Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

DERMATOLOGY phase 1b > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What is a melanoma?

A

Malignant tumour arising from melanocytes
Leads to >75% of skin cancer deaths
Can arise on mucosal surfaces (e.g. oral, conjunctival, vaginal) and within uveal tract of eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some risk factors for melanoma? (genetic,environmental,phenotypic)

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What role does the MAPK (RAS-RAF-MEK-ERK) pathway play in the pathogenesis of skin cancer?

A

It regulates cellular proliferation, growth and migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the subtypes of melanoma?

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Unclassifiable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How common is superficial spreading as a subtype of melanoma?

A

60-70% of all melanomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is superficial spreading most typically found?

A

Trunk of men and legs of women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In superficial spreading how does growth occur?

A

Horizontal growth then vertical growth through the skin layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the second most common type of melanoma?

A

Nodular
15-30% of all melanomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where does nodular melanoma typicaly present?

A

trunk, head and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of growth is shown in nodular melanoma?

A

Only vertical growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What population is lentigo maligna most prevelent in?

A

> 60 years old
- Occurs in chronically sun-damaged skin
- Most common on face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is lentigo maligna?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where is acral lentiginous typical presentation?

A

Typically palms and soles or in/around nail apparatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the ABCDE for detection of melanoma?

A

Asymmetry
Border irregularity
Colour variation
Diameter greater than 5mm
Evolving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some poor prognostic features?

A

Increased Breslow thickness >1mm
Ulceration
Age
Male gender
Anatomical site – trunk, head, neck
Lymph node involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is investigation for melanoma and what is to be noted about it?

A

Dermoscopy –can improve correct diagnosis of melanoma by nearly 50%

NB

Dermoscopic findings should not be considered n isolation

History and risk factor status are important

Excise lesion for histological assessment if in any doubt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the typical management for melanoma?

A

Primary excision down to subcutaneous fat
- 2mm peripheral margin

Wide excision
- Margin determined by Breslow depth
- 5mm for in situ
- 10mm for </=1mm
Prevents local recurrence or persistent disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is sentinel lymphoma node biopsy?

A

Lymphatic drainage of finite regions of skin drain specifically to an initial node within a given nodal basin - the ‘sentinel node’
Most likely nodes to contain metastatic disease
Currently offered for pT1b+
Extracapsular spread on lymph node biopsy – needs lymph node dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What imaging is done for melanoma?

A

Stage III, IV
And Stage IIc without SLNB

PET-CT
MRI Brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a mojor prognostic indicator in melanoma?

22
Q

What are two methods used in unresectable or metastatic melanoma?

A

Immunotherapy and mutated oncogene targeted therapy

23
Q

What does immunotherapy involve?

A

CTLA-4 inhibition – unresectable or metastatic BRAF negative melanoma (Ipilimumab)
PD-L1 (Programmed cell death ligand) inhibitors (Nivolumab)

24
Q

What does mutated oncogene targeted therapy involve?

A
  • Combination of aBRAFinhibitor (e.g. encorafenib, vemurafenib, dabrafenib) andMEK inhibitor (e.g. trametinib)
25
What are some examples of keratinocyte dysplasia?
Actinic keratoses - Dysplastic keratinocytes Bowen’s disease (Squamous cell carcinoma in situ) Squamous cell carcinoma - Potential for metastasis/ death Basal cell carcinoma - (Virtually) never metastasises - Locally invasive
26
26
What is the pathogenesis for basal cell carcinoma?
Cross talk between tumour cells and mesenchymal cells of stroma - Receptors for PDGF are upregulated in Stroma but PDGF is upregulated in tumour cells BCC has proteolytic activity e.g. metalloproteinases and collagenases – degrade pre-existing dermal tissue and facilitate spread of tumour cells Loss of function in chromosome 8q (PTCH gene) - p53 mutations are also important – majority are missense mutations that carry a UV signature
27
What is the pathogenesis for squamous cell carcioma?
Develops through addition of genetic alterations – alterations in p53 are most common - CDKN2A also NOTCH1 or NOTCH2 (Wnt / β-catenin signalling) also plays role
28
Which is more common between basal cell carcinoma na d squamous cell carcinoma?
BCC:SCC 4:1 Both commoner in pale skin types Both more common in men vs women (2-3:1) Median age at diagnosis of BCC is 68
29
What are some risk factors for keratinocyte carcinomas?
UV exposure - PUVA Fair skin Genetic syndromes - Xeroderma pigmentosum - Oculocutaneous albinism - Muir Torre syndrome - Nevoid basal cell carcinoma syndrome* Nevus sebaceous Porokeratosis Organ transplantation (immunosuppressive drugs) Chronic non-healing wounds Ionising radiation - Airline pilots Occupational chemical exposures - Tar, polycyclic aromatic hydrocarbons
30
What are some characteristics of actinic keratoses?
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
31
What is bowen's disease?
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
32
what is the treatment for bowen's disease and actinic keratoses?
5-fluorouracil cream Cryotherapy Imiquimod cream Photodynamic therapy Curettage and cautery Excision
33
What might squamous cell carcinoma look like?
Erythematous to skin coloured - Papule - Plaque-like - Exophytic - Hyperkeratotic - Ulceration
34
What are some clinical features of squamous cell carcinoma?
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
35
What are keratoacanthoma (how they present, how they resolve, where they present, what are they similar to)?
Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core Resolves slowly over months Most occur on head or neck / sun exposed areas Difficult to distinguish clinically and histologically from squamous cell carcinoma
36
What are some diffrential diagnoses for squamous cell carcinoma?
Basal cell carcinoma Viral wart Merkel cell carcinoma
37
What is the treatment for squamous cell carcinoma?
Examination of rest of skin and regional lymph nodes Excision Radiotherapy - Unresectable - High risk features e.g. perineural invasion Cemiplimab for metastatic SCC Secondary prevention - Skin monitoring advice - Sun protection advice
38
38
What are the main subtypes for basal cell carcinoma?
Nodular Superficial Morpheic Infiltrative Basisquamous Micronodular
39
Describe nodular basal cell carcinoma
Most common subtype Accounts for approximately 50% of all Basal cell carcinomas Typically presents as shiny, pearly papule or nodule
40
Describe superficial basal cell carcinoma?
Well-circumscribed, erythematous, macule / patch or thin papule /plaque
41
Describe morphoeic basal cell carcinoma?
Less common Slightly elevated or depressed area of induration Usually light-pink to white in colour More aggressive behaviour - Extensive local destruction
42
Describe basisquamous basal cell carcinoma
Histological features of both basal cell carcinoma and squamous cell carcinoma
43
Describe micronodular basal cell carcinoma?
Resembles nodular basal cell carcinoma clinically More destructive behaviour – high rates of recurrence and subclinical spread
44
What are soem diffrential diagnosis for basal cell carcinoma?
Squamous cell carcinoma Adnexal (sebaceous) carcinoma Merkel cell carcinoma
45
What are the main teeatment options for basal cell carcinoma?
Standard surgical excision Mohs micrographic surgery - Recurrent basal cell carcinoma - Aggressive subtype (morpheic / infiltrative / micronodular) - Critical site
46
What are some other options for treating basla cell carcinoma?
Topical therapy e.g. 5-Fluorouracil, Imiquimod Photodynamic therapy Curettage Radiotherapy Vismodegib - selectively inhibits abnormal signalling in Hedgehog (Hh) pathway
47
What are origin cell for merkel cell carcinoma?
Origin cell not a Merkel cell – are highly anaplastic cells which share features with neuroectodermally derived cells (including Merkel cells)
48
How does merkel cell carcinoma present?
Predilection for the head and neck region of older adults Solitary, rapidly growing nodule- pink-red to violaceous, firm, dome shaped, - Ulceration can occur

DERMATOLOGY phase 1b (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions