some things that may look like melanomas and therefore constitute differentials for melanoma?
basal cell carcinoma seborrhoeic keratosis dermatofibroma
31
what are some poor prognostic factors for melanoma
ANATOMY of an OLD THICK MAN with ULCER and LYMPH NODES (way to remember) Increased Breslow thickness >1mm Ulceration Increasing Age Male gender Anatomical site – trunk, nhead, neck Lymph node involvement
32
what is the 10 year survival rate for stage 1A vs thick (>4mm) and ulceration (pT4b) melanomas?
>95% of people get 10 yr surv with the first thing vs the other: 50% survival rate
33
what is berslow thickness of melanoma
its thickness measurement from granular layer (stratum granulosum) to BOTTOM of tumour
34
what investigations to do if suspecting melanoma, and what is their role/ significance.
1) dermoscopy can improve correct diagnosis of melanoma by nearly 50% BUT Dermoscopic findings should not be considered n isolation History and risk factor status are important if still in doubt 2) Excise lesion for histological assessment if in any doubt (if in doubt take it out)
35
what is the management of melanoma
primary excision down to subcutaneous fat with a 2mm peripheral margin (do this to send the lesion to biopsy and investigaitons - ex. determine breslow depth) then wide excision determined by berslow depth -5mm for in situ (Only on top layer of skin) -10 mm for
36
why is it important to lece magins in melanoma excision
to prevent recurrence or persistent disease
37
what are the staging methods for melanoma and why do we care about staging
pathological (breslow depth and other stuff from analyses) and TNM important because different excision extent for each
38
in melanoma, other than the local lesion biopsy what other part should you biopsy + why?
biopsy sentinel lymph nodes (a lymph node that contains lymph that drains into a particular skin area)
39
for what TNM staging of melanoma is sentimel lymph node biopsy currently offered for?
for pT1b + (dont need to know what that is)
40
when do you dissect a sentimel lymph node?
when theres extracapsular spread seen on lymph node biopsy (you also do immunotherapy probs)
41
for which melanoma stages do you need to do smth more after extraction? and what in particular?
for stage III and IV and IIc w/o SLNB you do imaging : PET CT AND MRI BRAIN and check LDH - major prognostic indicator in melanoma
42
what is a major prognostic indicator in melanoma
LDH
43
state the types of treatments for unresectable or metastatic melanoma?
Immunotherapy mutated oncogene targeted therapy
44
what are two mechanisms of 2 types of drugs + names of drugs
1)immunotherapy: CTLA-4 inhibition (eg ipilimumab) - used in unresectable or metastatic BRAF negative melanoma 2)mutated oncogene targeted therapy: combination of BRAF inhibitor (e.g. encorafenib, vemurafenib, dabrafenib) and MEK inhibitor (e.g. trametinib)
45
what is the pathology before a carcinoma called
actinic keratoses - there are dysplastic keratinocytes
46
what are the risk factors for keratinocyte dysplasia and by extension carcinomas?
solar induced and PUVA induced (a treatment with UV) - UV damage pale skin types genetic syndromes birth associated lesions prokeratosis (abnormal thickening of epidermis) immunosupression from organ transplant chronic non healing wounds eg ulcers ionising radiation- ariline pilots occupational chem exposures
47
some genetic syndromes risk factors of carcinomas
- Xeroderma pigmentosum (Most important!!) - Oculocutaneous albinism - Muir Torre syndrome - Nevoid basal cell carcinoma syndrome*
48
one birth associated lesion risk of carcinoma>?
nevus sebaceous
49
some occupational chemical exposures that are risks of carcinoma
Tar, polycyclic aromatic hydrocarbons
50
state the different types of carcinoma
Bowen's disease (squamous cell carcinoma in situ) Squamous cell carcinoma Basal cell carcinoma
51
explain difference between Bowen's disease, SSC and BCC
(Squamous cell carcinoma in situ)- if it’s the full thickness of the epidermis But not INVADING the dermis SCC: has invaded the dermis, AND has potential for metastasis/ death BCC: can ALSO be locally invasive like SCC but the difference to SCC is that IT NEVER METASTASISES
52
what is the most common type of skin cancer
Basal cell carcinoma
53
what is the ration BCC: SCC
4:1
54
what are the demographics of BCC and ACC (ADENOID cystic carcinoma)
both ore common in men men:women 2-3: 1 both more common in pale skin types median age diagnosis of BCC is 68
55
where (in skin leayers) are actinic keratoses found and what are they
Atypical keratinocytes confined to epidermis
56
where in body is actininc keratoses most prominent?
Develop on sun-damaged skin - usually head, neck, upper trunk and extremities
57
what do actininc keratoses lesions look like on skin and how do you distinguish from SSC
Macules or papules Red or pink Usually some scale – may be thick scale Distinction from squamous cell carcinoma sometimes difficult – requiring biopsy
58
risk of progression of actinic keratoses to SCC?
0.025–16% per year for any single lesion
59
WHAT does Bowen's disease look like on skin
Erythematous scaly patch or slightly elevated plaque May resemble actinic keratoses, psoriasis, chronic eczema
60
what does Bowens disease arise from? (not in sense of cause in sense of preceding "phase")
May arise de novo or from pre-existing AK
61
what does SCC arise from? (not in sense of cause in sense of preceding "phase")
Arises within background of sun-damaged skin
62
WHAT DOES scc LOOK LIKE on skin
- Erythematous to skin coloured - Papule - Plaque-like - Exophytic (protrudes sortof- slide 44) - Hyperkeratotic - Ulceration
63
clniical high risk features of SCC
Localisation and size: - Trunk and limbs > 2cm - Head / neck > 1cm - Periorificial zones Margins: Ill-defined Rapidly growing Immunosuppressed patients Previous radiotherapy or  site of chronic inflammation
64
HIstological high risk signs for SCC
Histology: - Grade of differentiation: poorly differentiated - Acantholytic, adenosquamous, demosplastic subtypes - Tumour thickness - Clark level: >6mm, Clark IV, V - Invasion beyond subcutaneous fat - Perineural, lymphatic or vascular invasion
65
WHAT IS a keratoacanthoma
Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core-( see it slide 48 its hard to imagine )
66
how long does Keratoacanthoma take to resolve
slowly over months
67
where does Keratoacanthoma typically occur
head and neck/ sun exposed areas
68
what is Keratoacanthoma commonly mistaken for?
Difficult to distinguish clinically and histologically from squamous cell carcinoma
69
investigations for keratoacanthoma
Often clinical diagnosis sufficient Diagnostic biopsy may be taken if diagnostic uncertainty Ultrasound of regional lymph nodes ± FNA if concerns regarding regional lymph node metastasis
70
differentials for SCC
BCC viral wart merkel cell carcinoma
71
what is typical treatment of SCC
(supper similar to melanomas) Examination of rest of skin and regional lymph nodes Excision Secondary prevention - Skin monitoring advice - Sun protection advice
72
when do you do radiotherapy for SCC
Unresectable - High risk features e.g. perineural invasion
73
WHAT TO DO FOR METASTATIC SCC
GIVE CEMIPLIMAB
74
BCC subtypes
Nodular micronodular Superficial Morpheic Infiltrative Basisquamous
75
what is the most common type of BCC
NODULAR Accounts for approximately 50% of all Basal cell carcinomas
76
what DOES Nodular BCC look like
Typically presents as shiny, pearly papule or nodule
77
superficial BCC appearance
Well-circumscribed, erythematous, macule / patch or thin papule /plaque
78
morphoeic BCC, how common? how aggressive? and characteristics
Less common Slightly elevated or depressed area of induration Usually light-pink to white in colour More aggressive behaviour - Extensive local destruction
79
what are the histological features of basisquamous BCC
Histological features of both basal cell carcinoma and squamous cell carcinoma
80
compare and contrast nodular BCC and micronodular
Micronodular basal cell carcincoma Resembles nodular basal cell carcinoma clinically More destructive behaviour – high rates of recurrence and subclinical spread
81
BCC investigations
Often clinical diagnosis sufficient Diagnostic biopsy may be taken
82
differentials for BCC
SCC Adnexal (Sebaceous) carcinoma Merkel cell carcinoma
83
treat of BCC
Standard surgical excision
84
WHEN do we do mohs micrographic surgery
- Recurrent basal cell carcinoma - Aggressive subtype (morpheic / infiltrative / micronodular) - Critical site
85
for people not suitable for excision what ar eother options for BCC treat
(if superficial) Topical therapy e.g. 5-Fluorouracil, Imiquimod Photodynamic therapy Curettage (scraping) Radiotherapy ( in elederly who surgery not good option for) Vismodegib –genetic treatment that selectively inhibits abnormal signalling in Hedgehog (Hh) pathway
86
describe the origin cells of merkel cell carcinoma
NOT MERKEL CELLS ORIGIN CELLS are highly anaplastic cells which share features with neuroectodermally derived cells (including Merkel cells)
87
aetiological factors of merkel cell carcinoma
80% are associated with polyomavirus UV exposure is also an aetiological factor
88
where in body does merkel cell carcinoma most occur
Predilection for the head and neck region of older adults
89
appearance of merkel cell carcinoma
Solitary, rapidly growing nodule- pink-red to violaceous, firm, dome shaped, - Ulceration can occur
90
how agressive is merkel cell carcinoma
Aggressive, malignant behaviour >40% develop advanced disease
91
TRUE OR FALSE Nodular melanoma has a rapid radial growth phase
FALSE : Nodular melanoma lacks a radial growth phase
92
T or F: ABCDE rule is helpful for early detection of nodular melanoma
false Asymmetry, border irregularity, colour variation and diameter >5-6mm are products of the radial growth phase, absent in nodular MM
93
what is the ugly ducking sign?
a mole that does not resemble other nevi - may indicate an MM (malignant melanoma)
94
t/f suspected melanoma should undergo punch biopsy
false, should undergo complete excision and biopsy form that
95
t/f confirmed melanoma shou undergo sentinel lymph node biopsy
false - only offered for pT1b melanomas currently
96
t/f BCC never metastasises, and thus treatment is usually desirable rather than essential
Untreated basal cell carcinomas may become highly destructive to local structures and if left untreated over many years, may eventually become metastatic
97
is melanoma or merkel cell carcinoma more aggressive?
merkel
98
when can radiation therapy be used anf not be used in carcinoma related stuff
Radiation therapy may be used in treatment of BCC, SCC, MCC but not actinic keratoses

dermatology yr 2 (2 decks)

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