Skin cancer overview & epidemiology

Question 1

What are the two categories of skin cancer?

Answer 1

Non-melanoma skin cancer (BCC & SCC) and melanoma skin cancer

Question 2

What cells do the three types of skin cancer arise form?

Answer 2

Melanocytes, basal cells & suprabasal cells

Question 3

List the types of skin cancer from most to least serious

Answer 3

Melanoma > SCC > BCC

Question 4

Which category of skin cancer has the highest incidence?

Answer 4

NMSC

Question 5

Which factors have contributed to the rise of skin cancer in Scotland?

Answer 5

Increase in sunbed use, increase in number of people going on sunny holidays, increased diagnosis

Question 6

Which cancer is the fastest increasing cancer in Scotland?

Answer 6

Melanoma

Question 7

Patients often develop multiple skin cancers. T/F

Answer 7

True

Question 8

How do BCCs typically present?

Answer 8

• Translucent/pearly, slow-growing lump with telangiectasia or non-healing ulcer (rodent ulcer).
• Often painless.
• Superficial BCC presents as a scaly plaque.
• Morphoeic BCC is infiltrative.

Question 9

How do SSCs typically present?

Answer 9

• Warty/crusted growth or non-healing ulcer.
• Tend to arise on sun-damaged skin and are fast(er) growing.
• May be painful and/or bleed

Question 10

BCCs grow slow but spread throughout the body fast. T/F

Answer 10

False - locally invasive but they don’t tend to spread

Question 11

There is generally a high surgical morbidity with skin cancer but a lower mortality. T/F

Answer 11

True - generally

Question 12

Malignant melanoma is responsible for the majority of skin cancer deaths. T/F

Answer 12

True

Question 13

What is the most common cancer affecting 15-24 year olds?

Answer 13

Malignant melanoma

Question 14

What is the distribution of melanoma between the sexes?

Answer 14

More woman get melanoma but more men die of melanoma

Question 15

Melanoma spreads at an early stage. T/F

Answer 15

True

Question 16

Describe the ABCDE approach to melanoma

Answer 16

A - asymmetry 
B - border
C - colour
D - diameter
E - evolution

Question 17

What is the ugly duckling sign?

Answer 17

When a person has multiple moles/skin markings and one stands out as “uglier” than the rest. This ugly duckling is typically cancerous

Question 18

Over which age do BCCs tend to arise?

Answer 18

> 40

Question 19

Where do BCCs tend to present?

Answer 19

Central facial ulcers

Question 20

Which type of BCC can be topically treated?

Answer 20

Superficial BCCs

Question 21

BCCs are never pigmented. T/F

Answer 21

False

Question 22

What is the difference between well differentiated and poorly differentiated SSCs in terms of risk?

Answer 22

Well differentiated - low risk

Poorly differentiated - high risk

Question 23

What is the general risk that a SSC will metastasise?

Answer 23

5% (significantly worsens prognosis)

Question 24

What the the precursor lesions to SSC?

Answer 24

Bowens, actinic keratosis

Question 25

What is a keratoacanthoma?

Answer 25

A self-resolving tumour of the skin follicles often confused with SSC and removed (hard to distinguish so this is for the best)

Question 26

How does keratoacanthoma present?

Answer 26

Rapidly growing, symmetrical, scaly, dome-shaped nodule surrounded by erythema

Question 27

What are actinic keratosis?

Answer 27

Scaly, erythematous lesions. AK present in multiples.

Question 28

What is bowens disease?

Answer 28

Well demarcarcated scaly, erythematous plaques

Question 29

What is a cutaneous horn?

Answer 29

Benign keratinous skin tumours appearing like horns

Question 30

The ears, lips and scalp are high risk sites for skin cancer. T/F

Answer 30

True

Question 31

50% of people who develop a NMSC will go on to develop a further skin cancer within 5 years. T/F

Answer 31

True

Question 32

Chronic ulcers/wounds may go on to become SSCs. T/F

Answer 32

True

Question 33

What are the risk factors for skin cancer?

Answer 33

Sun exposure, genetics, smoking, immunosuppression, HPV infection, chronic ulceration, skin type, occupation, age

Question 34

What are the sun exposure patterns for the various skin cancers?

Answer 34

SSC - chronic, cumulative UV exposure BCC - intermittent, intense sunburn episodes Melanoma - intermittent, intense sunburn episodes

Question 35

What are the most common sites for SCC?

Answer 35

Head, neck, hands, forearms (i.e exposed body sites)

Question 36

Sunburn in childhood is a particular risk factor for skin cancer. T/F

Answer 36

True

Question 37

What is xeroderma pigmentosum? What is the relationship between this and skin cancer?

Answer 37

A genetic (defect in nucleotide excision repair) photosensitivity condition also associated with neurological degeneration. Skin cancers develop more commonly on sun exposed sites

Question 38

What is the average age of onset of skin cancer in patients with xeroderma pigmentosum?

Answer 38

8 y/o

Question 39

Name some genetic conditions which are associated with an increased risk of skin cancer?

Answer 39

Xeroderma pigmentosum, oculocutaneous albinism & naevoid basal cell carcinoma (gorlin's) syndome, recessive dystrophic epidermolysis bullosa, hereditary type VII collagen deficiency

Question 40

What is Gorlin's syndrome? What are the features of this syndrome?

Answer 40

Autosomal dominant familial cancer syndrome. Early onset/multiple BCC, palmar pits, jaw cysts, ectopic calcification falx

Question 41

Which immunosuppressed group are a high risk for skin cancer?

Answer 41

Transplant patients

Question 42

How can skin cancer be prevented?

Answer 42

Behavioural changes, clothing, suncream & regular self surveillance