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*Dermatology > Skin Cancers > Flashcards

Skin Cancers Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the cells affected in non-melanoma skin cancer?

A

Basal cells

Squamous cells

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2
Q

Risk factors for non-melanoma?

A 
UV radiation 
Photochemotherapy - PUVA
Chemical carcinogens
X-ray + thermal radiation 
HPV
Familial cancer syndromes 
Immunosuppression
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3
Q

What are the characteristics of basal cell carcinoma?

A

Slowly growing
Locally invasive
Rarely metastasise

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4
Q

What is the appearance of basal cell carcinoma?

A 
Nodular
Pearly rolled edge
Telangectasia
Central ulceration 
Arborising vessels on dermoscopy
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5
Q

What are the 2 variables for appearance of basal cell carcinoma?

A

Pigmented

Morphoeic

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6
Q

What is the gold standard treatment for BCC?

A

Excision (curative if fully excised; will scar)

curettage in some circumstances

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7
Q

What is Mohs surgery?

A

Thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains

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8
Q

What are indications for Mohs surgery?

A 
Site
Size
Subtype
Poor clinical margin definition 
Recurrent
Perineural or perivascular involvement
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9
Q

What is Vismodegib?

A

cancer treatment drug

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10
Q

What are indications for Vismodegib?

A

Locally advanced BCC not suitable for surgery or radiotherapy
Metastatic BCC

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11
Q

How does Vismodegib work?

A

Selectively inhibits abnormal signalling in the Hedgehog pathway (molecular driver in BCC)

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12
Q

What effect does Vismodegib have?

A

Can shrink tumour and heal visible lesions in some; median progression free survival 9.5 months

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13
Q

Side effects of Vismodegib?

A

Hair loss, weight loss, altered taste

Muscle spasms, nausea, fatigue

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14
Q

What does squamous cell carcinoma derive from?

A

Keratinising squamous cells, usually on sun exposed sites

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15
Q

What does squamous cell carcinoma look like?

A

Fast growing, tender, scaly/crusted or fleshy growths
Can ulcerate
Can metastatise

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16
Q

Treatment of SCC?

A

Excision

+/- radiotherapy

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17
Q

Follow up of SCC patient after treatment if high risk - what would indicate a high risk patient?

A 
Immunosuppressed
>20mm diameter
>4mm diameter
Ear, nose, lip, eyelid 
Perineural invasion 
Poorly differentiated
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18
Q

What skin cancer is a variant of squamous cell carcinoma and erupts from hair follicles in sun damaged skin? How is it dealt with?

A

Keratocanthoma
Grows rapidly, may shrink after a few months and resolve
Surgical excision

19
Q

Risk factor for melanoma skin cancer?

A

UV radiation
Genetic susceptibility (fair skin, red hair, blue eyes, tendency to burn)
Familial melanoma + melanoma susceptibility genes

20
Q

What is the ABCDE rule for assessing melanoma?

A 
Asymmetry
Border
Colour
Diameter
Evolution
21
Q

7 point checklist for malignant melanoma?

A 
MAJOR
- change in size
- change in shape
- change in colour 
MINOR
- diameter more than 5mm
- inflammation 
- oozing/bleeding
- mild itch or altered sensation
22
Q

What tool is used to look at melanoma which has an improved clinical accuracy compared to unaided eye?

A

Dermoscope/dermatoscope

23
Q

What are some subtypes of malignant melanoma?

A

Superficial Spreading Malignant Melanoma - often at site of existing mole; most common
Lentigo Maligna Melanoma
Nodular Melanoma
Acral Lentiginous Melanoma/Subungal Melanoma
Ocular Melanoma

24
Q

Management plan for melanoma?

A 
Urgent surgical excision 
Sentinel lymph node biopsy
Chemo/immunotherapy
Regular follow up
Primary + secondary prevention
25
Q

What 3 biologic drugs are used to treat metastatic melanoma?

A

Ipilimumab
Pembrolizumab
Vemurafenib and Dabrafenib

26
Q

What is a cutaneous lymphoma a secondary cutaneous disease from?

A

From systemic/nodal involvement

27
Q

What can cause cutaneous lymphoma as a primary disease?

A

Abnormal neoplastic proliferation of lymphocytes in the skin (cutaneous T cell (65%); cutaneous B cell (20%))

28
Q

What are 2 the types of cutaneous T cell lymphoma?

A

Mycosis fungoides

Sezary syndrome

29
Q

What is the most common cytotixic T cell lymphoma which accounts for ~50% of all primary cutaneous lymphomas?

A

Mycosis fungoides

30
Q

Describe the appearance of the patch stage in MF

A

Flat, red, dry oval lesions
Usually covered sites
May slowly enlarge or spontaneously enlarge
May itch

31
Q

What is the patch stage of MF difficult to differentiate from?

A

Eczema/psoriasis

32
Q

Describe the appearance of the plaque stage in MF

A

Patches become thickened

Generally itch

33
Q

Describe the tumour stage of MF

A

Large, irregular bumps which can ulcerate
Arise from existing plaques or in normal skin
More likely to have metastatic spread

34
Q

Describe the metastatic stage of MF

A

Infiltration of neoplastic cells in lymph nodes, blood and solid organs

35
Q

How is MF diagnosed?

A

Bloods for sezary cells

CT imaging + staging

36
Q

What is Sezary Syndrome?

A

CTCL affecting skin of entire body

37
Q

Features of Sezary?

A 
Red Man Syndrome
Skin thickened, scaly + red 
ITCHY 
Lymph node involvement 
Sezary cells (atypical T cells) in peripheral blood
38
Q

What is the prognosis for Sezary?

A

Poor - median survival 2-4 yrs; opportunistic infection

39
Q

List off some treatments for cutaneous lymphoma (dependent on stage)

A
  • Topical steroids
  • PUVA or UVB
  • Localised radiotherapy
  • Interferon
  • Bexarotene
  • Low dose methotrexate
  • Chemotherapy
  • Total skin electron beam therapy
  • Extracorporeal photophoresis
  • Bone marrow transplantation
40
Q

What is total skin electron beam therapy?

A

Type of radiotherapy consisting of v small electrically charged particles
Delivers radiation primarily to superficial layers (epidermis + dermis)
Spares deeper tissues and organs

41
Q

What are the 4 stages of extracorporeal photophoresis?

A
  1. Patients blood is drawn and leukocytes collected
  2. Collected white cells mixed with psoralen which makes the T-cells sensitive to UVA radiation
  3. Exposed to UVA radiation, damaging diseased cells
  4. Treated cells re-infused back to patient
42
Q

Describe the occurrence of cutaneous metastases

A

Due to primary solid organ malignancy e.g. breast, colon, lung
or
Secondary to primary skin malignancy e.g. melanoma

43
Q

Management of cutaneous metastases?

A
  • Treat underlying malignancy
  • Local excision
  • Localised radiotherapy
  • Symptomatic

*Dermatology (11 decks)

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