Skin Cancer

Question 1

Precursors of SCC

Answer 1

Actinic keratosis
Bowen’s disease
Viral lesions

Question 2

Presentation of actinic keratosis

Answer 2

Sun exposed sites

Red and scaly

Question 3

Presentation of Bowen’s disease

Answer 3

Scaly patch/plaque with irregular border

Question 4

Treatment for actinic keratosis and Bowen’s disease

Answer 4

Cryotherapy, curettage, 5-fluorouracil, imiquimod, photodynamic therapy

Question 5

What is the most common skin cancer?

Answer 5

BCC

Question 6

BCC is associated with ______ of sun exposure

Answer 6

Intermittent burning episodes

Question 7

In BCC there is abnormality in ______ signalling

Answer 7

Hedgehog

Question 8

Presentation of BCC

Answer 8

Slow growing lump
Non-healing ulcer
Overlying telangiectasia
Central ulceration

Question 9

Risk factors for BCC

Answer 9

UV exposure
Smoking
Genetic predisposition: xeroderma pigmentosum, albinism, epidermolysis bullosa, naevoid basal cell carcinoma (Gorlin's) syndrome
Immunosuppression
Ankylosing spondylitis
Scalp ringworm
Environmental carcinogens
Previous skin cancer

Question 10

Complications of BCC

Answer 10

Neglected invasive BCC

Metastasis (rarely)

Question 11

Treatment of BCC

Answer 11

Surgical excision (4mm margin)
Superficial: cryotherapy,
Photodynamic therapy, fluorouracil, imiquimod
Vismodegib: (for advanced/inoperable BCC, inhibits hedgehog signalling pathway)

Question 12

SCC is associated with ___ UV exposure

Answer 12

Chronic

Question 13

Presentation of SCC

Answer 13

Warty/crusty lump or ulcer which is relatively fast growing

Question 14

Risk factors for SCC

Answer 14

UV exposure
Smoking
Genetic predisposition: xeroderma pigmentosum, albinism, epidermolysis bullosa
Immunosuppression: more common in immunosuppressed patients and transplant patients compared to other skin cancers
Ankylosing spondylitis
Scalp ringworm
Environmental carcinogens
Previous skin cancer

Question 15

Which has a higher metastatic potential? BCC or SCC

Answer 15

SCC

Question 16

Treatment of SCC

Answer 16

Surgical excision (6mm margin)
Radiotherapy

Question 17

Pathology of melanoma

Answer 17

Proliferation of atypical melanocytes with potential for dermal invasion and widespread metastases

Question 18

Melanoma is associated with _____ episodes of sun exposure

Answer 18

Intermittent

Question 19

ABCDE of melanoma

Answer 19

Asymmetry
Border
Colour
Diameter
Elevation

Question 20

What is the “ugly duckling sign” in melanoma?

Answer 20

A mole that looks different from other moles

Question 21

Risk factors for melanoma

Answer 21

UV exposure
Smoking
Genetic predisposition: xeroderma pigmentosum, albinism, epidermolysis bullosa
Immunosuppression
Ankylosing spondylitis
Scalp ringworm
Environmental carcinogens
Previous skin cancer
Pale skin 
Females

Question 22

Definition of Breslow’s thickness

Answer 22

Depth from the granular layer of the epidermis to the deepest melanoma cell

Question 23

Stage I (in situ) Breslow thickness 5-year survivial

Answer 23

90-100%

Question 24

Stage IV (>4mm) Breslow thickness 5-year survival

Answer 24

50%

Question 25

Where can melanoma metastasise?

Answer 25

Lymph node involvement
Lungs
Brain
Liver

Question 26

Treatment for melanoma

Answer 26

Surgical excision: (1cm margin if <1mm breslow, 3cm margin if >1mm breslow)
Sentinel node biopsy
Lymphadenectomy
Radio/chemotherapy
Immunotherapy: Ipilimumab, pembrolizumab
Genetic therapies: vermurafenib, dabrafenib, trametinib, dasatinib, imatinib