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Systems - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

What are risk factors for non-melanoma skin cancer?

A

UV radiation

Chemical carcinogens

Ionising radiation

HPV

Familial cancer syndromes (basal cell carcinoma when they are young suggests that they might have a familial cancer syndrome)

Immunosuppression

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2
Q

What are the pathogenic features of basal cell carcinoma?

A

Slowly growing

Locally invasive

Rarely metastasise

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3
Q

Describe the visual features of a basal cell carcinoma

(BCC is the most common type of cancer as well as the most common type of skin cancer)

A

Nodular:

–Pearly rolled edge

–Telangiectasia

–Central ulceration

–Arborising vessels on dermoscopy

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4
Q

What are these?

A

Pigmented

Morphoeic basal cell carcinomas

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5
Q

What is the treatment of BCC?

A

Excision

Courettage

Mohs surgery

Vismodegib (for locally advanced BCC that is not suitable for surgery or radiotherapy, metastatic basal cell carcinoma)

Side effects include hair loss, weight loss, altered taste, muscle spasms, nausea and fatigue

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6
Q

Describe the pathogenicity of squamous cell carcioma

A

Can metastasise

Faster growing, tender, scaly/crusted or fleshy growths

Can ulcerate

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7
Q

What do squamous cell carcinomas develop from?

A

Keratinising squamous cells

Usually on sun exposed sites

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8
Q

What is the treatment of small cell carcinoma?

A

Excision

With or without radiotherapy

Follow up is recquired for those who are considered high risk:

  • Immunosuppressed
  • Greater than 20 mm diameter
  • Greater than 4 mm depth
  • Ear, nose, lip, eyelid
  • Perineural invasion
  • Poorly differentiated
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9
Q

What skin cancer is a variant of squamous cell carinoma and erupts from hair follicles in sun damaged skin?

A

Keratocanthoma

Grows rapidly, may shrink after a few months and resolve

Surgical excision

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10
Q

What are the genetic risk factors for UV radiation?

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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11
Q

What is the ABCDE rule for melanoma?

A
  • Asymmetry
  • Border - ill defined
  • Colour - tends to vary
  • Diameter - over 6mm is likely to be a melanoma
  • Evolution - means the melanoma is changing
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12
Q

What is the 7 point checklist for malignant 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

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13
Q

What visual aid can be used to help in the diagnosis of malignant melanoma?

A

Dermoscope

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14
Q

What are the different types of malignant melanoma?

A

Superficial Spreading Malignant Melanoma - often at the site of a preexisting mole - most common type and confined to the epidermis

Lentigo maligna melanoma - confined to the epidermis

Nodular

Acral lentiginous Melanoma

Ocular

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15
Q

What is the treatment for melanoma?

A

Urgent surgical incicsion

Sentinal lymph node biopsy

Chemotherapy/immnotherapy

Regualr follow up

Primary and secondary prevention

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16
Q

What are the biological agents for metastatic melanoma?

A

•Ipilimumab

–Inhibits CTLA-4 molecule

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

•Pembrolizumab

–Targets PD-1 receptor on tumour cell

–One year survival 68-74%

•Vemurafenib and Dabrafenib

–Blocks B-RAF protein

–Only useful if B-RAF mutation

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

17
Q

Is cutaneous lymphoma primary or secondary?

A

Can be secondary (disease from systemic / nodal involvement)

Can also be primary - abnormal neoplastic proliferation of lymphocytes underneath the skin (cutaneous T cell lyphoma 65% and cutaneous B cell lymphoma 20%)

18
Q

What are types of cutanous T cell lymphoma (a primary cause of lymphoma)?

A

Mycosis fungiodes

Sezary syndrome

19
Q

What is the most common type of cytotoxic T cell lymphoma (accounts for around 50% of all primary cutaneous lymphomas)

A

Mycosis fungiodes

20
Q

What are the features of mycosis fungiodes?

A

Patch - flat, red oval lesions

May spontaneously enlarge or spontaneously resolve

may itch

Hard to differentiate from eczema and psoriasis

Plaque - Patches become thickened - generally itch

Tumour - large irregular lumps which arise from existing plaques or in normal skin - can ulcerate - more likely to have metastatic spread

Metastatic - neoplastic cells in lymph nodes, bloods and solid organs

21
Q

What is red man syndrome?

A

Sezary syndrome

Cytotoxic T cell lymphoma affecting the skin of the entire body

Skin thickened, scaly

ITCHY

Lymph nodes are involved and sezary cells are found are in the peripheral blood (atypical t cells)

Por prognosis - opportunistic infection

22
Q

What is the treatment of cutaneous lymphoma?

A

–Topical steroids

–PUVA or UVB

–Localised radiotherapy

–Interferon

–Bexarotene (this is a retinoid)

–Low dose Methotrexate

–Chemotherapy

–Total skin electron beam therapy

  • Extracorporeal photophoresis
  • Bone marrow transplantation
23
Q

What is total skin electron beam 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
24
Q

What is extracorporeal photophoresis?

A

•Step 1

–Patients blood is drawn and leucocytes collected

•Step 2

–Collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation

•Step 3

–Exposed to UVA radiation, damaging diseased cells

•Step 4

–Treated cells re-infused back to patient

25
Q

Where does cutaneous metastases arise from?

A

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

Systems - Dermatology (11 decks)

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