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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

What layer of the skin do melanocytes precide?

A

Stratum Basale

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2
Q

What are the layers of the epidermis from bottom to top?

A

Stratum basale Stratum spinosum Stratum granulosum Stratum lucidum Stratum corneum

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3
Q

Basal cell carcinoma effects what layer of the epidermis?

A

Stratum basale

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4
Q

What makes up Non-melanoma skin cancer?

A

Basal cell cancer Squamous cell cancer

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5
Q

What is the epidemiology of non-melanoma skin cancer?

A

Incidence has increased in the last 30-40 years Northern europe 3-4 times less than Australia BCCs account for 70% of NMSCs BBCs incidence from 146-788/100000 SCC 38-250/100000

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6
Q

What are the risk factors for non-melanoma skin cancer?

A

UV RADIATION Photochemotherapy Chemical carcinogens X-ray and thermal radiation Human papilloma virus Familial cancer syndromes Immunocuppression

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7
Q

How dangerous are Basal Cell Carcinomas?

A

Slow growing Rarely metastasise Removed because if left can form

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8
Q

Describe the appearance of Nodular Basal cell Carcinoma

A

Pearly rolled edge Telangiectasia Central Ulceration Arborising Vessels on dermoscopy

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9
Q

What is the most common BCC?

A

Nodular

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10
Q

Describe the appearacnce of superficial basal cell carcinoma

A

Larger diameter Flat Still a bit of a pearly look Eroded areas Telangiectasia

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11
Q

Descibe the appearance of pigmented BCC

A

Still pearly Very slow growing Telangiectasia Darker

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12
Q

Describe the appearance of morphoeic BCC

A

Much different to other BCCs

Look more like a scar

Very difficult to diagnose and treat, present late

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13
Q

What is the treatment for BCCs

A

Excision (GOLD STANDARD)

  • Curative if fully excised
  • Will scar

Curettage and Cautery

Moh’s Surgery

Photodynamic therapy

Cryotherapy

Imiquimod

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14
Q

What is curettage and cautery?

A

Lesion scrapped off and heat applied to sel vessels and destroy residual cancer cells

More likely for cancer to return as you cannot tell if you have removed it all

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15
Q

What are the indications for Moh’s Surgery?

A

Site (cannot remove alot of surrounding tissue)

Size (large)

Subtype

Poor clinical margin definition

Reccurrent

Perineural or perivascular involvement

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16
Q

What is Moh’s Surgery?

A

Thin layer of cancer removed

Put straight under microscope slide to see that there are clear margins all round

Next thin deeper layer removed

So on so that the whole cancer is gone with hopefully the minimum extra tissue

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17
Q

Where is Moh’s Surgery useful?

A

Places where alot of tissue cannot be spared like the nose

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18
Q

What is photo-dynamic tharapy?

A

Photochemical reaction to destroy cancer cells

Topical photsensitising agent applied which concentrates in cancerous cells

Red light applied

Photodynamic reaction occurs

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19
Q

What is photo-dynamic therapy good for?

A

Usually used for superficial BCC

Good for back aswell as it doesnt leave large scarring

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20
Q

What are the pros and cons of cryotherapy?

A

Pros:

  • Cheap
  • Easy to perform on the day

Cons

  • Can scar
  • Failure reccurence
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21
Q

What is Imiquimod?

A

Aldara

Immune response modifier

-Stimulates cytokine release (inflammation and destruction of lesion)

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22
Q

What are the pros and cons of Imiquimod?

A

Pros

  • Useful where surgery is undesirable
  • Usually good cosmetic result

Cons

  • Treatment time is 6 weeks
  • Significant inflammation
  • Failure/ reccurence
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23
Q

What is squamous cell carcinoma?

A

Derived from keratinising squamous cells

Usually on sun exposed skin

Can metastasise

Faster growing (than BCC), tender, scaly crusted growths

Can ulcerate

24
Q

What is the treatment of SCC?

A

Excision +/- radiotherapy

25
Q

Usually you dont follow up patients who have had Squamous cell carcinoma excised.

When would you?

A

If high risk:

  • Immunosuppressed
  • >20mm diameter
  • >4mm depth
  • Ear, nose, lip, eyelid
  • Perineural invasion
  • Poorly differentiated
26
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ

Slow growing

Erythomatous scaly patch

27
Q

What is the treatment for Bowen’s disease?

A

Cryotherapy

Imiquimod

Curettage and cautery

Photo-Dynamic Therapy

28
Q

What is actinic keratosis?

A

Rough scaly patches on background of sun damaged skin

Completely result of UV damage

29
Q

What is the treatment for actinic keratosis?

A

Diclofenac Gel

Cryotherapy

Curettage and Cautery

Imiquimod

30
Q

What is keratoacanthoma?

A

Varient of squamous cell carcinoma

Erupts from hair follicles in sun damaged skin

Grows rapidly, may shrink after a few months and resolve

31
Q

How is keratoacanthoma treated?

A

Excision

Very hard to differentiate from SCC even for pathology so excised to be safe

32
Q

What is Sebhorroeic Keratosis?

A

BENIGN but commonly referred

Warty growths with a “stuck on appearance” (like you could just pick them off)

Can have variable appearance (different colours etc)

Patients often have multiple +/- cherry angiomas

33
Q

How do you treat Sebhorroeic Keratoses?

A

Generally left untreated but if troublesome (getting caught on clothes etc)

  • Cryotherapy
  • Curettage
34
Q

What is the epidemiology of melanoma?

A

Incidence increased from 60s to 90s

About 10 to 40 per 100000 per annum

Mortality is about 1.9 per 100000 per annum

35
Q

What are the risk factors for melanoma?

A

UV radiation

Genetic susceptibility- fair skin, red hair, blue eyes and tendency to burn easily

Familial melanoma and melanoma susceptibility

36
Q

What systems can you use to decide if a mole is worrying enough to consider melanoma?

A

ABCDE rule

7 point checklist

37
Q

What is the ABCDE rule?

A

Asymmetry (worrying)

Border (loss of defined border)

Colour (new colours? 3 or more colours? dark areas?)

Diameter

Evolution (most important. Is it changing?)

38
Q

What is the 7 point checklist?

A

Major features

  • Change in size
  • Change in shape
  • Change in colour

Minor features

  • Diameter more than 5mm
  • Inflammation
  • Oozing or bleeding
  • Mild itch or altered sensation
39
Q

How can dermoscopy be used?

A

“Dermascope” or “dermatoscope”

Improved clinical accuracy compared to unaided eye

40
Q

How do melanomas grow?

A

2 growth phases

  • Radial growth phase
  • Vertical growth phase
41
Q

What is the most common type of melanoma?

A

Superficial spreading malignant melanoma

42
Q

What are lentigo malignant melanoma?

A

Generally found on the face

Have a pre cancer phase

Classical appearance of pigmentation around the hair follicles of the face

43
Q

What is nodular melanoma?

A

Most dangerous melanoma

Dont really have a radial growth phase -> straight into vertical growth phase

More likely to metastasise

44
Q

What is subungal melanoma?

A

Melanoma of nail

Looks like a bruised nail but doesnt grow out with nail

Bruise should be completely confined to nail. No involvement of skin (if not then melanoma: Hutchinson’s sign)

45
Q

What is acral lentiginous melanoma?

A

Acral lentiginous melanoma is a form of melanoma characterised by its site of origin: palm, sole, or beneath the nail (subungual melanoma). It is more common on feet than on hands. It can arise de novo in normal-appearing skin, or it can develop within an existing melanocytic naevus (mole).

46
Q

What is the treatment for melanoma?

A

Urgent surgical excision

  • Wide local excision
  • Subtype
  • Breslow thickness
47
Q

What is Breslow thickness?

A

Breslow depth in (mm) indicates the 10 year survival rate

Lower the breslow depth the better the survival

48
Q

In addition to urgent surgical excision how do you tackle melanoma?

A

Offer sentinal lymph node biopsy

-Used for prognosis but no benefit in survival of removing lymph nodes

Chemotherapy

Regular follow up

Primary and secondary prevention

49
Q

How do you protect yourself from sun?

A

Suncream

Cover up

Avoid sun at peak times (10am-4pm)

Dont burn at any time and try not to tan (tan just as damaging as burn!!)

Avoid sunbeds

50
Q

How should suncream be used?

A

UVA and UVB protection

At least SPF 30/ 4 star

Need to apply 2 tablespoons every 2 hours

51
Q

What does SPF mean?

A

SPF 30 means that if you burn in 1 min with this protection you should burn in 30 mins

When tested for SPF the participants are plastered so they are white. This means that IRL SPF 30 is more like 15 etc

52
Q

Give some examples of new therapies

A

Vismodegib

Ipilimumab

Vemurafenib

Dabrafenib

53
Q

What are the indications for vismodegib use?

A

Locally advanced BCC not suitable for surgery or radiotherapy

Metastatic BCC

54
Q

How does Vismodegib work?

A

Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)

Can shrink tumour and heal visible lesions in some

55
Q

What are the side effects of Vismodegib?

A

Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

56
Q

What is ipilimumab?

A

Monoclonal antibody therapy

Inhibits CTLA-4 molecule

One year survival 47-51% (double those not on treatment)

57
Q

How does Vemurafenib and Dabrafenib work?

A

Blocks B-RAF protein

Only useful if B-RAF mutation

Median suvival 10.5 months (7.8 months with standard chemotherapy)

Dermatology (7 decks)

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