Skin Cancer Flashcards by Kirsten Begg

What does ABCDE stand for in terms of skin cancer?

Asymmetry 
Border 
Colour 
Diameter 
Evolution

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What is Breslow’s thickness?

Deepest point of tumour invasion from the granular layer

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What are the 2 main subgroups of skin cancer and what is the main difference between the 2 groups?

Melanoma - arise from melanocytes in basal layer

Non-melanoma (BCC & SCC) - arise from keratinocytes

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Describe the differences basal cell carcinomas and squamous cell carcinomas in terms of how common they are, speed of growth, appearance, spread and prognosis?

Incidence: BCC more common that SCC
Speed of growth: BCC - slow growing. SCC - fast growing
Appearance: BCC - pearly, translucent +/- central ulceration, painless. SCC - crusty wart that is painful and can bleed
Spread & prognosis: BCC - local invasion, good prognosis. SCC - can become metastatic (rare)

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Name some precursor lesions for non-melanoma skin cancer?

Actinic keratoses

Bowens disease

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What is Xeroderma Pigmentosum?

Genetic disorder that increases risk of skin cancer on sun exposed sites - decreased ability to repair DNA damaged by UV light

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What is an oncogene?

Overactive form of a gene that positively regulates cell division - drives tumour formation when there are multiple oncogenes

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What is a proto-oncogene?

Normal, not yet mutated form of an oncogene

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What is p53?

A tumour suppressor

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What are tumour suppressors and an example?

Genes that negatively regulate cell division and prevent the formation of tumours
p53

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What are the different Fitzpatrick Skin Types?

Type I = always burns, never tans 
Type II = usually burns, can tan 
Type III = can burn, usually tans 
Type IV = Always tans, never burns 
Type V = brown skin 
Type VI = black skin

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Which type of skin cancer is ALWAYS found on skin exposed sites?

SCC - sun exposure is a risk factor for the other types but can be found elsewhere

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A mutation in PTCH1 (part of the hedgehog signalling pathway) is associated with what type of skin cancer?

Basal cell carcinoma

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Mutations in Ras/Raf/MAPK signalling pathways are associated with what type of skin cancer?

Melanoma

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What are freckles?

Patchy increase in melanin pigmentation

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What are actinic lentigines?

Liver/age spots

Increased melanin and basal melanocytes due to chronic sun exposure (not-premalignant)

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What are simple naevi?

moles - develop in childhood at the dermal-epidermal junction and migrate into the dermis by adulthood

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What are dysplastic naevi?

clinically atypical moles - >6mm diameter and asymmetrical border
two types - sporadic and familial

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What is the difference between sporadic and familial dysplastic naevi?

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sporadic: not inherited, one or two naevi, slight increased risk of malignant melanoma
familial: autosomal inheritance, lots of naevi, basically guaranteed to get malignant melanoma

What are halo naevi?

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Mole with a halo of depigmentation

What are blue naevi?

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spindle shaped naevi that are deep in the dermis and appear blue

What are spitz naevi?

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small, well defined bumps on face/limbs - occurs in children

What are melanoma?

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Malignant tumour of melanocytes in the basal layer of the epidermis

Explain the pathophysiology of melanoma?

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Genetic + environmental factors - fair skin and dysplastic naevi

How does melanoma typically present?

``` New pigmented lesion in adulthood Change in shape Irregular pigmentation Bleeding Satellite nodules (metastases within the skin) ```

What are the 4 different types of melanoma?

Superficial spreading melanoma Acral melanoma Lentigo maligna melanoma Nodular melanoma

What is superficial spreading melanoma?

most common type - enlarging pigmented lesion that becomes palpable once it grows vertically into the dermis

What is acral melanoma?

melanoma on palms, soles and nailbeds

What is lentigo maligna melanoma?

Arise from a prolonged lentigo maligna which is a mole that doesn't go away on the face/neck

What is nodular melanoma?

Most aggressive type of melanoma | Rapidly growing nodule that may bleed

What is the main thing that determines prognosis of melanoma?

Breslow's thickness - distance between deepest part of the tumour and the granular layer of the epidermis

Does ulceration make the prognosis better or worse in melanoma? In staging how do you know if ulceration is present/absent?

Ulceration makes prognosis worse "a" = no ulceration "b" = ulceration

If melanoma is staged as pTis what is its thickness and chance of survival?

Melanoma in situ | 100% survival

if melanoma is staged as pT1 tumour what is its thickness and chance of survival?

<1mm thickness | 90% survival

If melanoma is staged as pT2 tumour what is its thickness and chance of survival?

1-2mm thickness | 80% survival

If melanoma is staged as pT3 tumour what is its thickness and chance of survival?

2-4mm thickness | 55% survival

If melanoma is staged as pT4 tumour what is its thickness and chance of survival?

>4mm thickness | 20% survival

What is the treatment for melanoma?

- Primary excision with clear margins +/- sentinel lymph node biopsy - If biopsy is +ve then regional lymphadenectomy

What is basal cell carcinoma?

Cancer of the basal cells in the epidermis - cells invade into the dermis. Slow growing and hardly ever metastasises

Explain the pathophysiology of basal cell carcinoma?

combo of mutations to PTCH1 gene & hedgehog signalling pathway + sun exposure

How does basal cell carcinoma typically present?

Pale/pearly nodules which can ulcerate and have a rolling border Painless

What is the treatment for basal cell carcinoma?

Surgical excision

What is squamous cell carcinoma?

Cancer of keratinocytes that can arise in every layer above the basal layer in the epidermis (granular, prickle and keratin layers). Faster growing and can metastasise

How does squamous cell carcinoma typically present?

Crusty, warty lesion Painful Can bleed Can metastasise

Which factors would indicate bad prognosis in squamous cell carcinoma?

Thickness >4mm lymphatic invasion Poor differentiation

Management of squamous cell carcinoma?

Surgical excision

Which 3 factors worsen melanoma prognosis?

Nodular subtype Ulceration Venous invasion

Skin Cancer Flashcards

(47 cards)