Skin Cancer Flashcards
What are actinic keratoses
Partial thickness dysplasia of epidermal keratinocytes
What can actinic keratoses transform into
Squamous cell carcinoma
Presentation of actinic keratoses
Scaly, erythematous papules or patches
Feel gritty and rough
Where do actinic keratoses present
Sun exposed areas: scalp, face, hands
Lesion based treatment of actinic keratoses
Cryotherapy, curettage and cautery
Field based treatments for actinic keratoses
Topical 5-fluorouracil, photodynamic therapy
What is another name for bowens disease
Intraepithelial carcinoma
What is bowens disease
SCC in situ
Full thickness dysplasia of epithelial keratinocytes
Who typically presents with bowens disease and where does it present
Lower legs of fair skinned women
How does bowens disease present
Slowly enlarging, well demarcated, scaly red plaque with an irregular border
Management of bowens disease
5-fluorouracil
Cryotherapy, photodynamic therapy
What are a keratoacanthomas
Rapidly growing epidermal tumours
When does a keratoacanthoma present
On sun exposed skin in later life
Presentation of keratoacanthoma
Red papules with a central, crater-like crust keratinous plug
Management of keratoacanthoma
Usually excised by can regress spontaneously after about 3 months
What is the most common malignant skin cancer
Basal cell carcinoma
What is a common name for a BCC
Rodent ulcer
Where do BCCs arise from
Basal keratinocytes
What is the main cause of BCC
Intense intermittent exposure to UV radiation
Genetic association with BCC
90% have an inactivating mutation of PTCH
Name some other risk factors for BCC
Immunosuppression, smoking, ionising radiation, trauma
Name 2 conditions associated with BCC
Xeroderma pigmentosum
Oculocutaneous albinism
Inheritance in oculocutaneous albinism
Autosomal recessive
Pathophysiology of oculocutaneous albinism
Absence or a defect of tyrosinase resulting in an absence of melanin
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
