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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
Q

scale used to assess skin type

A

Fitzpatrick

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26
Q

2 genetic conditions that increase risk of skin cancer

A

albinism

xeroderma pigmentosum

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27
Q

xeroderma pigmentosum
defect is in __
increases risk of skin cancer by ___ in under 20yos
median age of skin cancer =

A

DNA repair genes
2000x
10yo

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28
Q

chemical risk factors for NMSC:

A 
coal tar
soot
creosate
petroleum
shale oils
arsenic
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29
Q

IS factors that increase the risk of skin cancer

A 
UC and Crohns
azathioprine
cyclosporin
adalimumab
transplants
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30
Q

the UV radiation that causes sunburn

A

B

31
Q

UVB is more/less damaging that UVA

wavelengths =

A

1000x more

290-320nm

32
Q

2 types of direct DNA damage caused by UVB

A

cyclobutane pyrimidine dimers (CPDs)

yrimidine-pyrimidone (6-4) photo products

33
Q

wavelength of UVA

deeper/more superficial penetration that UVB

A

320-400nm

deeper

34
Q

mutation passed on in UVB damaged cells =

A

GG is entered where AA should be entered or vice versa

35
Q

UVA causes __ __ DNA damage - especially deoxyguanosine > ___
causes ____ mutation

A

indirect oxidative
8-oxo-deoxyguanosine
GC>AT point mutation

36
Q

in UVA and UVB radiation skin damage normal cell repair response =

A 
UVA = base excision repair
UVB = nucleotide excision repair
37
Q

UV induces IS by :

A

reduces langerhans in skin, Treg generation and anti-inflam cytokines

38
Q

important mutation in BCC

A

PTCH1

39
Q

PTCH1 mutation in BCC causes ___activation > no longer stops ___ > activates __ > cell proliferation and angiogenesis activators induced

A

Hedgehog
SMO receptor
transcription factor Gli1/2

40
Q

drug used to treat BCC by binding to SMO

A

vismodegib

41
Q

important mutations in melanoma

A

Ras Raf MAPK

>50% have activating B-Raf mutation mostly V600E

42
Q

melanoma treatments that target B-raf or MEK

A 
B-raf = vemurafenib and dabrafenib
MEK = tramatenib
43
Q

2 genes that cause familial melanoma

A

CDKN2A

CDK4

44
Q

melanoma drugs targeted to c-KIT and their function =

A

dasatinib + imatinib

prevent cell growth

45
Q

melanoma drugs that target B-raf and their function =

A

vemurafenib
dabrafenib (with trametinib due to rapid resistance for 6-7mnths)
prevent cell growth

46
Q

melanoma drug that targets MEK and its function

A

trametinib

prevent cell growth

47
Q

melanoma drugs that target CTLA-4 on Ts and their function

A

ipilimumab + tremelimumab

T cell activation to enable tumour cell killing

48
Q

melanoma drug that targets PD-1 on Ts and its function

A

pemprolizumab

T cell activation to enable tumour cell killing

49
Q

ugly duckling sign that suggests melanoma

A

brown patch with otherwise healthy skin and few freckles

50
Q

BCC make up __% of NMSCs

A

75%

51
Q

characteristics of BCC

A 
pearly
painless
slow growing lump/non-healling ulcer
visible vessels
usually facial
central rodent ulcer
locally invasive
52
Q

morphoeic BCC means it is =

A

infiltrative - may look small but has roots so difficult to excise

53
Q

characteristics of SCC

A 
hyperkeratotic lump/ulcer
on sun damaged skin
grow fast
painful +/bleed
ear, lip and scalp are high risk sites
54
Q

pre cursor lesions of SCC

A

actinic keratoses and Bowen’s disease

55
Q

appearance of solar keratosis

A

dry, scaly patches - only 2/3 layers of epidermis

56
Q

appearance of Bowen’s disease

A

erythematous plaque, whole epidermis

57
Q

Resembles SCC- common low grade benign tumour of pilosebaceous unit that grows rapidly

A

keratocanthoma

58
Q

genetic defect in xeroderma pigmentosum

A

defect in 1/7 NER genes

59
Q

Major features of Naevoid BCC/Gorlin’s Syndrome

A

early onset/multiple BCCs
palmar pits
jaw cysts
ectopic calcification falx

60
Q

Naevoid BCC syndrome is also called ___

is ___ inherited

A

Gorlin’s syndrome

auto dominant

61
Q

Butterfly disease is also known as ___
causes ___ which are a risk for ___
caused by a hereditary ___ deficiency

A

Recessive dystrophic Epidermolysis Bullosa (RDEB)
mutilating ulcers
SCC
Type VII collagen deficiency

62
Q

transplant hands =

A

after transplant hands have field cancerisation with precancerous and SCC lesions

63
Q

Leser Trelat sign =

found in ___

A

eruptive appearance of seborrhoeic keratosis

may indicate malignancy

64
Q

3 types of BCC

A

nodular
superficial
morphoeic

65
Q

morphoeic BCC has prominent ____ with ___ margins and can spread along __

A

desmoplastic fibrous stroma
poorly defined
nerves

66
Q

precursor of SCC that is a scaly plaque/patch, irregular border and no dermal invasion

A

Bowen’s disease (may mimic inflammation)

67
Q

Rare genetic causes of SCC

A

XP

RDEB

68
Q

firm to touch nodule that often has increased pigment around rim

A

dermatofibroma

69
Q

craggy and looks like a maryland cookie

A

basal cell papilloma

70
Q

Rx for NMSC -

A

Sx/photodynamic therapy (ALA PDT)

5% imiquimod cream

71
Q

Rx for common pre-cancers

A

solaraze, 5 FU, resurfacing
cryotherapy
PDT or imiquimod

72
Q

5 layers of the scalp Superficial to deep

A 
SCALP
Skin 
CT
Aponeurosis
Loose CT
Periosteum
73
Q

To test sensory CNV of face

A

close eyes and lightly brush face with cotton bud and theyll tell you when feel it

74
Q

best ratio for sides of an elliptical excision

A

3:1

DermJaz (9 decks)

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