Skin Cancer Flashcards

1
Q

Spread of melanoma

A

Local spread
- lesion expands horizontally at basal lamina
- dermal invasion of lesion - metastatic potential
Lymphatic
Haematogenous

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2
Q

Risk factors for melanoma

A
UV radiation
- sun exposure and sunburns
- naturally light skin
- exposure early in life
Nevi
- benign growths
Genetic background
- xeroderma pigmentosum
- Werner syndrome
PMHx of melanoma
Immunosuppression
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3
Q

Pathophysiology of melanoma

A

Malignant tumour that starts in melanocytes (melanin-producing cells)
Often starts as slow-growing superficial tumour

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4
Q

Features of melanoma on examination

A
A - asymmetry
B - border irregularities
C - colour variegation (different colours in same region)
D - diameter greater than 6 mm
E - evolving
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5
Q

Ix for melanoma

A
Dermoscopy
Biopsy
USS to check lymph nodes
CXR
CT/MRI/PET
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6
Q

Mx of melanoma

A
Wide local excision +/- sentinel lymph node biopsy
Surgical resection
Lymph node dissection
Biological therapies - nivolumab
Radiotherapy
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7
Q

Features of basal cell carcinoma on examination

A

Nodular
- pink, pearly, well demarcated lesion with telangiectatic vessels
- bleeding
Superficial
- erythematous, well-defined, scaly/shiny lesion
- pruritius
Sclerosing
- pale colour with poorly defined borders
Most common over head and neck

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8
Q

Features of squamous cell carcinoma

A

Overlying scale
Erythematous
Well-defined borders

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9
Q

Mx of non-melanoma carcinoma

A
Surgical excision
Moh's surgery - microscopic margin control
Radiation therapy
Curettage and electrodessication
Cryotherapy
Topical 5-FU
Imiquimod
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10
Q

Premalignant conditions for non-melanoma

A

Actinic keratosis
- erythematous and scaly
Bowens disease

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11
Q

Nice major criteria for skin lesion

A

2 points each
Change in size
Irregular shape
Irregular colour

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12
Q

Nice minor criteria for skin lesion

A
1 point each
Largest diameter 6mm or more
Inflammation
Oozing/bleeding
Change in sensation
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13
Q

Nice criteria for skin lesions

A

3 points = secondary care skin cancer clinic within 2 weeks

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14
Q

Types of ix for skin lesions

A

Shave biopsy
Punch biopsy
Excision biopsy - whole lesion removed
Incisional biopsy - part of lesion and part of healthy skin removed

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15
Q

Key points of incisional biopsy

A

See border

Don’t have to remove whole lesion

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16
Q

Skin biopsy considerations

A

Does it look worrying - need to take out whole lesion
Location - cannot remove whole lesion
Patient

17
Q

Histology of squamous cell carcinoma

A

Atypical polygonal cells with abundant cytoplasm
Keratin formation
Prominent intercellular bridges

18
Q

Histology of basal cell carcinoma

A

Discrete nest of dark blue cells
Attached to epidermis
Peripheral palisading
Retraction artefact

19
Q

Hisology of malignant melanoma

A

Abundant melanin pigment in cells - brown
Light pink staining cytoplasm
Prominent nucleoli
Small nests of atypical cells

20
Q

Define basal cell carcinoma

A

Slow-growing locally invasive malignant tumour of the epidermal keratinocytes
Normally in older individuals

21
Q

Mx of basal cell carcinoma

A

Surgical excision - treatment of choice as allows histological examination of tumour and margins
Mohs micrographic surgery - excision of lesion and tissue borders progressively excised until specimens microscopically free of tumour
Radiotherapy - when surgery not appropriate
Cryotherapy
Curettage and cautery
Topical photodynamic therapy
Topical treatment - Imiquimod

22
Q

Describe squamous cell carcinoma

A

Locally invade malignant tumour of the epidermal keratinocytes or appendages
Potential to metastesise

23
Q

Presentation of squamous cell carcinoma

A

Keratotic, ill-defined nodule which may ulcerate

24
Q

Mx of squamous cell carcinoma

A

Surgical excision - treatment of choice
Mohs micrographic surgery
Radiotherapy - large non-resectable tumours

25
Q

Define malignant melanoma

A

Invasive malignant tumour of epidermal melanocytes

Potential to metastasise

26
Q

Mx of malignant melanoma

A

Surgical excision
Radiotherapy
Chemotherapy - metastatic disease