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DermJaz > Skin Cancers > Flashcards

Skin Cancers Flashcards

1
Q

Most deadly skin cancer

Is caused by a virus and is rare

A

Merkel cell carcinoma

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2
Q

Buckman 6 step is a framework for ___

A

breaking bad news

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3
Q

Buckman 6 step =

A 
initiate
focused Hx - how much does ptnt know
how much do they want to know
share info
acknowledge feelings
plan and follow through
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4
Q

ABCDE for melanoma

A 
Asymmetry
Border irregularity
Colour variation
Diameter >6mm
Evolving
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5
Q

Breslow thickness is for the extent of ___ measured from ___

measured in ___

A

melanoma
top of graular layer down
mm

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6
Q

3 main types of melanoma =

A

superficial spreading melanoma (70%)
nodular melanoma (10%)
lentigo maligna melanoma (10%)

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7
Q

rarer type of melanoma that occurs at palms soles around and under big toenail =

A

acral lentiginous melanoma

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8
Q

Type of melanoma that develops quickly, usually on chest/back, grows downwards

A

nodular melanoma

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9
Q

risk of metastasis in superficial spreading melanoma

A

low risk

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10
Q

melanoma type that grows v slowly, usually face and outdoorsy elderly =

A

lentigo maligna melanoma

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11
Q

Ix for melanoma

A

excision biopsy => if >1mm deep check lymph nodes (biopsy/US) if stage 3 => CT

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12
Q

Rx for in situ melanoma ( in epidermis)

A

excision/imiquimod cream

check ups

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13
Q

Rx for Stage 1-2 melanoma (in dermis)

A

excision

specialist follow up

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14
Q

Rx for Stage 3 melanoma (lymph nodes)

A

excision
possible radio (decrease recurrence risk)
perhaps excise nodes

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15
Q

Rx for Stage 4 melanoma ( metastasised)

A 
all possibilitoes:
sx
chemo 
radio
biological therapy
regular specialist check up
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16
Q

skin cancers tend to be homo/heterogenous

A

heterogenous - later cells acquire a slightly different final mutation

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17
Q

normal Ras: growth factor>receptor>___ binds to GTP > can bind to ___>kinase>___

A

Ras
Raf
division and proliferation

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18
Q

the Ras pathway in an oncogenic Ras

A

no growth factor but stil Ras binds to GTP and stays bound/slow to turn off = proliferation

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19
Q

p53 stops cells at __ if they are defective

A

G1 checkpoint

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20
Q

in p53 mutation___binds to __ causing cell progression through the cell cycle

A

Cdk:G/S cyclin

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21
Q

chronic UV radiation eg.

increases risk of ___ cancer by __%

A

outdoor worker

Squamous cell carcinoma 77%

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22
Q

intense intermittent/recreational UV radiation eg.

increases risk of __+__ by __%

A

holidays and outdoor leisure
melanoma 60%
basal cell carcinoma 43%

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23
Q

burning by UV radiation eg.

increases risk of __+__ by x__

A

pain/blistering burn

melanoma and basal cell carcinoma x2

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24
Q

artificial UV radiation eg.

increases risk of __+__+__ by __%

A

sunbeds
SCC 67%
melanoma 16-59%
BCC 29-40%

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25
scale used to assess skin type
Fitzpatrick
26
2 genetic conditions that increase risk of skin cancer
albinism | xeroderma pigmentosum
27
xeroderma pigmentosum defect is in __ increases risk of skin cancer by ___ in under 20yos median age of skin cancer =
DNA repair genes 2000x 10yo
28
chemical risk factors for NMSC:
``` coal tar soot creosate petroleum shale oils arsenic ```
29
IS factors that increase the risk of skin cancer
``` UC and Crohns azathioprine cyclosporin adalimumab transplants ```
30
the UV radiation that causes sunburn
B
31
UVB is more/less damaging that UVA | wavelengths =
1000x more | 290-320nm
32
2 types of direct DNA damage caused by UVB
cyclobutane pyrimidine dimers (CPDs) | yrimidine-pyrimidone (6-4) photo products
33
wavelength of UVA | deeper/more superficial penetration that UVB
320-400nm | deeper
34
mutation passed on in UVB damaged cells =
GG is entered where AA should be entered or vice versa
35
UVA causes __ __ DNA damage - especially deoxyguanosine > ___ causes ____ mutation
indirect oxidative 8-oxo-deoxyguanosine GC>AT point mutation
36
in UVA and UVB radiation skin damage normal cell repair response =
``` UVA = base excision repair UVB = nucleotide excision repair ```
37
UV induces IS by :
reduces langerhans in skin, Treg generation and anti-inflam cytokines
38
important mutation in BCC
PTCH1
39
PTCH1 mutation in BCC causes ___activation > no longer stops ___ > activates __ > cell proliferation and angiogenesis activators induced
Hedgehog SMO receptor transcription factor Gli1/2
40
drug used to treat BCC by binding to SMO
vismodegib
41
important mutations in melanoma
Ras Raf MAPK | >50% have activating B-Raf mutation mostly V600E
42
melanoma treatments that target B-raf or MEK
``` B-raf = vemurafenib and dabrafenib MEK = tramatenib ```
43
2 genes that cause familial melanoma
CDKN2A | CDK4
44
melanoma drugs targeted to c-KIT and their function =
dasatinib + imatinib | prevent cell growth
45
melanoma drugs that target B-raf and their function =
vemurafenib dabrafenib (with trametinib due to rapid resistance for 6-7mnths) prevent cell growth
46
melanoma drug that targets MEK and its function
trametinib | prevent cell growth
47
melanoma drugs that target CTLA-4 on Ts and their function
ipilimumab + tremelimumab | T cell activation to enable tumour cell killing
48
melanoma drug that targets PD-1 on Ts and its function
pemprolizumab | T cell activation to enable tumour cell killing
49
ugly duckling sign that suggests melanoma
brown patch with otherwise healthy skin and few freckles
50
BCC make up __% of NMSCs
75%
51
characteristics of BCC
``` pearly painless slow growing lump/non-healling ulcer visible vessels usually facial central rodent ulcer locally invasive ```
52
morphoeic BCC means it is =
infiltrative - may look small but has roots so difficult to excise
53
characteristics of SCC
``` hyperkeratotic lump/ulcer on sun damaged skin grow fast painful +/bleed ear, lip and scalp are high risk sites ```
54
pre cursor lesions of SCC
actinic keratoses and Bowen's disease
55
appearance of solar keratosis
dry, scaly patches - only 2/3 layers of epidermis
56
appearance of Bowen's disease
erythematous plaque, whole epidermis
57
Resembles SCC- common low grade benign tumour of pilosebaceous unit that grows rapidly
keratocanthoma
58
genetic defect in xeroderma pigmentosum
defect in 1/7 NER genes
59
Major features of Naevoid BCC/Gorlin's Syndrome
early onset/multiple BCCs palmar pits jaw cysts ectopic calcification falx
60
Naevoid BCC syndrome is also called ___ | is ___ inherited
Gorlin's syndrome | auto dominant
61
Butterfly disease is also known as ___ causes ___ which are a risk for ___ caused by a hereditary ___ deficiency
Recessive dystrophic Epidermolysis Bullosa (RDEB) mutilating ulcers SCC Type VII collagen deficiency
62
transplant hands =
after transplant hands have field cancerisation with precancerous and SCC lesions
63
Leser Trelat sign = | found in ___
eruptive appearance of seborrhoeic keratosis | may indicate malignancy
64
3 types of BCC
nodular superficial morphoeic
65
morphoeic BCC has prominent ____ with ___ margins and can spread along __
desmoplastic fibrous stroma poorly defined nerves
66
precursor of SCC that is a scaly plaque/patch, irregular border and no dermal invasion
Bowen's disease (may mimic inflammation)
67
Rare genetic causes of SCC
XP | RDEB
68
firm to touch nodule that often has increased pigment around rim
dermatofibroma
69
craggy and looks like a maryland cookie
basal cell papilloma
70
Rx for NMSC -
Sx/photodynamic therapy (ALA PDT) | 5% imiquimod cream
71
Rx for common pre-cancers
solaraze, 5 FU, resurfacing cryotherapy PDT or imiquimod
72
5 layers of the scalp Superficial to deep
``` SCALP Skin CT Aponeurosis Loose CT Periosteum ```
73
To test sensory CNV of face
close eyes and lightly brush face with cotton bud and theyll tell you when feel it
74
best ratio for sides of an elliptical excision
3:1

DermJaz (9 decks)

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