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Year 4 Cancer Care and Haem > Skin Cancer > Flashcards

Skin Cancer Flashcards

1
Q

Describe the distribution of melanocytes in different races?

A

Melanocytes are found in equal numbers between black and white ethnicities but melanocytes in black races produce more protective melanin

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2
Q

Why might melanomas be found later in darker skinned ethnicities?

A

Reduced public/physician awareness
Lower index of suspicion
Challenging detection (more likely acral)

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3
Q

Name two non cancerous melanocyte growths

A

Moles
Freckles

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4
Q

Name the four types of Malignant Melanoma

A

Lentigo Maligna
Superficial Melanoma
Nodular Melanoma
Acral Lentiginous

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5
Q

How do Superficial Melanomas present?

A

Irregularly pigmented
Grow laterally before vertically

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6
Q

How do Nodular Melanomas present?

A

Most aggressive
Rapidly growing pigmented nodule that bleeds/ulcerates

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7
Q

How do Acral Lentiginous Lesions present?

A

Pigmented lesions on palm/sole/nail bed

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8
Q

Where are the common sites of metastases from Malignant Melanoma?

A

Lymph nodes
Liver
Lung
Bone
Brain

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9
Q

Give four risk factors for Malignant Melanoma

A

Naevi
Sun Exposure
Skin Pigmentation (Fitzpatrick 1 or 2)
Immunosupression

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10
Q

Describe the risk factor ‘Naevi’ in terms of Malignant Melanoma

A

Individual with >100 common naevi or >2 atypical naevi

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11
Q

What is Atypical Mole Syndrome?

A

> 100 common naevi
AND
2 atypical naevi
AND
Naevi on unusual sites

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12
Q

Describe the risk factor ‘Sun Exposure’ in terms of Malignant Melanoma

A

Sharp short bursts of acute exposure in childhood, or severe sunburn

Post Sunbed use

Cumulative moderate occupational exposure may be protective in some

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13
Q

Using the A to E mnemonic, how can Malignant Melanomas be described?

A

Asymmetry
Border (uneven, scalloped)
Colour (variety in shade/colour)
Diameter (>6mm)
Evolving

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14
Q

There is a point system for examining Malignant Melanomas, and if patients score >3 then they require a 2ww. State the major factors scoring 2 points

A

Change in size
Irregular Shape
Irregular Colour

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15
Q

There is a point system for examining Malignant Melanomas, and if patients score >3 then they require a 2ww. State the minor factors scoring 1 point

A

Largest diameter >7mm
Inflammation
Oozing
Change in sensation

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16
Q

What are excisional biopsies?

A

Suspicious lesions are completely excised with 1-2mm margin
Includes subcut fat to ensure full dermal sample

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17
Q

When are incisional biopsies used?

A

Reserved for large lesions
Cosmetically sensitive
Close to vital structures

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18
Q

Name three types of histological analysis carried out on Malignant Melanoma biopsies

A

Breslow Thickness
Ulceration
Mitotic Index

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19
Q

What is Breslow Thickness?

A

Based on vertical thickness of tumour in mm

From Stratum Granulosum to point of maximum infiltration

Correlates with mortality

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20
Q

What is Mitotic Index?

A

Indicator of cell turnover
Number of mitoses per mm2

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21
Q

If the Malignant Melanoma is high risk, what other investigations should be done?

A

PET CT
LDH (Risk Stratifying)

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22
Q

Name two different ways to stage Malignant Melanomas

A

TNM
AJCC (American Joint Committee on Cancer)

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23
Q

Are Malignant Melanomas radiosensitive?

A

No

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24
Q

What levels should be maximised before initiating management for Malignant Melanomas?

A

Vitamin D

25
Q

How are Stage 0-2 Malignant Melanomas managed?

A

Stage 0 - Topical Imiquimod or Excision with 0.5cm margin
Stage 1 - Excision with 1cm margin
Stage 2 - Excision with 2cm margin

26
Q

Describe some management options for more advanced Malignant Melanomas

A

Lymph node dissection
Adjuvant radiotherapy
Topical Imiquimod
Electrochemotherapy
Palliative surgery

27
Q

Give two examples of Biological agents for Malignant Melanoma

A

Dabrafenib (BRAF V600 +ve)
Bevacizumab (VEGF)

28
Q

Give an example of an Immunotherapy agent used to treat Malignant Melanoma

A

Ipilimumab (Targets T lymphocytes and stimulates their anti tumour effects)

29
Q

How is stage 1A Malignant Melanoma followed up?

A

2-4 times in first year then discharge

30
Q

How is stage 1B-2B Malignant Melanoma followed up?

A

3m for 3y
then
6m for 2y

31
Q

How is Stage III Malignant Melanoma followed up?

A

3m for 3y
then
6m for 2y

and surveillance imaging

32
Q

How is Stage IV Malignant Melanoma followed up?

A

Personalised follow up

33
Q

What is a Mucosal Melanoma?

A

Rare and primarily affecting head and neck, vulvovagial and anorectal
Typically older patients
Worse prognosis

34
Q

Name two common Non Melanoma Skin Cancers

A

Basal Cell Carcinoma
Squamous Cell Carcinoma

35
Q

Name two rarer Non Melanoma Skin Cancers

A

Merkel Cell Carcinoma
Kaposi’s Sarcoma

36
Q

Give four risk factors for Non Melanoma Skin Cancers

A

UV radiation
Chronic Inflammation
HPV
Hereditary Conditions

37
Q

Define Basal Cell Carcinoma

A

Slow growing, locally invasive malignant epidermal skin tumours, commonly occuring on sun exposed regions of the body, rarely metastasising

38
Q

Name four genetic predispositions to Basal Cell Carcinoma

A

p53 mutations
Albinism
Gorlins Syndrome
Xeroderma Pigmentosum

39
Q

How does Gorlin Syndrome present?

A

Autosomal dominant condition increasing risk of BCC

Multiple early onset BCCs
Hyperteorism
Palmar and Plantar Pits
Falx Calcification

40
Q

Name the five types of Basal Cell Carcinoma

A

Nodular (60-80%)
Superficial
Morpheic
Pigmented
Basosquamous

41
Q

How does Nodular BCC present?

A

TURP
Telangiectasia, Ulceration, Rolled Edges, Pearly Edge

Central ulcer = rodent ulcer

42
Q

How do Superficial BCC present?

A

Erythematous plaques (commonly on trunk and limbs)

Difficult to distinguish from dermatitis/SCC

43
Q

How do Morpheic BCC present?

A

Presents as a scar like lesion
Commonly occurring on upper trunk/face
Deeply invasive

44
Q

How do Pigmented BCC present?

A

Difficult to distinguish from Melanoma

45
Q

How do Basosquamous BCC present?

A

Rare and aggressive form with increased risk of recurrence and metastases

46
Q

Give four BCC features that would make it high risk

A

> 2cm
Poorly defined
Perineural/Perivascular incasion
Immunosupression

47
Q

The definitive management for BCC is excision and histological analysis. What margins are required for low and high risk?

A

Low risk -> 4-5mm margin

High risk -> atleast 5mm margin, and referral for Mohs Micrographic surgery considered

48
Q

What is Moh’s Micrographic surgery?

A

Tumour is excised at an oblique angle in a series of stages and examined microscopically
Further excision until all margins negative

49
Q

If there is a low risk lesion, BCC may be treated by other treatments such as:

A

Cryotherapy
Electrosurgery

50
Q

When is radiotherapy for BCC appropriate?

A

For recurrent disease
In cosmetically sensitive areas

51
Q

What is Photodynamic Therapy?

A

Light + Topical Photosensitising Agent to produce tumour destruction
Good cosmetic results but lengthy process

52
Q

Squamous Cell Carcinomas make up around 20% of non melanoma skin cancer. How do they present?

A

Rapidly growing red papule or non healing lesion
Ulceration
Bleeding
May have background of Actinic Keratoses

53
Q

What makes a Squamous Cell Carcinoma more likely to metastasise?

A

Recurrent disease
Large Size
Certain sites (eg lip)

54
Q

Name 5 management options for Squamous Cell Carcinoma

A

Surgical excision (+histological analysis)
Cryotherapy (small low risk lesions)
Radiotherapy (if small and well localised, or as adjuvant)
Chemotherapy (Cisplatin)
Cetuximab

55
Q

What is Merkel Cell Carcinoma?

A

Rare malignant skin tumour arising in head/neck/limbs that has neuroendocrine features pathologically

56
Q

How does Merkel Cell Carcinoma present?

A

Red/purple nodule with overlying shiny epithelium

57
Q

How is Merkel Cell Carcinoma managed?

A

Ideally surgery (+/- adjuvant chemoradio)

58
Q

Define Selective and Extended Neck Dissection

A

Selective : One or more lymphatic groups preserved based on pattern of metastases

Extended : Extra lymphatic or non lymphatic structures are removed

Year 4 Cancer Care and Haem (16 decks)

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