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Week A10 - Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

Name the following benign skin lesions [2]

A
  1. fibroepithelial polyps “skin tags”
  2. seborrhoeic warts/keratoses
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2
Q

How does UV light cause skin cancer? [3]

A
  1. At least two distinct pathways interact or converge to cause skin cancer
    • Direct action of UV on target cells (keratinocytes) for neoplastic transformation via DNA damage
    • Effects of UV on the host’s immune system
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3
Q

What are the 3 main types of skin cancer? [3]

A
  1. Basal cell carcinoma
  2. Squamous cell carcinoma
  3. Malignant melanoma
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4
Q

Describe the pathogenesis of basal cell carcinoma [4]

A
  1. The process of creating new skin cells is controlled by a basal cell’s DNA.
  2. A mutation in the DNA causes a basal cell to multiply rapidly and continue growing when it would normally die.
  3. Eventually, the accumulating abnormal cells may form a tumour
  4. Rarely a PTCH gene mutation may predispose to the development of basal cell carcinoma
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5
Q

What are the subtypes of basal cell carcinoma? [4]

A
  1. Nodular
  2. Superficial
  3. Pigmented
  4. Morphoeic/Sclerotic
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6
Q

What are the typical features of nodular basal cell carcinoma appearance? [4]

A
  1. Nodule i.e. > 0.5cm raised lesion
  2. Shiny “pearly”
  3. Telangiectasia/blood vessels
    • Telangiectasia = condition in which widened venules (tiny blood vessels) cause threadlike red lines or patterns on the skin
  4. Often ulcerated centrally
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7
Q

What are the treatment options for basal cell carcinoma? [6]

A
  1. Gold standard = Surgical excision 3-4mm margin
  2. Curettage and cautery
  3. Cryotherapy
  4. Photodynamic therapy
  5. Topical imiquimod/5-fluorouracil cream
  6. Mohs micrographic surgery
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8
Q

Describe the clinical features of squamous cell carcinoma [3]

A
  1. May occur in normal skin or in skin that has been injured (burns) or chronically inflamed
  2. Originates from keratinocytes
  3. Most SCC occur on skin that is regularly exposed to sunlight or other ultraviolet radiation
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9
Q

What are the pre-malignant variants of squamous cell carcinoma? [2]

A
  1. Actinic keratoses
  2. Bowen’s disease
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10
Q

What are the treatment options for squamous cell carcinoma? [3]

A
  1. Gold standard = Surgical excision 4mm margin
  2. Curettage and cautery
  3. Sun protection
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11
Q

What are the treatment options for the pre-malignant squamous cell carcinoma in-situ? [3]

A
  1. Topical imiquimod/5-fluorouracil cream
  2. Cryotherapy
  3. Photodynamic therapy
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12
Q

What is melanoma and where is it typically found? [4]

A
  1. Malignant tumour of melanocytes
  2. Most common in skin (but can be bowel/eye)
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13
Q

Describe the pathogenesis and spread of melanoma [4]

A
  1. DNA damage - mainly UV, rarely genetic
  2. Radial growth phase, then vertical growth
  3. Depth of presentation determines prognosis
  4. Spread via lymphatics
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14
Q

What are the risk factors for developing melanoma? [15]

A
  1. Genetic markers (e.g. CDKN2A mutations)
  2. Family history of dysplastic nevi or melanoma
  3. Ultraviolet irradiation
  4. Sunburns during childhood
  5. Intermittent burning exposure in unacclimatized fair skin
  6. Number (>50) and size mm) of melanocytic nevi
  7. Congenital nevi
  8. Number of atypical nevi (>5)
  9. Atypical/dysplastic nevus syndrome
  10. Personal history of melanoma
  11. High socioeconomic status
  12. Skin type I, Il
  13. Equatorial latitudes
  14. DNA repair defects (e.g. xeroderma pigmentosum)
  15. Immunosuppression
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15
Q

What are the sub-types of melanoma? [8]

A
  1. Superficial spreading malignant melanoma
  2. Nodular melanoma
  3. Acral melanoma
  4. Subungual melanoma
  5. Amelanotic melanoma
  6. Lentigo maligna
  7. Lentigo maligna melanoma
  8. Melanoma in-situ
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16
Q

What are the treatment options for malignant melanoma? [4]

A
  1. Surgical excision
    • (Breslow <1mm) - 1cm margin
    • (Breslow > 1mm) - 2cm margin
  2. Immunotherapy (ipilimumab, nivolumab)
  3. Immune check point/MEK inhibitors (trametinib)
  4. Biologic antibodies e.g. BRAF genetic defects (debrafanib)
17
Q

Name and describe the clinical features of 4 tumour syndromes with cutaneous presentations [16]

A
  1. Gorlin’s syndrome
    • multiple basal cell carcinomas (BCCs)
    • jaw cysts,
    • risk of breast cancer
  2. Brook Spiegler syndrome
    • multiple basal cell carcinomas (BCCs)
    • trichoepitheliomas
      • uncommon condition in which a single lesion or multiple benign hair follicle tumours (harmless skin growths) arise on the face after puberty
  3. Gardner Syndrome:
    • soft tissue tumours,
    • polyps,
    • bowel cancer
  4. Cowden’s Syndrome:
    • multiple hamartomas
    • thyroid,
    • breast cancer

Week A10 - Dermatology (9 decks)

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