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MD2 Foundation > Skin Cancer > Flashcards

Skin Cancer Flashcards

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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
Describe infiltrating/morphoeic/sclerosing BCCs
Infiltrative histological pattern Frequently asymptomatic Can present as scar-like area of induration
26
What is the treatment for nodular/infiltrating BCCs?
Surgical excision with clear margins
27
What is the treatment for superficial BCCs?
Surgical excision Serial curretage Topical imiquimod Photodynamic therapy
28
Describe solar keratoses
Erythematous scaly lesions on dorsum of hands Not indurated Not tender Very common, increasing frequency with age
29
How often to solar keratoses progress to SCCs?
Rarely
30
Where do solar keratoses most commonly occur?
Sun-exposed skin on - Face - Scalp - Forearms - Dorsum of hands
31
What are the treatment options for solar keratoses?
``` Cryotherapy Topical Surgical excision for lesions which are - Resistant to treatment - Suspicious for SCC ```
32
Can frozen specimens be examined microscopically?
No
33
Describe Bowen's disease
In situ CSS Full thickness epidermal dysplasia Non-invasive
34
Where does Bowen's disease occur?
Sun exposed areas, in particular, lower limbs
35
What is the risk of malignant transformation into SCC?
3-5%
36
What are the symptoms of Bowen's disease?
``` Often asymptomatic Can be - Itchy - Painful - Bleed ```
37
What are the treatment options for Bowen's disease?
``` Topical Surgical excision for lesions which are - Resistant to treatment - Suspicious for SCC - Certain high risk patient groups ```
38
What are the possible things a pigmented lesion could be?
Benign naevi Other brown lesions Dysplastic naevi Melanoma
39
Are all pigmented lesions of melanocytic origin?
No; eg: - Pigmented BCC - Pigmented actinic keratosis - Seborrhoeic keratoses - Solar lentigines
40
What is the evolution of naevi?
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
What are benign junctional naevi?
``` Appear during childhood Located at epidermal side of dermal epidermal junction Macular = slightly raised Uniform in colour Less than <1 cm ```
42
What are benign compound naevi?
``` Cells in dermis and epidermis Papules/nodules Even colour Smooth/cobblestone border Less than 1 cm +/- hairs ```
43
What are benign intradermal naevi?
``` Cells intradermal Sharply defined Papule/nodule Even colour, but paler than other naevi Smooth surface Later onset ```
44
What are freckles?
``` Sun-induced pigmentation Can occur from childhood Prominent in summer Fade in winter Increase in melanin, not melanocytes ```
45
What are lentigines?
``` 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
What are seborrhoeic keratoses?
``` Commoner in older patients Warty, stuck on appearance Can get larger with time Can be pigmented Not melanocytic ```
47
What are dysplastic naevi?
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
What is the management of dysplastic naevi?
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
What are the risk factors for melanoma?
``` 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
What are the symptoms of melanoma?
Change in size Change in shape/border Change in colour Itch, pain, bleeding
51
What are the signs of melanoma?
``` A = asymmetry B = border irregularity C = colour variegation D = diameter >5 mm E = evolution = any changing lesion - Change trumps everything ```
52
What are the limitations of classifying melanomas using ABCDE on examination?
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
What are some clues that a skin lesion is a melanoma?
Ugly duckling sign = spot that doesn't belong with others New lesion History of change in naevus
54
What are some subtypes of melanomas?
Superficial spreading melanoma Lentigo maligna Acral lentiginous melanoma Nodular melanoma
55
Describe superficial spreading melanomas
80% of all melanomas Usually follow ABCDE rules Evolves over weeks-months
56
Describe lentigo maligna
``` Gradually enlarging pigmented lesion Usually on face Very slow evolution - May be present for years Progress into lentigo maligna melanoma ```
57
Who gets acral lentiginous melanomas?
Any skin type | Occur on palms of hands and soles of feet
58
Describe nodular melanomas
``` Often fit E but not ABCD criteria Rapid growth Early invasion Majority amelanotic More common in older males ```
59
What extra criteria are added to ABCDE when assessing nodular melanomas?
``` E = elevation F = firm G = growing ```
60
What are some biopsy techniques?
Punch biopsies Shave biopsies Excisional biopsies
61
Which biopsy is best for pigmented lesions and why?
Excisional biopsies, because don't miss the worst bit of lesion
62
What is the recommended margin for each of the Breslow thicknesses?
In-situ = 5 mm Less than 1 mm = 1 cm 1-4 mm = 1-2 cm More than 4 mm = 2 cm
63
What does prognosis of melanomas depend on?
``` Depth of cancer Ulceration Mitotic rate Age Sex Other patient factors Location ```
64
What is the follow-up protocol for patients who have had skin cancer?
``` 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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