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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

what are the 2 main types of skin cancer?

A

non-melanoma skin cancer & melanoma

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2
Q

where do the majority of non-melanoma skin cancers arise from?

A

keratinocytes in the epidermis

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3
Q

where do basal cell carcinomas (BCC) arise from?

A

keratinocytes within the basal layer

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4
Q

where do squamous cell carcinomas (SCC) arise from?

A

the supra basal layers

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5
Q

which is the most serious form of skin cancer?

A

melanoma

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6
Q

where do melanomas arise from?

A

melanocytes scattered along the basal layer of the epideris

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7
Q

what do BCCs usually present as?

A

painless, pearly/transluscent, slow-growing lump or non-healing ulcer, visible arborising blood vessels

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8
Q

how do SCCs present?

A

a number of ways including a warty or crusted growth or a non-healing ulcer (hyperkeratotic lump/ulcer)

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9
Q

where do SCCs usually arise?

A

on sun damaged skin

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10
Q

how do SCCs tend to grow?

A

fast & may be painful

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11
Q

do SCCs or BCCs spread around the body?

A

SCCs spread around the body with serious consequences

BCCs only spread locally

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12
Q

which is the most common cancer in 15-24 yr olds?

A

melanoma

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13
Q

are melanomas more common in men or women?

A

more common in women but more men die

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14
Q

what does melanoma survival depend on?

A

tumour depth

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15
Q

what is the ABCDE rule for diagnosing melanomas?

A 
A - asymmetry
B - border
C - colour 
D - diameter
E- evolution
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16
Q

what happens in a rodent ulcer presentation of BCC?

A

central ulceration

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17
Q

what happens in a superficial presentation of BCC?

A

scaly laque

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18
Q

what is an infiltrative BCC called?

A

morphoeic

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19
Q

what are the precursor lesions for SCCs & BCCs?

A

actinic keratoses (AK) & Bowen’s disease (carcinoma in-situ)

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20
Q

what is a keratocanthoma?

A

a self-resolving skin lesion that erupts in sun damaged skin, rather like a little volcano, usually has a central plaque

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21
Q

what is field cancerisation?

A

more severe field change

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22
Q

what are the risk factors for skin cancer?

A
  • sun exposure
  • genetic predisposition
  • immunosuppression
  • other environmental carcinogens (coal tar, smoking, ionising radiation, arsenic, trauma, chronic ulceration)
  • age
  • immunosuppression
  • HPV
23
Q

what sun exposure pattern would create a risk of SCC?

A

chronic, cumulative UV-exposure

24
Q

what sun exposure pattern would create a risk of BCC?

A

intermittent, intense sunburn episodes

25
Q

what sun exposure pattern would create a risk of melanoma?

A

intermittent, intense sunburn episodes

26
Q

who are at risk of SCCs?

A

outdoor workers, famers, sailors, recreational & dedicated sunbathers

27
Q

which genetic conditions increase your risk of skin cancer?

A
  • xeroderma pigmentosum
  • oculocutaenous albinism
  • naevoid BCC (Gorlin’s) syndrome
  • recessive dystrophic epidermolysis bullosa
28
Q

what immunological factors can increase your risk of skin cancer?

A
  • organ transplantation
29
Q

what is carcinogenesis?

A

the process by which a normal cell becomes a malignant cancer cell

30
Q

what is cancer?

A

an accumulation of abnormal cells that multiply through uncontrolled cell division & spread to other parts of the body by invasion &/or distant metastasis via the blood & lymphatic system

31
Q

what does uncontrolled cell proliferation require in terms of genes?

A

multi-step gene damage

e.g. gain of function of oncogenes & loss of function of tumour suppressors

32
Q

what is clonal evolution?

A

a series of mutations that accumulate in successive generations of the cell in a process

33
Q

what are the 6 hallmarks of cancer?

A
  1. autonomous growth signals
  2. insensitivity to anti-growth signals
  3. resist cell death (apoptosis)
  4. limitless potential to divide
  5. angiogenesis
  6. invasion & metastasis
34
Q

how can damage occur to our DNA causing cancer?

A
  • natural accumulation of DNA damage (cancer is usually a disease of old age)
  • carcinogens
  • inherited defects
35
Q

what does UV-A do to our DNA?

A

indirect DNA damage, much more prevalent, penetrates more deeply into skin

36
Q

what does UV-B do to our DNA?

A

direct DNA damage, much more damaging than UVA, only when sun is directly overhead

37
Q

what can mutations in genes involved in DNA repair lead to?

A

a mutator phenotype whereby cells accumulate further mutations at a greatly increased rate because of failure of DNA repair

38
Q

what can damage to genes that control the ingrate of cell devision lead to?

A

chromosome instability & the accumulation of chromosome abnormalities

39
Q

what does UVB generate?

A

DNA photoproducts

40
Q

what does UVA induce?

A

guanine oxidation roduces in DNA

41
Q

what does UV-induced immunosuppression lead to?

A
  • dendritic cells lose the ability to present antigens
  • T cells switch from helper to suppressor, regulatory T cells predominate
  • keratinocytes & DCs secrete immunosuppressive cytokines
42
Q

what happens in initiation of photocarcinogenesis & what does this form?

A

DNA damage forms photoproducts e.g. TP53, RAS mutations

43
Q

what happens in promotion of photocarcinogenesis & what does this form?

A

activation of signal transduction pathways & inflammation/oxidative stress causes AK

44
Q

what happens in progression of photocarcinogenesis & what does this form?

A

constitutive cell proliferation & survival. genetic instability. acquire hallmarks of cancer & causes SCC & metastases

45
Q

what do freckles mean in terms of tanning?

A

you cannot tan & need to protect your skin from sun

46
Q

which skin cancer do sunbeams increase the risk of?

A

melanomas

47
Q

what are the molecular drivers of BCC?

A
  • genetically homogenous tumour
  • aberrant hedgehog signalling
  • involvement of PTCH
48
Q

what gene is TP53?

A

guardian of the genome

49
Q

what does TP53 do?

A

protects cells from apoptosis, allowing accumulation of other mutations

50
Q

what are the phototoxic drugs?

A 
Voriconazole – antifungal agent
Thiazide diuretics
NSAIDs
Anti-TNF
Azathioprine
51
Q

how might specific cutaneous HPVS contribute towards cancer development?

A
  • inhibition of apoptosis
  • delay DNA repair
  • promote keratinocyte invasion
52
Q

which virus increases the risk of skin cancer?

A

HPV

53
Q

how can skin cancer be prevented?

A
  • screening/surveillance
  • treatment of premalignant conditions (cyrcotherapy/surgery)
  • sunscreens
  • UVA & UVB avoidance

Dermatology (16 decks)

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