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Medicine Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

2 main types of skin cancer

A

Keratinocyte skin cancer - basal cell carcinoma and squamous cell carcinoma
Melanoma

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2
Q

Why may the incidence of non-melanoma skin cancer in Scotland be increasing?

A

Cheap air travel
More leisure time
Sun-seeking behaviour
Ageing population

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3
Q

What does melanoma arise from?

A

Melanocytes - pigment forming cells scattered along the basal layer

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4
Q

Which skin cancer is most likely to spread - keratinocyte skin cancer or melanoma?

A

Melanoma as melanocytes migrate into the skin from the neural crest and move around

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5
Q

What does melanoma survival depend on?

A

Breslow thickness

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6
Q

What is Breslow thickness?

A

The measurement of depth of the melanoma from the surface of the skin to the deepest point of the tumour

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7
Q

5 year survival of melanoma with:

  • Breslow thickness <1mm
  • Breslow thickness >4mm
  • Metastases
A 
<1mm = 95-100%
>4mm = 50%
Metastases = 5%
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8
Q

Diagnosis of melanoma

A

ABCDE rule
“ugly duckling” sign
Dermoscopy

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9
Q

ABCDE rule in diagnosis of melanoma

A 
A = asymmetry
B = border
C = colour (change of colour or presence of 2/3 different)
D = diameter (>0.7mm is likely to be melanoma)
E = evolution (speed of change, changing over weeks/months)
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10
Q

“Ugly duckling sign”

A

The mole suspected as being a melanoma looks very different to all other moles

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11
Q

Why is dermoscopy useful in the diagnosis of melanoma?

A

It allows us to see a magnified view showing pigment pattern

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12
Q

Atypical mole syndrome

A

Genetic condition where patients have multiple atypical moles. These patients are more likely to develop melanoma but are harder to monitor as they have so many moles

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13
Q

Clinical presentation of basal cell carcinoma

A

Slow growing lumps or ulcers that are painless
‘Pearly’ or translucent
Visible, arborising blood vessels
Central ulceration
Locally invasive but rarely metastasise
Can look scar-like with ill-defined edges

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14
Q

Different types of basal cell carcinoma

A

May present as scaly plaque - superficial
Nodular or nodulystic
Infiltrative - “morphoeic”
Pigmented

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15
Q

Clinical presentation of squamous cell carcinoma

A

Hyperkeratotic (crusty) lump or ulcer
Arises on sun damaged skin - often seen in elderly
Grow fairly fast
May be painful and/or bleed

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16
Q

Risk of metastases of squamous cell carcinoma

A

3-5%

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17
Q

Common sites for squamous cell carcinoma (higher risk)

A

Ear, lip, scalp

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18
Q

Keratoacanthoma

A

Self resolving squamous cell carcinoma

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19
Q

Precursor lesions for squamous cell carcinoma

A

Actinic keratosis

Bowen’s disease - carcinoma in situ

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20
Q

Where to squamous cell carcinomas tend to spread to when they metastasise?

A

Lymph nodes and bone

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21
Q

Rarer sites for squamous cell carcinoma

A

Chronic ulceration/wounds/scarring

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22
Q

Actinic keratoses

A

Pre-cancerous skin lesions. Precursors for non-melanoma skin cancers

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23
Q

What do actinic keratoses tell us about the skin?

A

That the skin is damaged

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24
Q

Actinic keratoses are highly associated with the risk of developing what?

A

Squamous cell carcinoma or basal cell carcinoma

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25
What is Bowen's disease?
Carcinoma in situ
26
Which type of cancer is Bowen's disease related to?
Squamous cell carcinoma
27
Risk factors for skin cancer
Sun exposure Genetic predisposition Immunosuppression Other environmental
28
Genetic predisposition conditions that can cause increased risk for skin cancer
DNA repair syndromes Albinism Naevoid basal cell carcinoma syndrome Epidermolysis bullosa
29
What is albinism?
A congenital absence of melanin. | There is absence or defect of tyrosinase
30
Albinism is autosomal dominant/recessive
Recessive
31
Other environmental factors that are risk factors for skin cancer
``` Coal tar Smoking Ionising radiation Arsenic Trauma Chronic ulceration ```
32
Skin cancer prevention
Behaviour Clothing Sunscreens Regular self surveillance for early detection
33
Things that fall under behaviour modification in skin cancer prevention
Avoid sun in its height (11am-3pm) Use shade where possible Particular care of babies/children Avoid sunbeds
34
Things that fall under clothing modification in skin cancer prevention
Tightly woven, loose fitting clothing (dark clothing) | Long sleeves, trousers, skirts, hat, sunglasses
35
Information you should give about sunscreens in skin cancer prevention
The sunscreen should be broad spectrum (SPF 30+) with UVA protection You usually only get a 1/3rd of the protection it says Application is important - apply twice in sufficient quantities, re-apply after swimming or towelling
36
Oncogene
An overactive form of a gene that regulates cell division and drives tumour formation when activity or copy number is increased
37
Proto-oncogene
The normal, not yet mutated form of oncogene
38
Tumour suppressor
Inactive or non functional form of a gene that negatively regulates cell division. It prevents the formation of a tumour when functioning normally
39
Wavelength of UVB radiation
290-320nm
40
What does UVB radiation cause direct damage to?
Causes direct DNA damage
41
When is UVB radiation more damaging than UVA radiation?
It is 1000x more damaging than UVA when the sun is directly overhead
42
Wavelength of UVA radiation
320-400nm
43
What does UVA radiation cause indirect damage to?
Causes indirect oxidative damage
44
True or false: UVB radiation penetrates more deeply into the skin than UVA
False - UVA penetrates more deeply into the skin than UVB
45
Why are those with skin type I unable to tan?
Pheomelanin is produced instead of eumelanin, and pheomelanin absorbs UV less efficiently. Those with skin type I are unable to tan in a protective way
46
Sun exposure patterns
>90% on head, neck, ears, hands, forearms Outdoor workers Ageing population Arises from lifetime cumulative UV exposure
47
What is melanoma and basal cell carcinoma associated with, relating to UV exposure?
Associated with intermittent burning episodes | Also associated with subbed use
48
When does up to 80% of sun damage occur?
In first 18 years of life
49
Childhood sunburn increases the risk of melanoma by how much?
4-fold
50
Pyrimidine dimers
UV induced DNA lesions
51
2 types of pyrimidine dimers
Cyclobutane pyrimidine dimers and pyrimidine-pyrimidone photo-products
52
Which type of pyrimidine dimer is more common and which is more mutagenic?
Cyclobutane pyrimidine dimers are more common | Pyrimidine-pyrimidone photo-products are more mutagenic
53
How are pyrimidine dimers formed?
By covalent bonding between adjacent pyrimidines on the same DNA strand
54
How are pyrimidine dimers removed?
Nucleotide excision repair
55
Steps of nucleotide excision repair
1. Recognition of the damaged DNA 2. Cleavage of the damaged DNA on the other side of the photoproduct 3. DNA polymerase fills the gap, using the undamaged strand as a template 4. DNA ligase seals the end
56
What happens in UV induced immunosuppression? | Regards to Langerhans cells, T cells and cytokines
Depletion of Langerhans cells in the skin and reduced ability to present antigen Generation of UV induced regulatory T cells with immune suppressive activity Secretion of anti-inflammatory cytokines by macrophages and keratinocytes
57
Risk factors for UV induced immunosuppression
Inflammatory or autoimmune conditions Immunosuppressants Organ transplant recipients
58
Which autoimmune conditions can increase risk of UV induced immunosuppression
UC - 23% higher risk of melanoma | Crohn's - 80% higher risk of melanoma
59
Immunosuppressants that can cause IV induced immunosuppression
Azathioprine Cyclosporine Adalimumab
60
Exposure to which chemical materials can increase the risk of non-melanoma skin cancer?
``` Coal tar pitch Soot Creosote Petroleum products Shale oils Arsenic ```
61
Examples of drugs which are phototoxic
NSAIDs Thiazide diuretics Anti-TNF Azathioprine
62
Management of skin cancer
Sun protection Surgery main treatment for skin cancers Hedgehog inhibitors for BCC Targeted responses for melanoma
63
Examples of targeted therapies for melanoma
Vemurafenib, dabarefenib, MEK inhibitors
64
What is the target for vemurafenib and dabarefinib?
Mutated form of B-raf

Medicine Dermatology (19 decks)

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