Skin Cancer Flashcards by Evie Mander

What are actinic keratoses

Partial thickness dysplasia of epidermal keratinocytes

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What can actinic keratoses transform into

Squamous cell carcinoma

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Presentation of actinic keratoses

Scaly, erythematous papules or patches
Feel gritty and rough

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Where do actinic keratoses present

Sun exposed areas: scalp, face, hands

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Lesion based treatment of actinic keratoses

Cryotherapy, curettage and cautery

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Field based treatments for actinic keratoses

Topical 5-fluorouracil, photodynamic therapy

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What is another name for bowens disease

Intraepithelial carcinoma

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What is bowens disease

SCC in situ
Full thickness dysplasia of epithelial keratinocytes

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Who typically presents with bowens disease and where does it present

Lower legs of fair skinned women

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How does bowens disease present

Slowly enlarging, well demarcated, scaly red plaque with an irregular border

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Management of bowens disease

5-fluorouracil
Cryotherapy, photodynamic therapy

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What are a keratoacanthomas

Rapidly growing epidermal tumours

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When does a keratoacanthoma present

On sun exposed skin in later life

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Presentation of keratoacanthoma

Red papules with a central, crater-like crust keratinous plug

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Management of keratoacanthoma

Usually excised by can regress spontaneously after about 3 months

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What is the most common malignant skin cancer

Basal cell carcinoma

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What is a common name for a BCC

Rodent ulcer

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Where do BCCs arise from

Basal keratinocytes

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What is the main cause of BCC

Intense intermittent exposure to UV radiation

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Genetic association with BCC

90% have an inactivating mutation of PTCH

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Name some other risk factors for BCC

Immunosuppression, smoking, ionising radiation, trauma

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Name 2 conditions associated with BCC

Xeroderma pigmentosum
Oculocutaneous albinism

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Inheritance in oculocutaneous albinism

Autosomal recessive

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Pathophysiology of oculocutaneous albinism

Absence or a defect of tyrosinase resulting in an absence of melanin

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Describe the growth and spread of a BCC

Slow growing Rarely metastasise Can kill by invasion

What causes BCCs and SCCs

Epidermal keratinocyte DNA is damaged by solar UV radiation

History associated with BCC symptoms

Slow growing, just won’t heal, asymptomatic

Clinical features of a BCC

Rolled pearly edge, central ulceration, telangiectasia

Where do nodular BCCs usually present

On the face

Presentation of a superficial BCC

Erythematous, well demarcated scaly plaques Slightly raised whipcord margin

How are infiltrative BCCs characterised

By thickened yellowish plaques

Presentation of a pigmented BCC

Brown, blue or greyish May resemble malignant melanoma

In who is a pigment BCC more often seen in

Individuals with dark skin

Investigations for BCC

Biopsy

Management of a nodular BCC

Wide excision

Management of a superficial BCC

NON-SURGICAL TREATMENT cryotherapy, photodynamic therapy, topical imiquimod

Management of inflitrative BCC

MOHs surgery

Where do SCCs arise from

Supra-basal keratinocytes

What is the biggest association with SCC

Lifetime cumulative sun exposure

Genetic factors of SCCs

Fair skin type Xeroderma pigmentosum Oculocutaneous albinism

State 2 precursors to SCC

Actinic keratoses Bowens disease

What’s another word for actinic

Solar

What is the most common skin cancer in immunosuppressed patients

SCC

Name some other risk factors for SCC

Smoking Ionising radiation Trauma

Describe the growth and spread of SCCs

Locally invasive Low but definite risk of metastases

What are some high risk sites for SCC

Ear, lip and scalp

Presentation of an SCC

Warty or hyperkeratotic lump or ulcer Grow faster, may be painful and bleed

Usual management of an SCC

Complete wide surgical excision

Where does malignant melanoma arise from

Melanocytes in the basal layer of the epidermis

What is the main association with malignant melanoma

Intermittent intense sun exposure

Name some risk factors for malignant melanoma

Fair skin, multiple melanocytic naevi, family history of melanoma, immunosuppression

Genetic association with malignant melanomas

Activating BRAF mutation

Mutation seen in acral melanomas

c-kit mutations

Describe a superficial spreading melanoma

Large, flat, irregularly pigmented lesion Grows laterally before vertical invasion develops

Where are superficial spreading melanomas commonly seen

on the trunk and limbs

How do acral lentiginous malignant melanomas arise

Pigmented lesions on the palm or sole or under the nail

What is a lentigo maligna melanoma

Invasive tumour that develops within pre-existing lentigo maligna

Where do lentigo maligna melanomas usually present

Sun damaged face, neck or scalp

What is the most aggressive type of melanoma

Nodular malignant melanoma

Where do nodular malignant melanoma often occur

On the trunk

How do nodular melanomas present

Rapidly growing pigmented nodules which bleeds or ulcerates

What growth phase is a nodular melanoma always in

Vertical phase !!!

Radial growth phase

Tumour grows horizontally within the epidermis

Vertical growth phase

Tumour cells begin to invade deeper layers of the skin e.g. the dermis

What is used to stage melanomas

Breslow thickness

What is breslow thickness

Measures the vertical depth of invasion from the granular layer of the epidermis to the deepest tumour cell

What melanomas can metastasise

Those in the vertical growth phase

What do satellite deposits indicate

Local invasion of melanoma

Where can melanomas commonly spread to in the blood

Skin/soft tissues, heart, lungs, GI tract, liver, brain

History of symptoms in malignant melanoma

Changing pigmented lesions, itchy or bleeding

What approach is used to suspect melanoma

ABCDE approach

ABCDE approach in dermatology

Asymmetry Border- irregular Colour- 2 or more Diameter- >6mm Evolution- is it changing ?

Management of malignant melanoma

Narrow complete excision

What other assessment is useful in staging melanomas

Sentinel lymph node biopsy

What happens if sentinel node biopsy is positive in malignant melanoma

Regional lymphadenectomy

Management of advanced malignant melanoma

Chemo, immunotherapy, genetic therapies

Genetic therapies offered for malignant melanoma

Imatinib for c-kit mutations Debrafenib for BRAF mutations