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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the fastest increasing cancer in Scotland?

A

malignant melanoma

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2
Q

Where is malignant melanoma most common?

A

Sun exposed sites - scalp, face, neck, arms, legs

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3
Q

Where can a malignanct melanoma occur but this happens rarely?

A

eye, meninges, oesophagua, biliary tract, anus

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4
Q

Define the Breslow thickness.

A

the depth frm the granular layer of the epidermis to the deepest melanoma cell

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5
Q

What is the ABCDE of skin cancer?

A 
A - aymmetry 
B - border 
C - colour
D - diameter 
E - Evolution
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6
Q

Up to what diameter are you not concerned about a skin lesion?

A

6cm

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7
Q

Apart from Breslow thickness, what else is an adverse prognostic indicator of skin cancer?

A

Ulceration
Satellite deposits of melanoma
High itotic rate
Lymphovascular invasions

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8
Q

What are the 4 main types of malignant melanoma?

A

Superficial spreading melanoma
Acral/ mucosal lentiginous-acral and mucosal melanoma
Lentigo maligna melaoma
Nodular

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9
Q

What is the most common subtype of malignant melanoma and where is this most commonly found?

A

Superficial spreading melanoma

trunks of men and legs of women

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10
Q

Describe the appearance of a typical superficcial spreading melanoma.

A

Usually macule with irregular border and colour which may have been increasing in size for years (slow horizontal growth phase) before developing a nodule (rapid verticle growth phase)

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11
Q

Where are Acral/ mucosal lentiginous-acral and mucosal melanomas most commonly found?

A

palms, soles, nials and mucosal sites of elderly population

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12
Q

Where do Lentigo maligna melaoma usually appear?

A

Elderly face

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13
Q

Where are nodular maligant melanomas found?

A

Varied sites but often trunk

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14
Q

What is an amelanocytic melanoma?

A

Rare form of maligant melanoma where there is absent or minimal visible pigment

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15
Q

In nodular melanomas what is there no clinical evidence of?

A

Radial growth phase

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16
Q

Describe the typical appearance of a nodular melanoma.

A

Blue-black or red-skin coloured nodule whihc may be ulcerated or bleeding and has usually developed rapidly over preceding months

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17
Q

How do malignant melanomas spread?

A

Local dermal - satellite deposits
Regional lymph node mets - common pattern of disease progression
Haematogenous spread

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18
Q

How are MM treated?

A

Primary excision to give clear margins and SNB if indicated

Could give: chemo, immunotherapy, genetic therapies

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19
Q

Melanomas on intermittently sun-exposed skin may have what mutation?

A

BRAF mutation

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20
Q

What mutation do some acral melanomas have?

A

c-kit mutation

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21
Q

What are basal cell carcinoma and squamous cell carciomas classified as?

A

Non-melanoma skin cancer

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22
Q

How can basal cell carcinomas present?

A 
Slow growing lump or non-healing ulcer 
painless, often ignored 
"pearly" or translucent but can be pigmented 
visible, arborising vessels 
scaly plaque - superficial BCC
Infiltrative - morphoeic BCC 
Poory defined margins
23
Q

Do BCC commonly metastasise?

A

No, locally invasive but rarely metastasie

24
Q

How do SCC present?

A

hyperkeratotic (crusty) or warty ump or non-healing ulcer
grow relatively fast
may be painful and/or bleed
arise on sun damaged skin

25
Q

Where are high risk sites for SCC?

A

ear
face
lip
scalp

26
Q

What diseases are precursors to SCC?

A

Bowen’s disease
actinic keratosis
Viral lesions (esp on anogenital skin)

27
Q

What is an adverse prognostic indicator of SCC?

A

Perineural spread

28
Q

What is the risk of mets in SCC? How does this affect prognosis?

A

5% risk of mets
poor prognosis once metastatic
5 year survival rate of met SCC is 25%

29
Q

If you have one SCC, what is the likelihood that you will get another?

A

50% further SCC at 5 years

30
Q

What do actinic keratoses look like?

A

Erythematous sillver-scaly papules or patches with a conical surface and red base

31
Q

With actinic keratoses what does the background skin tend to look like?

A

Often inelastic, wrinkled and may show flat brown macules (solar lentigos) reflecting diffuse solar damage

32
Q

Where do actinic keratoses develop?

A

Sun exposed areas - scalp, face, hands

33
Q

If a patient has several actinic keratoses in one area, how can this be described?

A

“field damage” or more sever “field cancerisation”

34
Q

What treatment options are there for actinic keratoses?

A

cryotherapy
topical 5-fluoroacil cream
5% imiquimod cream
diclofenac gel

35
Q

How is Bowen’s disease typicaly described?

A

“Isolated red scaly patch”

or patch looking ike psoriasis but ti has an irregular edge

36
Q

What is the underlying mechanism behind Bowen’s disease?

A

Long term sun exposure leads to no maturation of cells giving parakeratosis on surface

37
Q

What are the treatments available for Bowen’s disease?

A

cryotherapy
topical 5-fluoroacil cream
5% imiquimod cream
curettage

38
Q

List the potentiall pre-maligant skin conditions.

A 
Actinic keratsis 
Bowen's disease 
Atypical/ dysplastic naevus syndrome 
Giant congenital melanocytic naevi 
Viral precursors associated with HPV
39
Q

What is the name for penile Bowen’s?

A

Erythroplasia of Queryat

40
Q

In terms of sun damage, what is the typical description for that required to get SCC?

A

Chronic sumulative UV- exposure

41
Q

In terms of sun damage, what is the typical description for that required for the development of BCC and MM?

A

Intermittent intense sunburn episodes

42
Q

Does UVA directly cause DNA damage?

A

No - indirectly

UVB directly causes DNA damage

43
Q

What is the proper term for “liver spots”?

A

Solar lentigo

44
Q

Up to what % of sun damage occurs in the first 18 years of life?

A

Up to 80%

45
Q

Childhodd sunburn increases the risk of melanoma … times?

A

4 x

46
Q

Which genetic conditions put you at an increased risk of skin cancer?

A

Xeroderma pigmentosum
Albinism
Naevoid basal cell carcinoma (Gorlin’s) syndrome

47
Q

What is Gorlin’s syndrome?

A

Autosomal dominant familial cancer syndrome

early onset and multiple BCCs

48
Q

For transplant patients on immunosuppresants, what is the most common form of skin cancer they can develop?

A

SCC

49
Q

Give some phototoxic drugs.

A 
Vorconazole 
Anti-TNF 
BRAF inhibitors 
Thiazide diuretics 
NSAIDs
50
Q

Why might a biopsy of a rash not provide a diganosis?

A

Different skin conditions may have same histology

One cause of a skin pathology may hvae different histology patterns

51
Q

What is the most common form of skin surgery for skin lesions?

A

Elliptical excision

52
Q

Give some benefits of punch biopsy?

A

Quick

produces good wound edges

53
Q

Give some disavantages to using punch biopsy?

A

Difficult to judge depth
round holes do not always heal well
pathology sample may be too small

54
Q

What complications can occur after skin surgery?

A 
Bleeding 
wound dehisence 
infection 
scarring 
loss of function 
motor or sensory nerve damage

Dermatology (11 decks)

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