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Derm > Skin cancer > Flashcards

Skin cancer Flashcards

1
Q

Most common modalities for examining skin cancers

A

Imaging and skin cancer

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2
Q

What is a melanoma?

A

Malignant tumour arising from melanocytes

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3
Q

Where can melanomas form?

A

Skin
Mucosal surfaces e.g. vaginal, bowel, oral, conjunctiva
Due to abnormal migration of melanocyte precursors

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4
Q

Genetic risk factors of melanoma

A

Family history
DNA repair defects - xeroderma pigmentosum
Pale skin
Red hair

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5
Q

Environmental risk factors of melanoma

A

Sun/UV exposure
Immunosuppression

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6
Q

Phenotypic risk factors of melanoma

A

> 100 moles
atypical moles
nevi = moles

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7
Q

What are some specific genetic mutation that is a risk factor for melanoma?

A

CDKN2A Mutation - tumour suppressor
cyclin kinase

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8
Q

What are four subtypes of melanoma?
LANS

A

Lentigo Maligna,
Acral Lentiginous,
Nodular,
Superficial Spreading

some are unclassifiable

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9
Q

What is the most common type of melanoma

A

Superficial spreading
Can arise de novo or from an old mole

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10
Q

Where do superficial spreading melanomas arise?

A

Trunk or Legs

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11
Q

Why is depigmentation in melanoma tumours found?

A

Shows as grey or hypopigmented area
Where there has been an immune response against the tumour

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12
Q

Describe the growth pattern of superficial spreading melanoma

A

First horizontal growth and then vertical growth

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13
Q

What is the horizontal growth in superficial spreading melanomas characterised by

A

asymmetry
colour variation
border irregularity

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14
Q

Where on the body do nodular melanomas occur

A

Trunk
head
neck

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15
Q

Describe the appearance of nodular melanomas?

A

Blue to black nodules (may also lack in colour), rapid development
more common in men

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16
Q

Describe the growth pattern of nodular melanomas?

A

Only vertical growth - therefore spherical shape
Deeper and more likely to metastasize

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17
Q

ABCDE of melanoma self detection
(nodular melanoma does not follow this rule)

A

Asymmetry
Border irregularity
Colour variation
Diameter >5/6mm
Evolution: change in size, shape, colour

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18
Q

Who does Lentigo maligna mainly affect

A

> 60yrs
chronically sun damaged skin

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19
Q

What is the appearance of lentigo maligna melanoma?

A

Slow growing, asymmetric brown/black macule with irregular border (not well defined)

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20
Q

Lentigo maligna vs Lentigo maligna melanoma?

A

Lentigo Maligna - in situ
Lentigo Maligna Melanoma - invasive

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21
Q

What body parts are affected by acral lentiginous melanoma

A

palms/soles - ulceration and scarring
nail apparatus - lines called melanonychia

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22
Q

Who is most affected by acral lentiginous melanoma

A

Affects all skin types equally
Though darker skinned people are more likely to be diagnosed with this over other types

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23
Q

Amelanotic melanoma

A

No pigment
appears pink

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24
Q

What are poor prognostic features for melanoma?

A

Increased Breslow thickness (>1mm) - main one!!!, Ulceration,
Age,
Lymph Nodes involvement

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25
Q

What are some differential diagnoses for melanoma?

A

Basal cell carcinoma, Seborrhoeic keratosis, Dermatofibroma

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26
Q

What is dermoscopy?

A

Tool to microscopically examine skin
Improves diagnosis

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26
Q

What is Breslow thickness?

A

Thickness of tumour from stratum granulosum

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27
Q

What is the primary management for melanoma?

A

Primary excision down to subcutaneous fat - wide border
In larger melanomas you must also check the surrounding lymph nodes for metastasis

28
Q

What is another biopsy done in melanoma management?

A

Sentinel lymphoma node biopsy - (sentinel lymph nodes are the initial nodes for skin drainage .: most likely for metastasis)

29
Q

What imaging is done in melanoma management?

A

PET-CT, Brain MRI

30
Q

What is a major prognostic factor in melanoma?

A

LDH - shows tissue damage
Good for patients with proven metastases

31
Q

What is the management of unresectable or metastatic melanoma?

A

Immunotherapy (CTLA-4 and PD-L1 inhibitors)
Mutated oncogene targeted therapy (BRAF, MEK)

32
Q

What is the main cause of keratinocyte dysplasia

A

UV damage

33
Q

What is another term for keratinocyte dysplasia?

A

Keratinocyte carcinoma

34
Q

What are the different conditions in keratinocyte dysplasia?
ABBS

A

Actinic keratoses
Bowen’s disease (in situ SCC)
Basal Cell Carcinoma
Squamous Cell Carcinoma (including keratacanthoses)

35
Q

What are actinic keratoses and where are they found?

A

Atypical keratinocytes confined to epidermis

36
Q

What is the difference between macules and papules?

A

Macules - flat // Papules - raised

37
Q

What is Bowen’s disease?

A

Squamous Cell Carcinoma in situ

38
Q

What is Squamous Cell Carcinoma

A

affects the Full thickness of the epidermis + invasive
Can metastasise

39
Q

What is Basal cell carcinoma

A

locally invasive, almost never metastasises
Most common skin cancer

40
Q

What are some other risk factors for keratinocyte carcinomas?

A

Pale Skin,
Genetic syndromes (xeroderma pigmentosum),
Organ transplantation, (immunosuppression)
Ionising radiation
Chemical exposure e.g. tar

41
Q

Where do actinic keratoses usually develop?

A

Sun-damaged skin - head, neck, extremities

42
Q

What are the features of actinic keratoses?

A

Erythematous Macules, some scaliness

43
Q

What does Bowen’s disease look like?

A

Erythematous scaly patch or elevated plaque

44
Q

What other diseases can Bowen’s disease replicate?

A

Actinic keratoses // Psoriasis

45
Q

What is the treatment for actinic keratoses and Bowen’s disease?

A

Topical chemotherapy, 5-fluorouracil
Cryotherapy,
Imiquimod cream, stimulates immunity
Photodynamic therapy, apoptosis of atypical cells
Excision

no radiation therapy

46
Q

Describe what a squamous cell carcinoma can look like

A

Erythematous or skin coloured // Papule // hyperkeratotic ulceration

47
Q

What is a keratoacanthoma?

A

Rapidly enlarging papule that spontaneously resolves.
Dome shaped nodule with keratotic core which resolves slowly by itself

48
Q

What condition mimics SCC

A

keratoacanthoma
often indistinguishable

49
Q

Investigation of SCC

A

Diagnostic biopsy
US of regional lymph nodes
Fine needle aspiration if concerned about metastasis

50
Q

What are the differential diagnoses for squamous cell carcinoma?

A

Basal cell carcinoma, Viral wart, Merkel cell carcinoma

51
Q

What is the treatment for squamous cell carcinoma?

A

Excision,
Radiotherapy (for unresectable/high risk features)
Cemiplimab immunotherapy for metastases (block own inhibitors)

52
Q

What are the different types of basal cell carcinoma?
(Basal Never Metastasises, Mustn’t Invade Systemically)

A

Basisquamous,
Nodular (most common),
Micronodular,
Morpheic,
Infiltrative,
Superficial

53
Q

How does nodular basal cell carcinoma present?

A

Shiny, pearly papule or nodule

54
Q

How does superficial basal cell carcinoma present?

A

Well-circumscribed, erythematous, macule/thin papule

55
Q

How does morphoeic basal cell carcinoma present?

A

Extensive Local destruction, light-pink to white (like a scar)

56
Q

What histological features do basisquamous BCCs present with?

A

Features of both basal cell and squamous cell carcinoma High risk of metastasis

57
Q

What is the difference between micronodular and nodular BCC?

A

Micronodular has more destructive behaviour and faster spread
determined histologically

58
Q

What are the differential diagnoses for basal cell carcinoma?

A

Squamous Cell Carcinoma, Sebaceous Carcinoma, Merkel Cell Carcinoma

59
Q

What is the treatment for basal cell carcinoma?

A

Surgical excision,
Mohs micrographic surgery, (for recurrent/aggressive BCC)
Topical therapy (5-fluorouracil),
radiotherapy
photodynamic therapy

60
Q

What is the treatment for unresectable BCC?

A

Radiotherapy,
Vismodegib - selectively inhibits abnormal signalling

61
Q

Mohs micrographic surgery

A

Remove individual layers of skin and examine until the cancer has all been taken out.
Means you can retain the surrounding tissue
Highly skilled technique which takes a long time

62
Q

Describe the ideal excision process for basal cell carcinoma

A

Bread-loafing method - take thin slices at edges of tumour to find the whole size (usually 4-5mm extra)
some areas such as the eyelids or nose do not have this extra space.

63
Q

What cells are impacted by merkel cell carcinoma?

A

Anaplastic cells (not Merkel Cells!)
share features with neuroendocrine cells (like Merkels)

64
Q

What are the common causes of merkel cell carcinoma?

A

Polyomavirus, UV Exposure

65
Q

How does Merkel Cell Carcinoma present?

A

Rapidly growing nodule -> pink-red dome shaped
ulceration can occur

66
Q

Merkel cell carcinoma

A

Most aggressive type of skin cancer
40% will metastasise

67
Q

How should suspected melanoma be treated and diagnosed

A

Complete excision for diagnosis

68
Q

High risk features of cutaneous SCC

A

localisation: head, neck, trunk, periorificial zones
ill defined margins
rapidly growing
immunosuppression
previous radiotherapy or chronic inflammation
acantholysis on histology
invasion beyond subcutaneous fat
perineural, vascular, lymphatic invasion

Derm (4 decks)

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