Skin lesions, tumours and cancers

Question 1

Freckles/ ephilides are caused by patchy increase in ____1______ They are most common in ____2____ those with freckles and red hair have two _____3______

Answer 1

1) melanin pigmentation
2) fair skin and red heads
3) I mean pathologist claims defective but I am going to go with mutated copies of the MC1R gene. If you just have freckles you only have one MUTATED copy :)

Question 2

What are actinic lentigines?

Answer 2

Age spots that occur in older people after chronic UV exposure they are due to an increase in melanin and basal melanocytes

Question 3

___1___ of babies are born with congenital nave. Large lesions have to excised because __2____

Answer 3

1) 1-2%

2) they increase risk of melanoma by 10-15%

Question 4

What allows the formation of simple naevi? How common are simple naevi? Do they have a low or high malignant potential?

Answer 4

During infancy the melanocytes: keratinocyte ratio breaks down at a number of cutaneous sites allowing the formation of simple naevi (moles). These are very common and the average person has 20-30. They have low malignant potential.

Question 5

Halo naevi have a peripheral halo of _____1________ due to ____2_______

Answer 5

1- depigmentation

2- inflammatory regression and lymphocytes

Question 6

Blue naevi are entirely __1____ and consist of ___2_____

Answer 6

1) dermal

2) pigment rich dendritic spindle cells

Question 7

Describe spitz naevi

Answer 7

occurs in young children, large spindle and or epithelia cells, closely mimics melanoma. Difficult to diagnose as there is a malignant variation of this disease.

Question 8

What do all dysplastic naevi show?

Answer 8

architectural atypia and cellular atypia

Question 9

Actinic keratoses are common on ____1____ They appear as __2____ A small minority of lesions ___3____ They can be treated with ___4______

Answer 9

1) fair skinned individuals on sun exposed areas
2) rough, scaly, erythematous papule or patches and the surrounding skin usually shows signs on sun damage
3) undergo malignant transformation to SCC
4) cryotherapy, curettage or creams

Question 10

Bowen’s disease is a indolent form of _____1____ which rarely progresses to ___2___ Lesions appears as ____3_____ resembling __4___ but lacking thick silvery scale

Answer 10

1) intraepidermal carcinoma in situ
2) which rarely progresses to SCC
3) slowly enlarging, well demarcated, scaly red patch or plaque
4) psoriasis

Question 11

What is an inherited condition that increases risk of malignant melanoma?

Answer 11

Familial atypical multiple mole melanoma

Question 12

What is the most serious skin cancer? Why?

Answer 12

Melanoma. Greatest potential to metastasise as melanocytes are naturally motile cells anyway.

Question 13

Describe the ABCDE criteria for a suspicious looking mole

Answer 13

A= asymmetry of the mole
B= border irregularity
C= colour variation
D= diameter more than 6mm
E= elevation

Question 14

What are the four types of melanoma?

Answer 14

Superficial spreading, lentigo maligna melanoma, nodular malignant melanoma, acral lentiginous melanoma.

Question 15

Describe superficial spreading melanoma

Answer 15

Large, flat, irregularly pigmented lesion that grows laterally before vertical invasion. Most common type in fair skinned people.

Question 16

Describe lentigo maligna melanoma

Answer 16

A patch of lentigo maligna (pigmented macular lesion on the face) that develops a papule or nodule which signals invasive melanoma.

Question 17

Describe nodular melanoma

Answer 17

Most aggressive type. It presents as a rapidly growing pigmented nodule which bleeds or ulcerates. Invasive from the outset.

Question 18

Describe acral lentiginous melanoma

Answer 18

Arises as pigmented lesions of the palm or sole or under the nail, and usually presents late. May not be related to sun exposure. This is the most common type of melanoma in black people.

Question 19

What does melanoma prognosis largely relate to?

Answer 19

Breslow thickness and ulceration

Question 20

Define breslow thickness

Answer 20

The deepest part of the tumour from the granular layer in mm

Question 21

Breslow thickness less than 1mm 5yr survival=?

Answer 21

95-100%

Question 22

Breslow thickness more than 4mm 5yr survival=?

Answer 22

50%

Question 23

Ulceration in a melanoma is good or bad?

Answer 23

Bad- it’s a strong adverse indicator

Question 24

Describe the spread of melanoma

Answer 24

Melanoma spreads to local dermal lymphatics (satellite deposits), regional lymph nodes and blood spread to: skin/ soft tissue, heart, lungs, GI tract, liver and brain.

Question 25

Describe treatment of melanoma

Answer 25

Primary excision is done to give clear margins. In thicker tumours may do sentinel node biopsies and if positive will then do a regional lymphadenectomy. Treatment of advanced disease is difficult. Removal of regional lymph nodes, isolated limb perfusion, radiotherapy, immunotherapy and chemotherapy done but no real improvement. New targeted therapies have improved prognosis such as BRAF inhibitors, MEK inhibitors. Also CTLA4 antibody and PDI antibody.

Question 26

What is the most common malignant skin tumour?

Answer 26

Basal cell carcinoma

Question 27

Where is basal cell carcinoma thought to arise from?

Answer 27

Thought to arise from pluripotential cells in the basal epidermis or follicular structures

Question 28

Basal cell carcinoma and squamous cell carcinoma are both caused by UV exposure what’s the difference?

Answer 28

BCC is thought to be caused by peak exposures (so like periods where your burn) whereas SCC is by chronic UV exposure so the result in cumulative.

Question 29

Who does BCC commonly arise in?

Answer 29

Fair, middle aged people with sun exposed skin.

Question 30

What are the three main subtypes of BCC?

Answer 30

Nodular
Superficial
Infiltrative/morpheic

Question 31

Describe nodular BCC

Answer 31

Typically appears as a shiny, pearly nodule with central ulceration

Question 32

Describe superficial BCC

Answer 32

BCC that spreads superficially as opposed to vertically

Question 33

Describe infiltrative/ morpheic BCC

Answer 33

Most important type and may infiltrate tissues widely. Prominent desmoplastic fibrous stroma. Margins are poorly defined and resection can be difficult as sometimes there is spread along nerves.

Question 34

Describe treatment of BCC

Answer 34

In most cases treatment of choice is a wide excision with histology to ensure clear and adequate tumour margins. BCCs rarely ever metastasise so main reason to remove is that they are locally invasive. For superficial BCCs can treat with cryotherapy, phototherapy or topical imiquimod. Vismodegib is a new oral therapy for inoperable BCCs that inhibits hedgehog signalling.

Question 35

What mutations are thought to cause BCC and can be a target for drugs?

Answer 35

Mutations in PTCH1, the human homolog of the Patched gene that regulates hedgehog intracellular signalling pathway

Question 36

What does squamous cell carcinoma arise from

Answer 36

Epidermal squamous epithelium

Question 37

Presentation of squamous cell carcinoma?

Answer 37

Most commonly presents as a hyperkeratotic nodule or area of induration. In more advanced stages, ulceration and destruction of underlying tissues may be present. SCC can also arise in pre-existing solar keratoses or Bowen’s disease and can also complicate areas of chronic inflammation.

Question 38

Treatment of squamous cell carcinoma?

Answer 38

Complete surgical excision with a minimal margin of 5mm. Radiotherapy is also used.

Question 39

Seborrhoeic keratosis is a ______1___________ common on __2_____ Eruptive appearance of many lesions may indicate _______

Answer 39

1) benign proliferation of epidermal keratinocytes
2) ageing skin on face and trunk
3) malignancy

Question 40

Dermatofibromas are _______1__________ often surrounded by a peripheral ring of _____2_____ they are usually found on ___3_____ Excision only needed if ____4_____

Answer 40

1- pink beige firm dermal nodules
2- hyperpigmentation
3- leg in females
4- symptomatic or uncertainty of diagnosis

Question 41

What is dermatofibrosarcoma protuberans?

Answer 41

Rare type of soft tissue cancer that develops in the deep layers of the skin

Question 42

What are angiomas?

Answer 42

benign tumours derived from vascular cells

Question 43

What is angiosarcoma? How may it appear?

Answer 43

Cancer that forms in the lining of blood and lymph vessels. Often affects the skin and may appear as a bruise like lesion that spreads over time.

Question 44

What type of cancer is derived from mechanoreceptors in the epidermis and is rare and highly aggressive?

Answer 44

Merkel cell cancer

Question 45

How can you tell the difference between Bowens and superficial BCC?

Answer 45

Bowens tends to be slightly more scaly- go on site swell, bowens will always be sun exposed area whereas superficial BCC may not