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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

In general skin cancer can be divided into what?

A

Non melanoma - basal cell carcinoma and squamous cell carcinoma
Melanoma (malignant melanoma)

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2
Q

What is the single most preventable risk factor for skin cancer?

A

Sun exposure

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3
Q

What is the most common malignant skin tumour?

A

Basal cell carcinoma

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4
Q

Describe basal cell carcinoma

A

A slow growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older people

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5
Q

Basal cell carcinoma only rarely metastasises. True or false?

A

True

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6
Q

What are the risk factors for basal cell carcinoma?

A 
UV exposure
History of frequent or severe sunburn in childhood
Skin type 1 - always burns and never tans
Increasing age
Male 
Immunosuppression 
Previous history of skin cancer 
Genetic predisposition
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7
Q

What are the morphological types of basal cell carcinoma?

A 
Nodular 
Superficial 
Cystic
Morphoeic (sclerosing)
Keratotic 
Pigmented
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8
Q

What is the most common type of BCC?

A

Nodular

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9
Q

Describe a nodular BCC

A

A small, skin coloured papule or nodule with surface telangiectasia, and a pearly rolled edge.
May have a necrotic or ulcerated centre

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10
Q

What is a complication of BCC?

A

Local tissue invasion and destruction

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11
Q

What is the treatment of choice for BCC?

A

Surgical excision - allows histological examination of the tumour and margins

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12
Q

For high risk, recurrent BCC what type of surgery is done?

A

Mohs micrographic surgery - involves excision of the affected skin and examination of the skin removed under the microscope straight away to see if all the BCC has been removed. If residual is left, further skin excised.

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13
Q

For small or low risk BCC what treatment can be done?

A

Cryotherapy - freezing with liquid nitrogen
Curettage and cautery
Topical photodynamic therapy
Topical treatment e.g Imiquimod or 5- fluorouracil- if superficial BCC

Radiotherapy can be used to treat primary BCC or as adjuvant treatment if margins are incomplete

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14
Q

What is another name for BCCs?

A

Rodent ulcer

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15
Q

Where are BCCs most commonly found on the body?

A

Sun exposed areas - face, head, neck and ears

It is possible for BCCs to develop in a longstanding scar

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16
Q

How do people often become aware of BCCs?

A

As a scab that does not heal completely or a new lump on the skin.

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17
Q

What does a superficial BCC look like?

A

A scaly, flat red mark on the skin

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18
Q

What does cryotherapy mean?

A

Freezing the lesion with liquid nitrogen

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19
Q

What is curettage and cautery?

A

Curettage- when an area is scraped away (after numbing) and the skin is then sealed by heat (cautery)

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20
Q

How is BCC diagnosed?

A

Clinically by the presence of slowly enlarging skin lesion with typical appearance.

Usually confirmed pathologically by a diagnostic biopsy or following excision.

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21
Q

Describe squamous cell carcinoma

A

A locally invasive malignant tumour of the epidermal keratinocytes or its appendages, which has the potential to metastasise.

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22
Q

What are the risk factors for squamous cell carcinoma?

A

Excessive UV exposure e.g outdoor occupation or recreation
Pre malignant skin conditions - actinic keratoses
Chronic inflammation - leg ulcers, wound scars
Immunosuppression
Organ transplant recipients
Smoking
Genetic predisposition
Previous skin cancer
Genetic conditions e.g xeroderma pigmentosum

23
Q

Describe the appearance of SCC

A

Enlarging keratotic (scaly, crusty) ill-defined nodule, which may ulcerate
They usually arise within previous actinic keratosis
Often tender and painful
Grow over weeks to months

24
Q

Metastatic SCC is usually found where?

A 
Regional lymph nodes 80%
Lungs
Liver
Brain 
Bones
Skin
25
Q

What is the treatment of choice for SCC?

A

Surgical excision - usually with a 3-10mm boarder. A flap or skin graft may be required to repair defect

26
Q

Other than surgical excision, how else might an SCC be treated?

A

Mohs microsurgery - if ill- defined, large, recurrent tumour
Radiotherapy - if large and non resectable or as adjuvant
Aggressive cryotherapy if very small and low risk

27
Q

What is actinic or solar keratoses and why does it develop?

A

A common premalignant skin lesion that develops as a consequence of chronic sun exposure.
Keratinocytes damaged by radiation and overproduce keratin

28
Q

What are the features of actinic keratoses?

A

Small, crusty or scaly lesions
Pink, red, brown or same colour as skin
Sun exposed areas
Multiple lesions may be present

29
Q

What are the management options for actinic keratoses?

A

Prevention of further risk - sun avoidance, sun cream
If mild: topical diclofenac - fewer side effects
Fluorouracil cream - 2 to 3 week course (skin will become red and inflamed) hydrocortisone May be prescribed alongside
Topical imiquimod
Cryotherapy
Curettage and cautery

30
Q

Describe malignant melanoma

A

An invasive malignant tumour of the epidermal melanocytes, which has the potential to metastasise

31
Q

What are the risk factors for malignant melanoma?

A

Excessive UV exposure
Skin type 1
Past episodes of severe sunburn, often with blisters and particularly in childhood
History of multiple moles or atypical moles (dysplastic naevi)
FH of melanoma or previous history
Immunosuppression

32
Q

Describe the presentation of melanoma using the ABCDE Symptoms rule

A

A - asymmetry
B - boarder irregularity
C - colour irregularity (different shades of black, brown or pink)
D - diameter > 6mm
E - evolution of lesion ie change in shape, colour, size
S - symptoms ie bleeding or itching or tingling

33
Q

Melanomas are more common on which area of the body in women?

A

Legs

34
Q

Melanomas are more common on which area of the body for men?

A

The trunk

35
Q

Name the 4 main subtypes of melanoma

A

Nodular
Superficial spreading
Lentigo maligna
Acral lentiginous

36
Q

Which subtype of melanoma is the most aggressive?

A

Nodular

37
Q

Which is the most common subtype of melanoma?

A

Superficial spreading - 70% of cases

38
Q

Describe nodular melanoma

A

Common on the trunk and sun exposed skin
Middle aged people
Red or black lump or lump which bleeds or oozes
Related to intermittent high intensity UV exposure

39
Q

Describe superficial spreading melanoma

A

Common on lower limbs, back and chest
Young and middle aged adults
Related to intermittent high intensity UV exposure
A growing mole with ABCDES features

40
Q

Describe lentigo maligna melanoma

A

Less common type
The face of elderly people
Related to long term cumulative sun exposure
Begins as a flat freckle which grows over years

41
Q

Describe acral lentiginous melanoma

A 
Rare form
On the palms, soles, nails beds
African Americans or Asians 
Elderly 
No clear relation with UV exposure 
Starts as an enlarging patch of discoloured skin
42
Q

What is subungual melanoma?

A

When acral lentiginous melanoma arises in the nail region it is known as melanoma of the nail unit. If it starts in the nail growth area = subungual melanoma.

May present as diffuse discolouration or irregular pigmented longitudinal bands on the nail plate.

43
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ - the tumour can be found in the epidermis but it has not broken through the basement membrane

44
Q

What is fluorouracil cream?

A

A cytotoxic agent - it is toxic to living cells, especially certain cancer or pre cancerous cells
It is a pyrimidine analogue - prevents the incorporation or uracil into nuclear RNA

Requires a prolonged course - BD for 6-12 weeks
Can cause inflammation
High risk of recurrence

45
Q

What is fluorouracil cream used to treat?

A

Small, superficial BCC
Actinic keratoses
In situ SCC

46
Q

What percentage of people with BCC develop a second BCC within 3 years of the first?

A

50%

47
Q

What are the clinical features of BCC?

A

Slow growing plaque or nodule
Skin coloured, pink or pigmented
Varies in size from a few millimetres to several centimetres
Spontaneous bleeding or ulceration

48
Q

What is the most common type of BCC in young adults?

A

Superficial BCC

49
Q

Describe superficial BCC

A

Most common type on upper trunk and shoulders
Slightly scaly, irregular plaque
Thin, translucent rolled border
Multiple microerosions

50
Q

Describe morphoeic BCC

A

Usually found in mid facial sites
Waxy, scar like plaque with indistinct borders
May infiltrate cutaneous nerves

51
Q

What characteristics does high risk SCC have?

A

Diameter great or equal to 2cm
Location on ear, vermillion of lip, central face, hands, feet, genitalia
Arising in elderly or immunocompromised
Histology - poorly differentiated, thickness > 2mm, subcutaneous invasion

High risk may undergo staging investigations to see if spread to LNs or elsewhere

52
Q

In melanoma, what is the most important prognostic factor?

A

Depth of melanoma

53
Q

The invasion depth of melanoma is classified by what?

A

Breslow thickness

Lesions 0-1mm thick, margin of excision = 1cm
Lesion 1-2mm thick = 1-2cm
Lesion 2-4mm = 2-3cm
More than 4mm = 3cm

54
Q

What is Imiquimod?

A 
A immune response modulator 
Used for small BCCs <2cm diameter
Applied 3 to 5 times a week for 6-16 weeks
Variable inflammatory reaction 
Minimal scarring

Dermatology (35 decks)

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