Skin Cancer Flashcards
What are the possible differential diagnoses?
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What are the investigations conducted to narrow down the differentials, and which are most important?
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What is melanoma and where can it develop?
Malignant tumour arising from melanocytes
Leads to >75% of skin cancer deaths
Can
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What are the genetic, environmental and phenotypic risk factors for developing melanoma?
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Atypical moles (e.g. aymmetrical)
What is the pathogenesis of melanoma?
The MPK pathway in our body is responsible for cellular proliferation, growth and migration
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Further downstream, CDK2NA (tumour suppressor) mutations can also lead to melanoma
What is the host response to melanoma?
Our CD8T cells can recognise melanoma
What is imoirtant about our host response to melanoma?
Immunotherapy - blocks x
also PD1 important in autoimmunity and so prevents melanocytes being killed - block this so abnormal melanocytes in melanoma are killed by host’s own immune system
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What are the different subtypes of melanoma?
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What is superficial spreading melanoma?
What is the growth pattern of superficial spreading and so how does it look clinically?
Majority of melanomas
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Firstly, slow radial growth phase = horizontal growht restricted to dermis, shows up as assymetrical / atypical ‘mole’ with blurred edges and colour variation
Afterwards, vertical growth - nodule going deeper into the skin
What is nodular melanoma?
What is the growth pattern of nodular melanoma and so how does it look clinically?
2nd most common type of melanoma in fair skinned individuals
May be black, blue or pink
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Skips radial / horizontal growth phase - lack of asymmetry, not much colour variation and no blurred edges
Goes straight to vertical growth
What is Lentigo Maligna?
What is the growth pattern of lentigo maligna and so how does it look clinically?
When is becomes invasion it is called lentigo maligma
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Grey circles / rhomboid structures seen in lentigo maligna
What is acral lentiginous melanoma?
What is the growth pattern of acral lengtiginous and so how does it look clinically?
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Vary variable in appearance, asmmetric, ulcerific, scaly, non-specific, often presents at late stage
Can also appear in the nail, longitudinal dark appearance on nails
Can lack pigment
What is the best way to catch melanoma early?
Self-detection - history in colour, shape or size of a pigmented skin lesion
ABCDE rule
What is the ABCDE rule?
A = asymmetry
B = border irregularity
C =
First ABCD = horizontal growth = not useful for nodular melanoma (so that is why E is also v important)
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Which types of melanoma can you diagnose without doing a biopsy?
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What are the features of melanoma with poorer prognoses?
>1mm Ulceration Age Male Anatomical site
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How is melanoma thickness measured?
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What are the different investigations conducted for suspected melanoma?
- Firstly, dermascopy
What is Dermascopy?
look at the melanoma - look for
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Helps diagnosis of melanoma by 50% - but cannot be used in isolation as it needs to consider history, risk factors etc.
What is essential lymph node biopsy?
The most likely node that area of skin drains to - looking for malignancy at lymph node - has the cancer spread?
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What is the primary management for melanoma?
Primary exision down to subcutaneous fat - 2mm peripheral margin
Wide exicision…
How do we conduct TNM staging?
Use imaging for stages II, IV
Use bloods for prognostic factor in metastatic
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What is the management for unresectable or metastatic melanoma?
Immunotherapy - use the hosts immune system
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Mutated oncogene targeted therapy
What is Kertinocyte Dysplasia / Carcinoma?
What are the different subtypes within this?
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Actinic keratoses =
Bowen’s disease =
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What is the risk factor for basal cell carcinoma?
UV radiation
What is the pathogenesis of basal cell carcinoma?
Invasion of tumour is supported by mellatoproteinases and collagenases
p53 mutations are important
What is the pathogenesis of squamous cell carcinoma?
UV radiation causes genetic alterations - commonly in p53, but also CDKN2A
What is the epidemiology of keraintocyte carcinomas?
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What are the risk factors of keratinocyte carcinomas?
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What is actinic keratoses?
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Can be difficult to distinguish
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What does a keratoacanthoma look like?
Pseudomalignancy?
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What is the treatment / management for squamous cell carcinoma?
Primarily = resection
Metastatis = traditional chemotherapy or Cemiplimab = check cell inhibitor
What are the main subtypes of basal cell carcinoma?
Nodular = most ocmmon, presents as shiny papule / nodule, accounts for half of BCCs
Morphoeic = more locally invasive and destructive, but almost never metastatis
Basisquamous = scalyness on top of papules
Micronodular = resembles nodular but more destructive (spreads locally quicker)
What are the appropriate investigations for suspected basal cell carcinoma?
Clinical diagnosis
Can take biopsy
What is the treatment for basal cell carcinoma?
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