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Clinical lectures: Yr2 > Skin cancers and benign differentials: SCC, BCC, Melanoma > Flashcards

Skin cancers and benign differentials: SCC, BCC, Melanoma Flashcards

1
Q

What is an actinic/solar keratosis?

A

Premalignant, slow-growing lesion formed by UV-induced hyperplasia of epidermal keratinocytes

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2
Q

Which skin cancers is actinic keratosis a strong predictor of?

A

Non-melanoma skin cancers

Mostly SCC

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3
Q

Give 5 common risk factors of developing actinic keratoses?

A

Older age

Lots of past sun-exposure or tanning beds

Blonde/red hair with fair skin and blue eyes, skin that burns instead of tans: Types 1,2 fitzpatrick scale

Past history of AKs or skin cancer

Male

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4
Q

Describe the appearance of actinic keratoses?

A

2-6 mm irregular erythematous/pink scaly, crusty macules, papules or plaques on sun-exposed body areas

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5
Q

Where on the body are actinic keratoses most likely to develop?

A

Sun-exposed areas

eg. nose, scalp, backs of hands

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6
Q

Give 4 common signs that actinic keratosis is progressing to a SCC?

A

Enlargement

Tender

Ulceration

Thickened

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7
Q

Give 4 common treatment options for actinic keratosis?

A

5-fluoracil chemotherapy cream

Imiquimod 5% cream

Cryotherapy

Shave, cutterage and electrocautery

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8
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ

Very slow-growing premalignant lesion on top layer of skin (epidermis) and is induced by UV exposure

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9
Q

Give 5 common risk factors of Bowen’s disease?

A

Lots of past sun-exposure or tanning beds

People over 40

Fitzpatrick types 1,2

Women

Past history of skin cancer

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10
Q

Describe the appearance of Bowen’s disease?

A

Erythematous plaque or patch that has well-demarcated borders and irregular shape with overlying crust/scale

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11
Q

Give 5 common treatment options for Bowen’s disease?

A

5-fluoracil chemotherapy cream

Imiquimod 5% cream

Cryotherapy

Shave, cutterage and electrocautery

Excision

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12
Q

.Give 2 differentiations between Bowen’s disease and actinic keratosis?

A

Bowen’s disease lesions usually are larger than AK lesions

Bowen’s disease have finer scale than AK

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13
Q

What is lentigo maligna (Hutchinson’s melanotic freckle)?

A

Growth of malignant melanocytes along the basal layer of the epidermis and within the hair follicle

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14
Q

Which skin cancer can lentigo maligna progress to?

A

In-situ form of melanoma as it hasn’t invaded below epidermis yet

Lentigo Maligna Melanoma (LMM)

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15
Q

Give 5 common risk factors for lentigo maligna?

A

People over 40 yrs old

Lots of sun exposure or tanning beds

Fitzpatrick types 1,2

Multiple solar lentigines: Benign dark patches on face or back of hands

Family history or past history of melanoma

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16
Q

Describe the appearance of a lentigo maligna?

A

Freckle-like, poorly-demarcated macule with irregular shape and different shades of brown, that enlarges slowly

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17
Q

Which surgical treatments can be used for lentigo maligna?

A

Wide local excision, then sealed with skin graft

Mohs Micrographic surgery

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18
Q

Which non-surgical treatments can be used for lentigo maligna?

A

Radiation therapy

Imiquimod cream

Cryotherapy

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19
Q

Give 5 differential diagnoses of actinic keratosis?

A

Bowen’s disease

Psoriasis

Lichen planus

Viral wart

SCC

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20
Q

Give 5 differential diagnoses of Bowen’s disease?

A

AK

SCC

Eczema

Psoriasis

Lichen planus

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21
Q

Give 4 differential diagnoses of lentigo maligna?

A

Solar lentigo

Early seborrheic keratosis

Lentigo maligna melanoma

Dysplastic naevus

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22
Q

What are the main classifications of malignant skin lesions?

A

Melanoma and Non-Melanoma

Non-Melanoma is further classified into Basal Cell Carcinoma and Squamous Cell Carcinoma.

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23
Q

What type of carcinoma is Basal Cell Carcinoma (BCC) derived from?

A

Keratinocytes

BCC is classified under Non-Melanoma skin lesions.

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24
Q

What is the primary risk factor associated with Basal Cell Carcinoma (BCC)?

A

Chronic UV exposure

This is a significant epidemiological factor for BCC.

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25
Q

Which phenotypic factors increase the risk of developing BCC?

A

Blonde/red hair, blue eyes, freckles, Type 1 or 2 skin

Type 1 or 2 skin is characterized by always or almost always burning.

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26
Q

Which genetic factors are associated with a higher incidence of BCC?

A

North European ancestry, family history of skin cancer, PTCH mutation

Gorlin’s syndrome and Xeroderma Pigmentosum are also genetic diseases linked to high BCC risk.

27
Q

What are common presentations of Basal Cell Carcinoma (BCC)?

A

Non-healing ulceration, pearly nodules, occasional bleeding, crusting

Hallmark features include pearly rolled edges and arborising telangiectasia.

28
Q

What are the subtypes of Basal Cell Carcinoma (BCC)?

A
  • Nodular BCC
  • Superficial BCC
  • Pigmented BCC
  • Morphoeic BCC
  • Basosquamous BCC

Each subtype may present differently and require specific management.

29
Q

How does Basal Cell Carcinoma (BCC) typically progress?

A

Enlarges slowly and may cause a tingling/stinging sensation

This slow progression can lead to delayed diagnosis if not monitored.

30
Q

What is the management approach for Nodular or Pigmented Nodular BCC?

A

Surgical excision

This is the standard treatment for these specific subtypes.

31
Q

What are the management options for Superficial BCC?

A

Cryotherapy, 5-FU cream, phototherapy

These non-surgical approaches are preferred for Superficial BCC.

32
Q

What is the recommended management for Morphoeic/Sclerosing BCC?

A

Surgical excision

This subtype requires a more aggressive treatment approach due to its infiltrative nature.

33
Q

What is Squamous Cell Carcinoma (SCC)?

A

Malignant neoplasm derived from epidermal keratinocytes.

34
Q

What is the incidence of Squamous Cell Carcinoma?

A

More common in men; incidence increases with age and sun exposure.

35
Q

What are the predisposing factors for Squamous Cell Carcinoma?

A

Premalignant lesions, burns or long-term heat exposure, chronic scarring, papillomavirus infection, genetic diseases such as xeroderma pigmentosum and albinism.

36
Q

What is the typical presentation of Squamous Cell Carcinoma?

A

Flesh-coloured/erythmateous nodule that is hyperkeratotic, can ooze and crust, can ulcerate, form cutaneous horn, or become verrucous.

37
Q

What does a painful lesion indicate in Squamous Cell Carcinoma?

A

It is a red flag, as this indicates nerve infiltration.

38
Q

What is the management for Squamous Cell Carcinoma?

A

Surgical excision.

39
Q

What is Melanoma?

A

Macular skin neoplasm arising from the malignant degeneration of melanocytes.

40
Q

What are the environmental factors associated with Melanoma?

A

UV exposure, blistering sunburns, spending childhood in sunny regions.

41
Q

What are the phenotypic factors associated with Melanoma?

A

Fair skin that easily burns and freckles, blue/green eyes, blonde/red hair, multiple normal naevus and/or abnormal naevus, a large congenital naevus.

42
Q

What are the genetic factors associated with Melanoma?

A

Family history of melanoma, past melanoma, mutations in p16, BRAF, MC1R genes.

43
Q

What is melanoma?

A

Melanoma is a macular skin neoplasm arising from the malignant degeneration of melanocytes, a pigment-producing cell found in the epidermal skin layer.

44
Q

What are the environmental factors contributing to melanoma?

A

Environmental factors include UV exposure, blistering sunburns, and spending childhood in sunny regions.

45
Q

What are the phenotypic factors associated with melanoma?

A

Phenotypic factors include fair skin that easily burns and freckles, blue/green eyes, blonde/red hair, multiple normal naevus, and/or abnormal naevus, and a large congenital naevus.

46
Q

What genetic factors are linked to melanoma?

A

Genetic factors include family history of melanoma, past melanoma, and mutations in p16, BRAF, and MC1R genes.

47
Q

What are the four classifications of melanoma?

A
  1. Superficial Spreading Malignant Melanoma (SSMM)
  2. Nodular Melanoma
  3. Lentigo Maligna Melanoma (LMM)
  4. Acral Lentiginous Melanoma
48
Q

Describe Superficial Spreading Malignant Melanoma (SSMM).

A

SSMM is a dark brown, irregular naevus with a blue-white overlay that changes over time.

49
Q

Describe Nodular Melanoma.

A

Nodular Melanoma is typically a uniformly dark blue-black or bluish-red papule/nodule.

50
Q

Describe Lentigo Maligna Melanoma (LMM).

A

LMM is a large macule that arises in a pre-existing naevus.

51
Q

Describe Acral Lentiginous Melanoma.

A

Acral Lentiginous Melanoma is a large dark patch that arises in a pre-existing naevus with hallmark Hutchinson’s sign (nail pigment that extends onto the skin surrounding the nail).

52
Q

What is Breslow Depth?

A

Breslow Depth is the measurement of the depth of the melanoma from the surface of the skin down through to the deepest point of the tumour (the vertical growth).

53
Q

How does Breslow Depth relate to survival rates?

A

The higher the Breslow Depth score, the lower the survival rate.

54
Q

What is the purpose of Breslow Depth measurement?

A

It is completed after staging the surgically excised melanoma and guides management such as wide local excision, sentinel node biopsy, whole body scan, and immunotherapy.

55
Q

What is a sentinel lymph node biopsy?

A

A sentinel lymph node biopsy is a staging and prognostic tool that detects micrometastases in regional lymph nodes.

56
Q

How is the sentinel lymph node biopsy performed?

A

Blue dye and technetium-99m-labelled radiocolloid solution are injected intradermally at the primary site.

57
Q

What is the detection rate of sentinel lymph node biopsy?

A

The detection rate is 92%.

58
Q

What is Seborrhoeic Keratosis?

A

A benign skin neoplasm made up of immature epidermal keratinocytes.

59
Q

How does the number of Seborrhoeic Keratosis lesions change with age?

A

The number increases with age, but there is no increased risk of malignancy.

60
Q

What is the typical presentation of Seborrhoeic Keratosis?

A

Well-demarcated, rough patch that has a hallmark ‘stuck-on’ appearance, with color varying from black to skin-colored.

61
Q

What happens to Seborrhoeic Keratosis lesions when traumatized?

A

Trauma will cause bleeding or ulceration that heals.

62
Q

How can you differentiate Seborrhoeic Keratosis from melanoma?

A

Seborrhoeic Keratosis is rough, while melanoma is smooth.

63
Q

What is the ABCDE rule of melanoma?

A

Asymmetry: Lesion is asymmetrical, if you draw a line through the halves won’t match

Border: Uneven, scalloped, jagged, irregular borders

Colour: Multicolored, non-uniform

Diameter: More than 6mm (size of a pencil eraser)

Evolution: Sudden change

Clinical lectures: Yr2 (52 decks)

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