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Systems: Dermatology AB > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

Give 2 examples of cancers that come under the category non-melanoma skin cancer

A
  • Basal cell cancer

- Squamous cell cancer

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2
Q

Which non-melanoma skin cancer is there more incidence of?

A

Basal cell carcinoma

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3
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
  • Immunosuppression
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4
Q

What is the appearance of basal cell carcinoma?

A
  • Superficial
  • Pigmented
  • Morphoeic
  • Nodular
    • Pearly rolled edge
    • Telangiectasia
    • Central ulceration
    • Arborising vessels on dermoscopy
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5
Q

Describe the features of basal cell carcinomas.

A
  • Slow growing
  • Locally invasive
  • Rarely metastasise
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6
Q

What is the gold standard treatment for BCC?

A

Excision

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7
Q

What will excision of BCCs result in?

A
  • Ellipse with rim of unaffected skin
  • Curative if fully excised
  • Will scar
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8
Q

Other than excision and Mohs surgery, what can be done in some cases of BCC?

A

Curettage

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9
Q

What are the indications for Mohs surgery?

A
  • Site
  • Size
  • Subtype
  • Poor clinical margin definition
  • Recurrent
  • Perineural or perivascular involvement
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10
Q

What does vismodegib do?

A
  • Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
  • Can shrink tumour and heal visible lesions in some
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11
Q

What are the indication for the use of vismodegib?

A
  • Locally advanced BCC not suitable for surgery or radiotherapy
  • Metastatic BCC
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12
Q

What are the side effects of vismodegig?

A
  • Hair loss
  • Weight loss
  • Altered taste
  • Muscle spasms
  • Nausea
  • Fatigue
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13
Q

How effective if vismodegib?

A

Median progression free survival 9.5 months

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14
Q

What is squamous cell carcinoma derived from?

A

Keratinising squamous cells

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15
Q

Where does SCC usually occur?

A

Sun exposed sites

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16
Q

Describe the appearance of SCC.

A
  • Fats growing, tender, scaly/crusted or fleshy growths

- Can ulcerate and metastasise

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17
Q

How is SCC treated?

A
  • Excision

- +/- Radiotherapy

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18
Q

How is considered high risk and should be followed up following treatment of SCC?

A
  • Immunosuppressed
  • > 20mm diameter
  • > 4mm depth
  • Ear, nose, lip, eyelid
  • Perineural invasion
  • Poorly differentiated
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19
Q

What is keratoacanthoma?

A

Variant of SCC which erupts from hair follicles in sun damaged skin

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20
Q

How is keratoacanthoma treated?

A
  • Surgical excision

- Undergoes period of rapid growth but may then shrink and resolve on its own after a few months

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21
Q

What is the epidemiology if melanoma?

A
  • The incidence of malignant melanoma has increased by 360% since the 1970s in the UK
  • About 10 to 40 per 100000 per annum
  • Mortality is about 1.9 per 100000 per annum
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22
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 genes
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23
Q

What is the ABCDE rule of melanoma?

A
  • Asymmetry
  • Border
  • Colour
  • Diameter
  • Evolution
24
Q

What is the 7 point checklist of melanoma?

A

Major features

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

Minor features

  • Diameter more than 5 mm
  • Inflammation
  • Oozing or bleeding
  • Mild itch or altered sensation
25
Q

What is the benefit of dermoscopy?

A

Improved clinical accuracy compared to unaided eye

26
Q

Give examples of different types of melanoma.

A
  • Superficial spreading malignant melanoma
  • Lentigo maligna melanoma
  • Nodular melanoma
  • Acral lentiginous melanoma/ subungal melanoma
  • Ocular melanoma
27
Q

What is the treatment for melanoma?

A
  • Urgent surgical excision (based on subtype and Breslow thickness)
  • Wide local excision
  • Sentinel lymph node biopsy
  • Chemotherapy/immunotherapy
  • Regular follow up
  • Primary and Secondary Prevention
28
Q

What drugs can be used in the management of metastatic melanoma?

A
  • Ipilimumab
  • Pembrolizumab
  • Vemurafenib and Dabrafenib
29
Q

What does ipilimumab do?

A
  • Inhibits CTLA-4 molecule

- Has a one year survival 47-51% (double those not on treatment)

30
Q

What does pembrolizumab do?

A
  • Targets PD-1 receptor on tumour cell

- One year survival 68-74%

31
Q

What do venurafenib and dabrafenib do?

A
  • Blocks B-RAF proteins so only useful if B-RAF mutation

- Median survival 10.5 months (7.8 months with standard chemotherapy)

32
Q

What is cutaneous lymphoma?

A
  • Primary cutaneous disease – abnormal neoplastic proliferation of lymphocytes in the skin
  • Secondary cutaneous disease from systemic/nodal involvement
33
Q

What are the 2 classifications of cutaneous lymphoma?

A
  • Cutaneous T cell lymphoma (65%)

- Cutaneous B cell lymphoma (20%)

34
Q

What types of cutaneous T cell lymphomas are there?

A
  • Mycosis fungoides
  • Sezary syndrome
  • CD30+ lymphoproliferative disorders
  • Subcutaneous panniculitis like T cell lymphoma
  • Cutaneous CD4+ lymphoma
  • Extranodal NK/T cell lymphoma
35
Q

What types of cutaneous B cell lymphomas are there?

A
  • Cutaneous follicle centre lymphoma
  • Cutaneous marginal zone lymphoma
  • Cutaneous diffuse large B Cell lymphoma
36
Q

What is the most common type of CTCL?

A
  • Mycosis fungoides

- It account for around 50% of all primary cutaneous lymphomas

37
Q

What causes Mycosis fungoides?

A

Unknown

38
Q

Who is MF more common in?

A
  • Older patients

- M>F

39
Q

What kind of course does MF follow?

A

Indolent

40
Q

What are the stages of MF?

A
  • Patch
  • Plaque
  • Tumour
  • Metastasis
41
Q

Describe the patch stage of MF.

A
  • Flat, red, dry oval lesions
  • Usually covered sites
  • May slowly enlarge of spontaneously resolve
  • May itch
  • Difficult to differentiate from eczema/psoriasis
42
Q

Describe the plaque stage of MF

A
  • Patches become thickened

- Generally itch

43
Q

Describe the tumour stage of MF.

A
  • Large irregular lumps, can ulcerate
  • Arise from existing plaques or in normal skin
  • More likely to have metastatic spread
44
Q

Describe the metastatic stage of MF

A

Infiltration of neoplastic cells in lymph nodes, blood and solid organs

45
Q

What does the work up for MF include?

A

Work up includes bloods for sezary cells and CT imaging for staging

46
Q

What is Sezary syndrome?

A
  • Red man syndrome
  • CTCL affecting skin of entire body (ski is thickened, scaly red and very itchy)
  • Lymph nodes are involved
47
Q

What is the prognosis of Sezary syndrome?

A

Poor prognosis

  • Median survival 2-4 years
  • Opportunistic infection
48
Q

What can be seen in the peripheral blood with Sezary syndrome

A
  • Sezary cells in peripheral blood

- Atypical T cells

49
Q

What is treatment of cutaneous lymphoma dependent on?

A

Stage

50
Q

What are the possible treatment options for cutaneous lymphoma?

A
  • Topical steroids
  • PUVA or UVB
  • Localised radiotherapy
  • Interferon
  • Bexarotene
  • Low dose Methotrexate
  • Chemotherapy
  • Total skin electron beam therapy
  • Extracorporeal photophoresis
  • Bone marrow transplantation
51
Q

What is total skin electron bean therapy?

A
  • Type of radiotherapy consisting of very small electrically charged particles
  • Delivers radiation primarily to superficial layers i.e. Epidermis and Dermis
  • Spares deeper tissues and organs
52
Q

What are the steps in extracorporeal photophoresis?

A
  1. Patients blood is drawn and leucocytes collected
  2. Collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation
  3. Exposed to UVA radiation, damaging diseased cells
  4. Treated cells re-infused back to patient
53
Q

What can cutaneous metastases be due to?

A

Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy

54
Q

Where does cutaneous metastases most commonly effect?

A

Most commonly breast, colon and lung

55
Q

What are the management options for cutaneous metastases?

A
  • Treat the underlying malignancy
  • Local excision
  • Localised radiotherapy
  • Symptomatic

Systems: Dermatology AB (11 decks)

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