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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

What are some examples of non-melanoma skin cancer?

A

Basal cell cancer (BCC)

Squamous cell cancer

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2
Q

What does BCC stand for?

A

Basal cell cancer

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3
Q

Is the incidence of non-melanoma skin cancer increasing or decreasing?

A

Increasing

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4
Q

What does NMSC stand for?

A

Non-melanoma skin cancer

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5
Q

What is the most common kind of non-melanoma skin cancer?

A

Basal cell cancers (BCC) - 70%

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6
Q

What are risk factors for non-melanoma skin cancer?

A
  • UV radiation
  • Photochemotherapy
  • Chemical carcinogens
  • X-ray and thermal radiation
  • Human papilloma virus
  • Familial cancer syndromes
  • Immunosuppression
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7
Q

Describe basal cell carcinoma?

A

Slow growing, locally invasive and rarely metastasis

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8
Q

Does basal cell carcinoma metastasis?

A

Slow growing, locally invasive and rarely metastasis

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9
Q

Describe the appearance of basal cell carcinoma?

A
  • Pearly rolled edge
  • Telangiectasia (widened venules cause threadlike patterns on skin)
  • Central ulceration
  • Arborising vessels on dermoscopy
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10
Q

What are the different kinds of basal cell carcinoma?

A
  • Superficial
  • Pigmented
  • Morphoeic
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11
Q

What is the treatment of basal cell carcinoma?

A
  • Excision is gold standard
    • Ellipse with rim of unaffected skin
    • Curative if fully excised
    • Will scar
  • Curettage (use of curette to remove tissue by scraping or scoping) used sometimes
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12
Q

What is curettage?

A

Use of curette to remove tissue by scraping or scooping

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13
Q

What is Mohs surgery?

A
  • Scrapping of layers of skin
  • Indications
    • Site
    • Size
    • Subtype
    • Poor clinical margin definition
    • Recurrent
    • Perineural or perivascular involvement
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14
Q

What are some indications for Mohs surgery?

A
  • Site
  • Size
  • Subtype
  • Poor clinical margin definition
  • Recurrent
  • Perineural or perivascular involvement
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15
Q

What treatment is used for locally advanced BCC?

A

Vismodegib

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16
Q

What are indications for vismodegib?

A
  • Locally advanced BCC not suitable for surgery or radiotherapy
  • Metastatic BCC
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17
Q

What is the mechanism of action of vismodegib?

A
  • Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
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18
Q

What effect does vismodegib have?

A
  • Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)
  • Can shrink tumours and heal visible lesions in some
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19
Q

What is the molecular driver in BCC?

A

Hedgehog pathway

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20
Q

What are some side effects of vismodegib?

A
  • Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

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21
Q

What does SCC stand for?

A

Squamous cell carcinoma

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22
Q

What is squamous cell carcinoma derived from?

A

Keratinising squamous cells

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23
Q

Can squamous cell carcinoma (SCC) metastasis?

A

Yes

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24
Q

Does SCC or BCC grow faster?

A

SCC

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25
Q

Describe the lesions due to SCC?

A

Faster growing, tender, scaly/crusted or fleshy growths

Can ulcerate

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26
Q

What is the treatment of SCC?

A
  • Excision
  • With or without radiotherapy
  • Follow up if high risk
    • Immunosuppressed
    • >20mm diameter
    • >4mm depth
    • Ear, nose, lip, eyelid
    • Perineural invasion
    • Poorly differentiated
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27
Q

What should be done for patients with a SCC that is considered to be high risk?

A

Followed up

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28
Q

When is a SCC considered to be high risk?

A
  • Immunosuppressed
  • >20mm diameter
  • >4mm depth
  • Ear, nose, lip, eyelid
  • Perineural invasion
  • Poorly differentiated
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29
Q

What diameter makes a SCC high risk?

A

>20mm

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30
Q

What depth makes a SCC high risk>

A

>4mm

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31
Q

What is keratoacanthoma?

A

Variant of squamous cell carcinoma, erupts form hair follicles in sun damaged skin

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32
Q

Describe the lesion due to keratoacanthoma?

A

Grows rapidly, may shrink after a few months and resolve

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33
Q

What is the treatment of keratoacanthoma?

A

Treatment is surgical excision

34
Q

Is the incidence of melanoma skin cancer increasing or decreasing?

A

Increasing

35
Q

What are some risk factors for melanoma skin cancer?

A
  • UV radiation
  • Genetic susceptibility
    • Fair skin, red hair, blue eyes and tendency to burn easily
  • Familial melanoma and melanoma susceptibility genes
36
Q

What genetic aspects are risk factors for melanoma skin cancers?

A

Fair skin

Red hair

Blue eyes

Tendency to burn easily

37
Q

What rule should be used when evaluating a lesion to be melanoma?

A

ABCDE rule:

  • Asymmetry
  • Border
  • Colour
  • Diameter
  • Evolution

7 point checklist:

  • Major features
    • Change in size
    • Change in colour
    • Change in shape
  • Minor features
    • Diameter more than 5mm
    • Inflammation
    • Oozing or bleeding
    • Mild itch or altered sensation
38
Q

What is the ABCDE rule?

A
  • Asymmetry
  • Border
  • Colour
  • Diameter
  • Evolution
39
Q

What is the 7 point checklist for melanoma?

A
  • Major features
    • Change in size
    • Change in colour
    • Change in shape
  • Minor features
    • Diameter more than 5mm
    • Inflammation
    • Oozing or bleeding
    • Mild itch or altered sensation
40
Q

What are some major features for the 7 point checklist for melanoma?

A
  • Change in size
  • Change in colour
  • Change in shape
41
Q

What are some minor features for the 7 point checklist for melanoma?

A
  • Diameter more than 5mm
  • Inflammation
  • Oozing or bleeding
  • Mild itch or altered sensation
42
Q

What is melanoma investigated by?

A

Investigated by dermoscopy:

  • Uses dermosocpe
  • Improved clinical accuracy compared to unaided eye
43
Q

Describe the biologic progression of melanoma?

A
44
Q

What are the different kinds of melanoma?

A
  • Superficial spreading malignant melanoma
  • Lentigo maligna melanoma
  • Nodular melanoma
  • Acral lentiginous melanoma/subungal melanoma
  • Ocular melanoma
45
Q

What is the treatment of melanoma?

A
  • Urgent surgical excision
    • Subtype
    • Breslow thickness
46
Q

How does prognosis of melanoma change with Bewslow depth?

A

The greater the depth the worse the prognosis

47
Q

What does Brewslow depth range from?

A

0mm to 5mm

48
Q

What is the treatment of metastatic melanoma?

A
  • Ipilimumab
    • Inhibits CTLA-4 molecule
  • Pembrolizumab
    • Blocks activity of PD-1
  • Vemurafenib and dabrafenib
    • Blocks B-RAF protein
    • Only useful if B-RAF mutation
49
Q

What is the mechanism of action of ipilmumab?

A
  • Inhibits CTLA-4 molecule
50
Q

What is the mechanism of action of pembrolizumab?

A
  • Blocks activity of PD-1
51
Q

What is the mechanism of action of vemurafenib and dabrafenib?

A
  • Blocks B-RAF protein
52
Q

What are examples of treatment for metastatic melanoma that is only useful if B-RAF mutation is present?

A
  • Vemurafenib and dabrafenib
53
Q

What is cutaneous lymphoma?

A

Rare subtype of non-Hodgkin lymphoma that starts in the skin. It is not classified as a skin cancer because the cancer cells originate in white blood cells called lymphocytes, whereas skin cancers develop from other non-lymphoid cells

54
Q

When can cutaneous lymphoma be secondary?

A

Secondary cutaneous disease from systemic/nodal involvement

55
Q

What are examples of primary cutaneous lymphoma?

A
  • Cutaneous T cell lymphoma (65%)
    • Mycosis fungoides
    • MF varients
    • Sezary syndrome
    • CD30+ lymphoproliferative disorders
    • Subcutaneous panniculitis like T cell lymphoma
    • Cutaneous CD4+ lymphoma
    • Extranodal NK/T cell lymphoma
  • Cutaneous B cell lymphoma (20%)
    • Cutaneous follicle centre lymphoma
    • Cutaneous marginal zone lymphoma
    • Cutaneous diffuse large B Cell lymphoma
56
Q

What is the most common primary cutaneous lymphoma?

A

Cutaneous T cell lymphoma (65%)

57
Q

What are different kinds of cutaneous T cell lymphoma?

A
  • Mycosis fungoides
  • MF varients
  • Sezary syndrome
  • CD30+ lymphoproliferative disorders
  • Subcutaneous panniculitis like T cell lymphoma
  • Cutaneous CD4+ lymphoma
  • Extranodal NK/T cell lymphoma
58
Q

What are different kinds of cutaneous B cell lymphoma?

A
  • Cutaneous follicle centre lymphoma
  • Cutaneous marginal zone lymphoma
  • Cutaneous diffuse large B Cell lymphoma
59
Q

What does MF stand for?

A

Mycosis fungoides

60
Q

What is the most common cutaenous T cell lymphoma?

A

Mycosis fungoides (MF)

61
Q

What does CTCL stand for?

A

Cutaneous T cell lymphoma

62
Q

What is the aetiology of mycosis fungoides (MF)?

A

Unknown

63
Q

Who does mycosis fungoides more common in?

A

Older people

Men affected more than woman

64
Q

Does mycosis fungoides affect more men or woman?

A

Men

65
Q

What are the different stages of mycosis fungoides?

A
  • Patch
    • Flat, red, dry oval lesions
    • Usually covered sites
    • May slowly enlarge of spontaneously resolve
    • May itch
    • Difficult to differentiate from eczema/psoriasis
  • Plaque
    • Patches become thickened
    • Generally itch
  • Tumour
    • Large irregular lumps, can ulcerate
    • Arise from existing plaques or in normal skin
    • More likely to have metastatic spread
  • Metastatic
    • Infiltration of neoplastic cells in lymph nodes, blood and solid organs
66
Q

What investigations are done for mycosis fungoides?

A
  • Bloods for sezary cells
  • CT imaging for staging
67
Q

What re sezary cells?

A

Lymphoid cells with prominently folded

68
Q

What is sezary syndrome?

A
  • CTCL affecting skin of entire body
    • Skin thickened, red and scaly
    • Very itchy
69
Q

What is sezary syndrome also known as?

A

“Red man syndrome”

70
Q

What is the clinical presentation of sezary syndrome?

A
  • CTCL affecting skin of entire body
    • Skin thickened, red and scaly
    • Very itchy
  • Lymph node involvement
  • Sezary cells in peripheral blood
    • Atypical T cells
71
Q

What is the prognosis of sezary syndrome?

A

Poor

72
Q

What does the treatment of cutaneous lymphoma depend on?

A

The stage

73
Q

What are possible treatments for cutaneous lymphoma?

A
  • Topical steroids
  • PUVA or UVB
  • Localised radiotherapy
  • Interferon
  • Bexarotene
  • Low dose Methotrexate
  • Chemotherapy
  • Total skin electron beam therapy
    • Type of radiotherapy consisting of very small electrically charged particles
    • Delivers radiation primarily to superficial layers (ie epidermis and dermis)
    • Spares deeper tissues and organs
  • Extracorporeal photophoresis
    • 1) Patients blood drawn and leukocytes collected
    • 2) Collected white cells wixed with psoralen which makes T cells sensitive to UVA radiation
    • 3) Exposed to UVA radiation, damaging diseased cells
    • 4) Treated cell reinfused back to patient
  • Bone marrow transplantation
74
Q

What is total skin electron beam therapy?

A
  • Type of radiotherapy consisting of very small electrically charged particles
  • Delivers radiation primarily to superficial layers (ie epidermis and dermis)
  • Spares deeper tissues and organs
75
Q

What is a major advantage of total skin electron beam therapy?

A

Spares deeper tissues and organs

76
Q

Explain the process of extracorporeal photophoresis?

A
  • 1) Patients blood drawn and leukocytes collected
  • 2) Collected white cells wixed with psoralen which makes T cells sensitive to UVA radiation
  • 3) Exposed to UVA radiation, damaging diseased cells
  • 4) Treated cell reinfused back to patient
77
Q

What are the different kinds of cutaneous metastasis?

A

Can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy:

  • Most commonly breast, colon and lung
78
Q

What cancers commonly metastasis to the skin?

A
  • Most commonly breast, colon and lung
79
Q

What is the management of cutaneous metastasis?

A
  • Treat the underlying malignancy
  • Local excision
  • Localised radiotherapy
  • Symptomatic
80
Q

What are the commonest skin cancers?

A

BCC and SCC

81
Q

What is the most serious skin cancer?

A

Melanoma

Dermatology (11 decks)

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