Skin Cancer

Question 1

What are the possible differential diagnoses?

Answer 1

x

Question 2

What are the investigations conducted to narrow down the differentials, and which are most important?

Answer 2

x

Question 3

What is melanoma and where can it develop?

Answer 3

Malignant tumour arising from melanocytes

Leads to >75% of skin cancer deaths

Can
x

Question 4

What are the genetic, environmental and phenotypic risk factors for developing melanoma?

Answer 4

x

Atypical moles (e.g. aymmetrical)

Question 5

What is the pathogenesis of melanoma?

Answer 5

The MPK pathway in our body is responsible for cellular proliferation, growth and migration

x

Further downstream, CDK2NA (tumour suppressor) mutations can also lead to melanoma

Question 6

What is the host response to melanoma?

Answer 6

Our CD8T cells can recognise melanoma

Question 7

What is imoirtant about our host response to melanoma?

Answer 7

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

Question 8

x

Answer 8

x

Question 9

x

Answer 9

x

Question 10

What are the different subtypes of melanoma?

Answer 10

x

Question 11

What is superficial spreading melanoma?

What is the growth pattern of superficial spreading and so how does it look clinically?

Answer 11

Majority of melanomas
x

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

Question 12

What is nodular melanoma?

What is the growth pattern of nodular melanoma and so how does it look clinically?

Answer 12

2nd most common type of melanoma in fair skinned individuals
May be black, blue or pink

x
Skips radial / horizontal growth phase - lack of asymmetry, not much colour variation and no blurred edges
Goes straight to vertical growth

Question 13

What is Lentigo Maligna?

What is the growth pattern of lentigo maligna and so how does it look clinically?

Answer 13

When is becomes invasion it is called lentigo maligma

x
Grey circles / rhomboid structures seen in lentigo maligna

Question 14

What is acral lentiginous melanoma?

What is the growth pattern of acral lengtiginous and so how does it look clinically?

Answer 14

x

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

Question 15

What is the best way to catch melanoma early?

Answer 15

Self-detection - history in colour, shape or size of a pigmented skin lesion

ABCDE rule

Question 16

What is the ABCDE rule?

Answer 16

A = asymmetry

B = border irregularity

C =

First ABCD = horizontal growth = not useful for nodular melanoma (so that is why E is also v important)

x

Question 17

Which types of melanoma can you diagnose without doing a biopsy?

Answer 17

x

Question 18

What are the features of melanoma with poorer prognoses?

Answer 18

>1mm
Ulceration
Age
Male
Anatomical site

x

Question 19

How is melanoma thickness measured?

Answer 19

x

Question 20

What are the different investigations conducted for suspected melanoma?

Answer 20

1. Firstly, dermascopy

Question 21

What is Dermascopy?

Answer 21

look at the melanoma - look for

x
Helps diagnosis of melanoma by 50% - but cannot be used in isolation as it needs to consider history, risk factors etc.

Question 22

What is essential lymph node biopsy?

Answer 22

The most likely node that area of skin drains to - looking for malignancy at lymph node - has the cancer spread?

Question 23

x

Answer 23

x

Question 24

x

Answer 24

x

Question 25

What is the primary management for melanoma?

Answer 25

Primary exision down to subcutaneous fat - 2mm peripheral margin Wide exicision...

Question 26

How do we conduct TNM staging?

Answer 26

Use imaging for stages II, IV Use bloods for prognostic factor in metastatic x

Question 27

What is the management for unresectable or metastatic melanoma?

Answer 27

Immunotherapy - use the hosts immune system x Mutated oncogene targeted therapy

Question 28

What is Kertinocyte Dysplasia / Carcinoma? What are the different subtypes within this?

Answer 28

x Actinic keratoses = Bowen's disease = x

Question 29

What is the risk factor for basal cell carcinoma?

Answer 29

UV radiation

Question 30

What is the pathogenesis of basal cell carcinoma?

Answer 30

Invasion of tumour is supported by mellatoproteinases and collagenases p53 mutations are important

Question 31

What is the pathogenesis of squamous cell carcinoma?

Answer 31

UV radiation causes genetic alterations - commonly in p53, but also CDKN2A

Question 32

What is the epidemiology of keraintocyte carcinomas?

Answer 32

x

Question 33

What are the risk factors of keratinocyte carcinomas?

Answer 33

x

Question 34

What is actinic keratoses?

Answer 34

x | Can be difficult to distinguish

Question 35

x

Answer 35

x

Question 36

x

Answer 36

x

Question 37

x

Answer 37

x

Question 38

x

Answer 38

x

Question 39

x

Answer 39

x

Question 40

What does a keratoacanthoma look like?

Answer 40

Pseudomalignancy?

Question 41

x

Answer 41

x

Question 42

x

Answer 42

x

Question 43

What is the treatment / management for squamous cell carcinoma?

Answer 43

Primarily = resection Metastatis = traditional chemotherapy or Cemiplimab = check cell inhibitor

Question 44

What are the main subtypes of basal cell carcinoma?

Answer 44

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)

Question 45

What are the appropriate investigations for suspected basal cell carcinoma?

Answer 45

Clinical diagnosis | Can take biopsy

Question 46

What is the treatment for basal cell carcinoma?

Answer 46

x