Skin Cancer

Question 1

What are the 2 types of non-melanoma skin cancers?

Answer 1

Basal cell and squamous cell cancer

Question 2

What are the risk factors for non-melanoma skin cancers?

Answer 2

Causation skin types 
UV radiation
Photo chemotherapy - PUVA 
Chemical carcinogens
X-ray and thermal radiation
Human papilloma virus 
Familial cancer syndromes
Immunosuppression

Question 3

What type of non -melanoma skin cancer is slow growing ?

Answer 3

Basal cell

Squamous cell is faster growing

Question 4

What does basal cell carcinoma look like?

Answer 4

Nodular with pearly rolled edge
Telangiectasis
Central ulceration
Arborising vessels on dermoscopy (telangiectasias with tree branching appearance)

Question 5

What is characteritic of basal cell carcinoma on dermatoscopy?

Answer 5

Arborising vessels

Question 6

What are superifical basal cell carcinomas termed as?

Answer 6

Morphoeic

Question 7

What is the treatment for basal cell carcinoma?

Answer 7

Excision
Curettage in some circumstances
Vismodegib (when surgery isnt an option)
Mohs surgery

Question 8

How would you investigate would you carry out if you suspected skin cancerous lesion?

Answer 8

Dermatoscope

Question 9

What is squamous cell carcinoma associated with?

Answer 9

Immunosppression and smoking

Question 10

Where do you normally find suqmaous cell carcinomas?

Answer 10

Sun exposed areas of the skin

Question 11

What does squamous cell carcinomas look like?

Answer 11

Tender / painful
Scaly / crusted
Fleshy
Can ulcerate

Question 12

What is the treatment for squamous cell caricnoma?

Answer 12

Excision

+/- radiotherapy

Question 13

What high risk patients will be followed up after 3 years of removal of squmaous cell carcinoma?

Answer 13

Immunosuppressed (transplant patients)
> 20 mm diameter
> 5mm depth
Ear, node, lip, eyelid
Perineural invasion (invading along nerves)
Poorly differentiated

Question 14

What is keratokanthoma and what it is presentation?

Answer 14

Variant of squamous cell carcinoma
erupts from hair follicles in sun damaged skin
Grows rapidly (may resolve itself or need excision)

Question 15

What are the risk factors for melanoma skin cancer?

Answer 15

UV radiation
Genetic suseptibility - fair skin, red hair, blue eyes, burn easily
Familial melanoma and melanoma susceptible genes

Question 16

What is the ABCDE rule for identifying melanoma?

Answer 16

Asymmetry 
Border (il-defined) 
Colour (different colours)
Diameter ( > 6MM)
Evolution (is it changing)

Question 17

What are common sites of metastatsis of melanoma?

Answer 17

Lung, liver and brain

Question 18

What criteria is used to stage melanoma ?

Answer 18

Breslow thickness

Question 19

What are the tretaments for melanoma?

Answer 19

Surgical excision
Sentinel lymph node biopsy
Chemotherapy
Primary and secondary prevention

Question 20

If there is positive lymph node involvement what stage is the melanoma?

Answer 20

Stage 3

Question 21

If there is mets what stage is the melanoma?

Answer 21

Stage 4

Question 22

What is the tretament for metastatic melanoma?

Answer 22

Immunotherapy + excision

Question 23

What is cutaneous lymphoma?

Answer 23

Abnormal neoplastic proliferation of lymphocytes in the skin
- cutaneous B or T cell lymphoma
Can be primary or secondary to systemic lymphoma

Question 24

What is the most common type of cutaneous T cell lymphoma?

Answer 24

Mycosis fungoides

Question 25

What are the 4 stages of progression of mycosis fungoides ?

Answer 25

Patch Plaque Tumour Metastasis

Question 26

What is the presntation of an early stage mycocis fungoides patch?

Answer 26

Flat, red, dry oval lesions May slowly enlarge May itch Difficult to differentiate between eczema and psorias

Question 27

Why is mycosis fungoides difficult to differentiate between eczema and psoriasis and how would you determine between the two?

Answer 27

Due to the red, dry oval patches | They wouldnt respond to eczema/psoriasis treatment

Question 28

What investigations would you carry out if you suspected mycosis fungoides?

Answer 28

Blood for sezary cells | CT scan for staging

Question 29

What is sezary syndorme?

Answer 29

An aggressive form of cutaneous t cell lymphoma that affects the skin of the entire body

Question 30

What is the presentation of sezary syndrome?

Answer 30

Red man syndrome Patient is erythrodermic affecting skin of entire body Skin is thickened, scaly and red Very itchy

Question 31

What is the prognosis of sezary syndrome with lymph node involvement?

Answer 31

2-4 years

Question 32

What is the treatment for cutaneous lymphoma?

Answer 32

``` Topical steroids PUVA or UVB Localised radiotherapy Interferon Bexarotene Low dose methotrexate Chemotherapy Total skin electron beam therapy Extracorporeal photohoresis ```

Question 33

From what cancers do cutaneous metastasis commonly arise?

Answer 33

Breast Colon Lung

Question 34

What is the indication of the use of Vismodegib?

Answer 34

Vismodegib used to treat basal cell carcinoma that cannot be cured with excision

Question 35

What is the indication of mohs surgery?

Answer 35

Used to treat basal cell carcinoma and at the same time biopsy to make sure all margins are excised

Question 36

what is the term used to describe pigmented and superficial basal cell carcinomas?

Answer 36

``` Superficial = morphoeic Pigmented = monomorphic ```

Question 37

What does squamous cell carcinoma develop from?

Answer 37

Keratinizing squamous cells