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MD2 Foundation > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What is more common: non-melanoma, or melanoma skin cancers?

A

Non-melanoma

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2
Q

What are two common non-melanoma cancers?

A

Basal cell carcinoma (BCC)

Squamous cell carcinoma (SCC)

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3
Q

What are high cancer rates directly related to?

A

UV exposure in a genetically susceptible population

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4
Q

Other than UV radiation and genetic susceptibility, what are other potential causes of and associations with skin cancers?

A 
Immunosuppression
Some rare genetic disorders
Burns scars
Chronic ulcers - especially (SCC)
Sites previously exposed to x-rays/certain chemicals
Large numbers and/or atypical moles
Personal and family history
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5
Q

What is the graded progression from which SCCs arise?

A

Actinic keratosis

SCC in situ

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6
Q

What cells do melanomas arise from?

A

Melanocytes

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7
Q

What is the association between moles and melanomas?

A

Don’t necessarily arise from moles > usually de novo

If an adult presents with a new mole, it’s melanoma until proven otherwise

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8
Q

Describe an SCC

A 
Hyperkeratotic patch/nodule
- Thickened
- Scaly
- Red
Tender on palpation
May bleed easily/ulcerate
Skin freely moveable
- If tethered, then invaded into dermis, possibly deeper
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9
Q

Which are more common and more dangerous: BCCs or SCCs?

A

SCCs less common but more dangerous

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10
Q

Why are SCCs more dangerous than BCCs?

A

Rapid growth rater
- Over weeks-months
Greater potential to metastasise to regional lymph nodes and distant sites

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11
Q

Where are SCCs most commonly found?

A

Chronically sun-exposed sites

  • Hands
  • Forearms
  • Head
  • Neck
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12
Q

Describe SCCs on the lip

A

Tend to ulcerate rather than become keratin nodules
Risk factor: smoking
Risk of metastatic disease increased

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13
Q

What is the treatment for SCCs?

A

Surgery
- Complete surgical excision with clear margins
High risks lesions may need extra adjunctive management
Radiotherapy may be used alone if clinically warranted; eg:
- Elderly
- Surgical risks
- Size of defect

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14
Q

What is telangiectasia also called?

A

Arborisation of vessels

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15
Q

Where do BCCs occur?

A

Chronically sun-exposed skin

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16
Q

Are BCCs invasive?

A

Locally invasive

Very rarely metastasise

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17
Q

What is the growth rate of BCCs compared to SCCs?

A

More indolent

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18
Q

Why are BCCs on the scalp most dangerous?

A

Easily missed
Very locally invasive > can erode to brain
Patients usually die of infection, like meningitis

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19
Q

What is the histology of nodular BCCs?

A

Palisading

Basaloid cells with pushing border invading into stroma

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20
Q

Describe nodular BCCs

A

Peraly nodules
With telangiectasia
Often on head and neck

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21
Q

What is a red flag for nodular BCCs?

A

Bleeding

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22
Q

How do you confirm whether a lesion is a pigmented nodular BCC or a melanoma?

A

Microscopically

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23
Q

Describe superficial BCCs

A

Presents as slowly enlarging plaque
May develop superficial erosion
Red flag: solitary red plaque not responding to topical treatment

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24
Q

How are superficial BCCs histologically characterised?

A

Superficially budding basaloid cells

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25
Q

Describe infiltrating/morphoeic/sclerosing BCCs

A

Infiltrative histological pattern
Frequently asymptomatic
Can present as scar-like area of induration

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26
Q

What is the treatment for nodular/infiltrating BCCs?

A

Surgical excision with clear margins

27
Q

What is the treatment for superficial BCCs?

A

Surgical excision
Serial curretage
Topical imiquimod
Photodynamic therapy

28
Q

Describe solar keratoses

A

Erythematous scaly lesions on dorsum of hands
Not indurated
Not tender
Very common, increasing frequency with age

29
Q

How often to solar keratoses progress to SCCs?

A

Rarely

30
Q

Where do solar keratoses most commonly occur?

A

Sun-exposed skin on

  • Face
  • Scalp
  • Forearms
  • Dorsum of hands
31
Q

What are the treatment options for solar keratoses?

A 
Cryotherapy
Topical
Surgical excision for lesions which are
- Resistant to treatment
- Suspicious for SCC
32
Q

Can frozen specimens be examined microscopically?

A

No

33
Q

Describe Bowen’s disease

A

In situ CSS
Full thickness epidermal dysplasia
Non-invasive

34
Q

Where does Bowen’s disease occur?

A

Sun exposed areas, in particular, lower limbs

35
Q

What is the risk of malignant transformation into SCC?

A

3-5%

36
Q

What are the symptoms of Bowen’s disease?

A 
Often asymptomatic
Can be
- Itchy
- Painful
- Bleed
37
Q

What are the treatment options for Bowen’s disease?

A 
Topical
Surgical excision for lesions which are
- Resistant to treatment
- Suspicious for SCC
- Certain high risk patient groups
38
Q

What are the possible things a pigmented lesion could be?

A

Benign naevi
Other brown lesions
Dysplastic naevi
Melanoma

39
Q

Are all pigmented lesions of melanocytic origin?

A

No; eg:

  • Pigmented BCC
  • Pigmented actinic keratosis
  • Seborrhoeic keratoses
  • Solar lentigines
40
Q

What is the evolution of naevi?

A

Pigmented lesions present at birth/shortly after = congenital naevi
- Increased risk of developing into melanoma
Mole pattern develops during childhood = acquired naevi
- Lower risk of developing into melanoma
Fully developed by 20s
Involution in old age

41
Q

What are benign junctional naevi?

A 
Appear during childhood
Located at epidermal side of dermal epidermal junction 
Macular = slightly raised
Uniform in colour
Less than <1 cm
42
Q

What are benign compound naevi?

A 
Cells in dermis and epidermis
Papules/nodules
Even colour
Smooth/cobblestone border
Less than 1 cm
\+/- hairs
43
Q

What are benign intradermal naevi?

A 
Cells intradermal
Sharply defined
Papule/nodule
Even colour, but paler than other naevi
Smooth surface
Later onset
44
Q

What are freckles?

A 
Sun-induced pigmentation
Can occur from childhood
Prominent in summer
Fade in winter
Increase in melanin, not melanocytes
45
Q

What are lentigines?

A 
Sun-induced pigmented macules
Middle-aged people
Static with time
Mixture of colours
On sun-exposed areas
Sunburn induced/due to chronic sun exposure
46
Q

What are seborrhoeic keratoses?

A 
Commoner in older patients
Warty, stuck on appearance
Can get larger with time
Can be pigmented
Not melanocytic
47
Q

What are dysplastic naevi?

A

Show atypical features clinically and histologically
Not malignant melanoma
More than 5 mm
Atypical pigment net on dermascopy
Smudgy borders
Symmetrical
Independent risk factor for development of melanoma, especially if several

48
Q

What is the management of dysplastic naevi?

A

Can’t take them all off because taking off most of skin

Take photos of all of them with dermatascope and monitor every 6 months (with new photos) for rest of their life

49
Q

What are the risk factors for melanoma?

A 
More than 5 dysplastic naevi
More than 100 typical naevi
Past history of melanoma
Strong family history
History of blistering sunburn, especially during childhood
Previous non-melanoma skin cancer
Type 1 skin
Freckling
Blue eyes
Red hair
Immunosuppression
50
Q

What are the symptoms of melanoma?

A

Change in size
Change in shape/border
Change in colour
Itch, pain, bleeding

51
Q

What are the signs of melanoma?

A 
A = asymmetry
B = border irregularity
C = colour variegation
D = diameter >5 mm
E = evolution = any changing lesion
- Change trumps everything
52
Q

What are the limitations of classifying melanomas using ABCDE on examination?

A

Melanomas may have a diameter of <5 mm, especially early in evolution
Some subtypes of melanoma often don’t fulfill criteria
Many benign lesions may satisfy all ABCDE criteria

53
Q

What are some clues that a skin lesion is a melanoma?

A

Ugly duckling sign = spot that doesn’t belong with others
New lesion
History of change in naevus

54
Q

What are some subtypes of melanomas?

A

Superficial spreading melanoma
Lentigo maligna
Acral lentiginous melanoma
Nodular melanoma

55
Q

Describe superficial spreading melanomas

A

80% of all melanomas
Usually follow ABCDE rules
Evolves over weeks-months

56
Q

Describe lentigo maligna

A 
Gradually enlarging pigmented lesion
Usually on face
Very slow evolution
- May be present for years
Progress into lentigo maligna melanoma
57
Q

Who gets acral lentiginous melanomas?

A

Any skin type

Occur on palms of hands and soles of feet

58
Q

Describe nodular melanomas

A 
Often fit E but not ABCD criteria
Rapid growth
Early invasion
Majority amelanotic
More common in older males
59
Q

What extra criteria are added to ABCDE when assessing nodular melanomas?

A 
E = elevation
F = firm
G = growing
60
Q

What are some biopsy techniques?

A

Punch biopsies
Shave biopsies
Excisional biopsies

61
Q

Which biopsy is best for pigmented lesions and why?

A

Excisional biopsies, because don’t miss the worst bit of lesion

62
Q

What is the recommended margin for each of the Breslow thicknesses?

A

In-situ = 5 mm
Less than 1 mm = 1 cm
1-4 mm = 1-2 cm
More than 4 mm = 2 cm

63
Q

What does prognosis of melanomas depend on?

A 
Depth of cancer
Ulceration
Mitotic rate
Age
Sex
Other patient factors
Location
64
Q

What is the follow-up protocol for patients who have had skin cancer?

A 
Regular follow-up
Full skin examination to look for
- Suspicious lesions
- Recurrences of previous lesions
- Examine
   - Lymph nodes
   - Liver
   - Spleen
Frequency of checks depends on skin cancer and risk factors
Need to be told to seek urgent medical opinion if they have any concerns about new/changing skin lesions

MD2 Foundation (42 decks)

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