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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
Which phenotypic factors increase the risk of developing BCC?
Blonde/red hair, blue eyes, freckles, Type 1 or 2 skin ## Footnote Type 1 or 2 skin is characterized by always or almost always burning.
26
Which genetic factors are associated with a higher incidence of BCC?
North European ancestry, family history of skin cancer, PTCH mutation ## Footnote Gorlin's syndrome and Xeroderma Pigmentosum are also genetic diseases linked to high BCC risk.
27
What are common presentations of Basal Cell Carcinoma (BCC)?
Non-healing ulceration, pearly nodules, occasional bleeding, crusting ## Footnote Hallmark features include pearly rolled edges and arborising telangiectasia.
28
What are the subtypes of Basal Cell Carcinoma (BCC)?
* Nodular BCC * Superficial BCC * Pigmented BCC * Morphoeic BCC * Basosquamous BCC ## Footnote Each subtype may present differently and require specific management.
29
How does Basal Cell Carcinoma (BCC) typically progress?
Enlarges slowly and may cause a tingling/stinging sensation ## Footnote This slow progression can lead to delayed diagnosis if not monitored.
30
What is the management approach for Nodular or Pigmented Nodular BCC?
Surgical excision ## Footnote This is the standard treatment for these specific subtypes.
31
What are the management options for Superficial BCC?
Cryotherapy, 5-FU cream, phototherapy ## Footnote These non-surgical approaches are preferred for Superficial BCC.
32
What is the recommended management for Morphoeic/Sclerosing BCC?
Surgical excision ## Footnote This subtype requires a more aggressive treatment approach due to its infiltrative nature.
33
What is Squamous Cell Carcinoma (SCC)?
Malignant neoplasm derived from epidermal keratinocytes.
34
What is the incidence of Squamous Cell Carcinoma?
More common in men; incidence increases with age and sun exposure.
35
What are the predisposing factors for Squamous Cell Carcinoma?
Premalignant lesions, burns or long-term heat exposure, chronic scarring, papillomavirus infection, genetic diseases such as xeroderma pigmentosum and albinism.
36
What is the typical presentation of Squamous Cell Carcinoma?
Flesh-coloured/erythmateous nodule that is hyperkeratotic, can ooze and crust, can ulcerate, form cutaneous horn, or become verrucous.
37
What does a painful lesion indicate in Squamous Cell Carcinoma?
It is a red flag, as this indicates nerve infiltration.
38
What is the management for Squamous Cell Carcinoma?
Surgical excision.
39
What is Melanoma?
Macular skin neoplasm arising from the malignant degeneration of melanocytes.
40
What are the environmental factors associated with Melanoma?
UV exposure, blistering sunburns, spending childhood in sunny regions.
41
What are the phenotypic factors associated with Melanoma?
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
What are the genetic factors associated with Melanoma?
Family history of melanoma, past melanoma, mutations in p16, BRAF, MC1R genes.
43
What is melanoma?
Melanoma is a macular skin neoplasm arising from the malignant degeneration of melanocytes, a pigment-producing cell found in the epidermal skin layer.
44
What are the environmental factors contributing to melanoma?
Environmental factors include UV exposure, blistering sunburns, and spending childhood in sunny regions.
45
What are the phenotypic factors associated with melanoma?
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
What genetic factors are linked to melanoma?
Genetic factors include family history of melanoma, past melanoma, and mutations in p16, BRAF, and MC1R genes.
47
What are the four classifications of melanoma?
1. Superficial Spreading Malignant Melanoma (SSMM) 2. Nodular Melanoma 3. Lentigo Maligna Melanoma (LMM) 4. Acral Lentiginous Melanoma
48
Describe Superficial Spreading Malignant Melanoma (SSMM).
SSMM is a dark brown, irregular naevus with a blue-white overlay that changes over time.
49
Describe Nodular Melanoma.
Nodular Melanoma is typically a uniformly dark blue-black or bluish-red papule/nodule.
50
Describe Lentigo Maligna Melanoma (LMM).
LMM is a large macule that arises in a pre-existing naevus.
51
Describe Acral Lentiginous Melanoma.
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
What is Breslow Depth?
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
How does Breslow Depth relate to survival rates?
The higher the Breslow Depth score, the lower the survival rate.
54
What is the purpose of Breslow Depth measurement?
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
What is a sentinel lymph node biopsy?
A sentinel lymph node biopsy is a staging and prognostic tool that detects micrometastases in regional lymph nodes.
56
How is the sentinel lymph node biopsy performed?
Blue dye and technetium-99m-labelled radiocolloid solution are injected intradermally at the primary site.
57
What is the detection rate of sentinel lymph node biopsy?
The detection rate is 92%.
58
What is Seborrhoeic Keratosis?
A benign skin neoplasm made up of immature epidermal keratinocytes.
59
How does the number of Seborrhoeic Keratosis lesions change with age?
The number increases with age, but there is no increased risk of malignancy.
60
What is the typical presentation of Seborrhoeic Keratosis?
Well-demarcated, rough patch that has a hallmark 'stuck-on' appearance, with color varying from black to skin-colored.
61
What happens to Seborrhoeic Keratosis lesions when traumatized?
Trauma will cause bleeding or ulceration that heals.
62
How can you differentiate Seborrhoeic Keratosis from melanoma?
Seborrhoeic Keratosis is rough, while melanoma is smooth.
63
What is the ABCDE rule of melanoma?
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 (56 decks)

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