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Y2 Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

What does ABCDE stand for in terms of skin cancer?

A 
Asymmetry 
Border 
Colour 
Diameter 
Evolution
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2
Q

What is Breslow’s thickness?

A

Deepest point of tumour invasion from the granular layer

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3
Q

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

A

Melanoma - arise from melanocytes in basal layer

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

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4
Q

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

A

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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5
Q

Name some precursor lesions for non-melanoma skin cancer?

A

Actinic keratoses

Bowens disease

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6
Q

What is Xeroderma Pigmentosum?

A

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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7
Q

What is an oncogene?

A

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

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8
Q

What is a proto-oncogene?

A

Normal, not yet mutated form of an oncogene

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9
Q

What is p53?

A

A tumour suppressor

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10
Q

What are tumour suppressors and an example?

A

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

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11
Q

What are the different Fitzpatrick Skin Types?

A 
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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12
Q

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

A

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

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13
Q

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

A

Basal cell carcinoma

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14
Q

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

A

Melanoma

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15
Q

What are freckles?

A

Patchy increase in melanin pigmentation

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16
Q

What are actinic lentigines?

A

Liver/age spots

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

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17
Q

What are simple naevi?

A

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

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18
Q

What are dysplastic naevi?

A

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

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19
Q

What is the difference between sporadic and familial dysplastic naevi?

A

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

20
Q

What are halo naevi?

A

Mole with a halo of depigmentation

21
Q

What are blue naevi?

A

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

22
Q

What are spitz naevi?

A

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

23
Q

What are melanoma?

A

Malignant tumour of melanocytes in the basal layer of the epidermis

24
Q

Explain the pathophysiology of melanoma?

A

Genetic + environmental factors - fair skin and dysplastic naevi

25
Q

How does melanoma typically present?

A 
New pigmented lesion in adulthood 
Change in shape 
Irregular pigmentation
Bleeding 
Satellite nodules (metastases within the skin)
26
Q

What are the 4 different types of melanoma?

A

Superficial spreading melanoma
Acral melanoma
Lentigo maligna melanoma
Nodular melanoma

27
Q

What is superficial spreading melanoma?

A

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

28
Q

What is acral melanoma?

A

melanoma on palms, soles and nailbeds

29
Q

What is lentigo maligna melanoma?

A

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

30
Q

What is nodular melanoma?

A

Most aggressive type of melanoma

Rapidly growing nodule that may bleed

31
Q

What is the main thing that determines prognosis of melanoma?

A

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

32
Q

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

A

Ulceration makes prognosis worse
“a” = no ulceration
“b” = ulceration

33
Q

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

A

Melanoma in situ

100% survival

34
Q

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

A

<1mm thickness

90% survival

35
Q

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

A

1-2mm thickness

80% survival

36
Q

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

A

2-4mm thickness

55% survival

37
Q

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

A

> 4mm thickness

20% survival

38
Q

What is the treatment for melanoma?

A
  • Primary excision with clear margins
    +/- sentinel lymph node biopsy
  • If biopsy is +ve then regional lymphadenectomy
39
Q

What is basal cell carcinoma?

A

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

40
Q

Explain the pathophysiology of basal cell carcinoma?

A

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

41
Q

How does basal cell carcinoma typically present?

A

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

42
Q

What is the treatment for basal cell carcinoma?

A

Surgical excision

43
Q

What is squamous cell carcinoma?

A

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

44
Q

How does squamous cell carcinoma typically present?

A

Crusty, warty lesion
Painful
Can bleed
Can metastasise

45
Q

Which factors would indicate bad prognosis in squamous cell carcinoma?

A

Thickness >4mm
lymphatic invasion
Poor differentiation

46
Q

Management of squamous cell carcinoma?

A

Surgical excision

47
Q

Which 3 factors worsen melanoma prognosis?

A

Nodular subtype
Ulceration
Venous invasion

Y2 Dermatology (11 decks)

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