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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What classifies skin types

A

Fitzpatrick

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2
Q

What are the 6 skin types

A

1 - never tans, burns (red hair, blue eyes)
2 - tans but burns
1+2 have increased cancer risk
3 - always tans, sometimes burns (dark hair and eyes)
4 - always tans, rarly burn (olive skin)
5 - sunburn and tan after extreme UV (brown / Asian)
6 - black (never tans or burns)

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3
Q

What are the non-melanoma skin cancers and most common

A

Basal cell = 70%

Squamous cell

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4
Q

What are the RF for BCC / SCC

A 
UV light exposure 
- SCC = chronic long term 
- BCC = sporadic burning 
Skin type 1 +2
Age
Male 
FH skin cancer 
PMH skin cancer 
Photo chemotherpay
Chemical carcinogens
X-ray / radiation
HPV
Smoking
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5
Q

What are RF for SCC

A 
Chronic inflammation 
Marjolins ulcer = excision 
Pre-malignant condition 
Organ transplant
Immunosuppressoin
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6
Q

Where does BCC commonly affect

A

Head and neck

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7
Q

What is prognosis

A

Slow growing
Locally invasive causing destruction
Don’t tend to metastasis
Depends on tumour size, site, growth and histiological subtype
Failure of Rx / recurrent of immunosuppression = poorer prognosis

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8
Q

What is the presentation of BCC

A 
Most common
Pearly pink lesion
Flesh coloured lesion
Erythemtous keratotic papule or nodule 
Areas of sun exposure
Irregular border 
May have central erosion o ulceration
Telangiectasia around 
Rolled edge
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9
Q

What is BBC and types

A 
Slow growing locally invasive malignant tumour of keratinocytes 
Superficial - plaque like 
Nodular = most common
Ulcerative - rodent ulcer
Pigmented
Morphoeic = aggressive
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10
Q

How do superficial BCC present

A 
Scaly and crusty
Pigmented
Pink to red brown 
Erosions / ulceration = less common 
Often resembles eczema or psoriasis
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11
Q

How do you manage superficial

A

Can be Rx conervatively
Cyrosurgery
Curettage and cautery

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12
Q

What do you do if high risk site or large

A

Excision
RT
Mohs procedure if high risk or cosmesis

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13
Q

What do nodular lesions tend to have

A

Smooth elevated surface
Telengiectasia’s
Arborizing vessel on dermoscopy
Central ulceration

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14
Q

How do you Rx

A

Excision

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15
Q

How does ulcerative present

A

Cycles of crusting and bleeding

May progress from nodular

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16
Q

What do you do if suspect BCC

A

Refer
Dermascope
Biopsy

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17
Q

What is gold standard Rx for BCC

A

Excision with margins

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18
Q

What are other options

A

Mohs = highly specalised
Curettage / cyroterhapy if unfit
RT

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19
Q

What can be used if not suitable for surgery / RT or metastatic

A

Vismodegib

Shrinks tumour and heals lesions

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20
Q

What are SE

A 
Hair loss
Weight loss
Taste
Muscle spasms
Nausea
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21
Q

Where do SCC arise from

A

Keratinising squamous cells

Potential to metastasise

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22
Q

What are predisposing pre-malignancy conditions / RF

A 
Bowen's - well defined 
Marjolins ulcer - chronic inflamation
Acitinic keratitis - crust 
HPV 
Post transplant on immunosuppressants 
Chronic granuloma
Chronic radiant heat - erythema ab igne
Chronic UV
Age
Smoking
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23
Q

What are 1st signs of SCC and where does it affect

A

Induration of skin
Skin coloured papule
Head / ear / neck

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24
Q

How does it then go on to present

A 
Plaque like
Keratotic - scaly / crusty 
Ulceration
Firm on palpation
Irregular border
Asymmetrical
Hard to define
Tender
Scaly / crusting
Common on sun exposed sites 
Grows more rapidly
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25
Q

Does SCC metastasis

A

Yes

3% at Dx have nodal mets

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26
Q

How do you Dx

A

Excision biopsy

Urgent referral if no response to 2 weeks topical Ax

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27
Q

How do you Rx SCC if insitu

A

5FU / imiquimod 2 week course with steroid
Excision
Mohs micrographic surgery may be needed for ill-defined large recurrent tumour

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28
Q

How do you Rx if +Ve nodes + what margins

A

Chemo / RT + block dissection
>4mm margin if low risk
>6mm if high risk

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29
Q

What is high risk requiring follow up

A 
Immunosuppressed
>20mm or 2cm
>4mm depth
On ear, nose, lip, perineurial invasion
Poorly differentiated 
Recurrent
2 to chronic inflammation
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30
Q

What do you follow up for

A

Local recurrence

Nodal involvement

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31
Q

If in situ how do you follow up

A

No follow up - immediate Dx

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32
Q

If well differentiated + no other features

A

Discharge in 6 months

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33
Q

How do you follow up high risk

A

5 years

3/3/6 monthly

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34
Q

What factors affect malignant potential

A 
Anatomical site
Size >2cm or >4mm depth 
Rate of growth
Aetiology
Degree of differentiation - if poor = high risk 
Host immunosuppression
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35
Q

What sites are high and low risk

A

Radiation / thermal injury / chronic inflammation or Bowen = high risk
Sunexposed = low risk

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36
Q

What are pre-malignant conditions

A 
Acitinic keratosis 
Bowen's
Dysplastic naevi
Sebaceous naevi
Erythema ab igne
Keratocanthoma
Giant Congenital Hairy Naevus
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37
Q

What is actinic keratosis

A

Chronic pre-malignant condition to SCC
Low risk of progression
May referee

38
Q

What are the features

A 
Start as telanigiectasis capillary
Rough, crusty, erythematous plaque
White-yellow scale
Flat, scaly, hyperkeratotic skin 
May be pink, brown or same colour
Can form cutaneous horn
On areas of chronic skin exposure
39
Q

What are RF

A

Age
Proximity to equator
Fair skin
Outdoors

40
Q

How do you Rx

A 
Sun avoidance / cream
Fluorouracil cream for 2-3 weeks then hydrocortisone to settle inflammation
Topical diclofenac - mild 
Topical imiquimod - good result
Cryotherapy or curettage to remove
41
Q

If any doubt what do you do

A

Excision biopsy

42
Q

What is Bowen’s disease

A

Intra-epidermal SCC in situ
Full thickness dysplasia contains within epidermis
Risk of becoming invasive

43
Q

What are RF

A 
Female
Sun exposure UV
Radiation 
Immunosuppression 
HPV 
Age 
Agricultural work
44
Q

How does it present

A 
3/4 of lesions on legs
Irregular scaly erythematous persistent red plaque
Non elevated
Crust or scaling
Clear border 
No bleeding
Well demarcated
Slower growing than SCC
45
Q

What is 1st line Rx

A

Excision

46
Q

What are other Rx options

A

Local 5-flouracicil cream + steroid if small
Imiquimod
Cryotherapy or curettage
Photodynamic therapy

47
Q

What are sebaceous naevi

A 
Circumscibed lesions / plaque
Comprised of sebaceous glands
Vary between yellow-ten
Velevety
Commonly present with bald patch
Usually present from birth
48
Q

What is risk

A

Small risk of malignancy change to BCC / SCC

49
Q

How do you Rx

A

Excision due to malignant potential

50
Q

What causes erythema ab igne

A

Overexposure to infrared e.g. sitting next to open fire

51
Q

How does it present

A

Reticulated erythematous patches
Hyperpigmentation
Telangiectasia

52
Q

What may develop

A

SCC

53
Q

What is a keratocanthoma

A

Benign epithelial tumour of SCC in situ

54
Q

How does it present

A 
Erupt from hair follicles in sun damaged skin
Rapid
Initially a small domed pink papule 
Hyperkeratotic crater forms 
Most common on face
55
Q

What is it related to

A

Sun exposure
Immunosuppression
Age

56
Q

How does it progress

A

Can shrink and resolve in healthy skin

Small risk of SCC if >3 months so refer to exclude

57
Q

How do you Rx

A

Excision

Topical 5-fu or RT if no surgery

58
Q

How do you classify congenital hairy naves

A

Small <1.5cm
Medium 1.5-19.5
Large >20cm or >5% of BSA

59
Q

What are features

A

Flat, round oval pigmented lesion

Covered in coarse hair

60
Q

What is risk

A

Melanoma if multiple or large

61
Q

How do you Rx

A

Surgical
Grafting
Laser to improve cosmoses but does not deal with malignancy risk

62
Q

What are RF for melanoma

A 
UV radiation
Skin type 1 
Hx of moles 
Sunburn 
Tropical country 
Outdoor work
Previous history
FH of melanoma 
Genetics- fair skin , red hair
63
Q

What is melanoma and what are types

A 
Invasive malignant tumour of melanocytes 
70% related to BRAF mutation - role of Vemurafinib
Potential to metastasise 
Superficial spreading = 70%
Nodular
Lentingo maligna
Acral lentiginous
Ocular
Amelanotic
64
Q

What are superficial spreading melanoma

A 
Growing moles
Affect young and middle aged adult 
Related to high intensity UV 
Commonly LL 
Common in arm, leg, back and chest
65
Q

What s nodular

A 
Sun exposed skin in middle age
Commonly on trunk 
Red or black lump which bleeds and grows rapidly and invades deep 
Most aggressive with early mets
Related to high intensity UV exposure
66
Q

What is acral letiginous

A 
Affects nails, palms or soles
Subungual pigemntaiton
Hutchinson's nail 
Very rare
Common in elderly and black 
No clear relation with UV
67
Q

What is amelanotic

A

Lack pigmentation

Dx more difficult

68
Q

What is lentigno maligna

A

Melanoma in situ (confined to epidermis)
Does not invade into dermis
Common on face
Related to Lon term cumulative exposure
Common in chronic sun exposed skin in elderly
Can become invasive
More slowly growing than superficial spreading

69
Q

What are features of letigno maligna

A

Flat
Two tone brown lesion
Irregular boder

70
Q

What is ABCDE of suspicious melanoma

A 
Asymmetrry 
Border irregular
Colour irregular 
Diameter >6mm
Evolution of size and shape 
Symptoms - bleeding or itching or change in sensation
71
Q

How do you investigate

A

Refer 2WW if any suspicion
Dermoscopy
Biopsy

72
Q

How do you Rx melanoma

A

can do topical 5FU or cryotherapy but high risk of recurrence
Urgent surgical excision with 2-5mm margin = definite
If lesion >1mm = SLNB
RT is sometimes useful
Chemotherapy for metastatic disease
Immunotherapy
- Targeted therapy against BRAF v 600 (Darbrafenib) has revolutionised Rx
Regular follow up

73
Q

What does prognosis depend on

A 
Breslow thickness = main determinant 
Depth of invasion 
<2mm = TNM1 
>2m = TNM 2 
N = 3
M = 4
Mets rare
74
Q

How do you Rx metastatic

A

Immunotherapy revolutionised Rx

75
Q

What can cutenaeous mets be from

A

Primary skin malignant - melanoma
Breast
Colon
Lung

76
Q

How do you Rx

A

Treat malignancy
Excision
RT

77
Q

How does sebaceous gland carcinoma present

A

Thick eyelid
Recurrent infection - Chalazion / unilateral blepharitis
Nodular, indurated lid
Yellow discolouration

78
Q

How do you Rx

A

Excision

79
Q

How can cutaneous lymphoma arise

A

Secondary from nodes

Primary disease from abnormal proliferation of lymphocytes in skin

80
Q

What types do you get

A

T cell

B cell

81
Q

What are T cell lymphomas

A

Mycosis fungiodes = most common

Sezary syndrome

82
Q

How does mycosis fungiodes present

A

Flat,red dry oval patch
May itch
Can be difficult to differentiate from eczema/ psoriasis
Patch becomes thickened to form a plaque
Tumour can then cause large irregular lumps
Ulceration

83
Q

Can it metastasis

A

Yes

84
Q

How do you investigate

A

Blood - look for sezary cells

CT to stage

85
Q

What is Sezary syndrome

A

Entire body affected
Thick scaly red skin
Very itch
LN involvement

86
Q

What is seen on blood

A

Sezary cells

87
Q

What else can cause

A

Vancomycin

88
Q

How do you Rx cutaneous lymphoma

A 
Steroid
Photochemotherapy 
RT 
Total skin electron bean therapy 
Chemotherapy - low dose methotrexate 
Interferon 
Extracorporeal photophoresis
Bone marrow transplant
89
Q

What is extracorporeal photophoresis

A 
Luekocytes collected
Mixed which psoralen which makes T cells sensitive to UVA
Exposed to UVA
This damages diseased cells
Reinfuse patient
90
Q

What is Marjolin’s ulcer

A 
SCC arising in chronically damaged skin 
Presents as non-healing sore of granulation tissue
- Burns 
- Scar
- Ulcer - venous 
- OM 
- RT
- Vaccination 
Usually 30+ years after injury
91
Q

How do you Ix

A

Biopsy = very important

Very aggressive form of SCC

Dermatology (12 decks)

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