Skin Lumps Flashcards
What is the ABCDE of skin lumps?
Asymmetry Border/Bleeds Colour Diameter Evolution
Which skin cancer does chronic, intermittent, burning and artificial UV light predispose to?
Chronic = SCC
Intermittent and burning = BCC and melanoma
Artificial = all 3
Where are organ transplant patients most likely to get skin cancer + what type?
Hands
SCC
What histology do all SCC precursors show + name 3 treatments?
Squamous dysplasia
5-flurouracil
Imiquimod
Liquid nitrogen
What is actinic keratosis + how does it present + 3 places it commonly affects?
Partial thickness dysplasia
Red scales
Scalp, face and arms
What is Bowen’s disease + how does it present + who and where does it commonly affect?
Carcinoma-in-situ
Red plaque
Females
Lower leg
What is seborrheic keratosis also know as + appearance + 2 histological signs?
Basal cell papilloma
Stuck on raisin
Hyperkeratosis and horn cysts
What is Leser-Trelat sign?
Sudden multiple seb Ks indicating malignancy
What is melanoma + mutation + who is it more common in?
Cancer of basal melanocytes
B-Raf
Women
Which genes are associated with familial melanoma?
CDKN2A and CDK4
2 ways melanoma spreads + 3 most common places?
Blood or lymph
Lungs, liver and brain
Name the 2 growth phases of melanoma + which one can metastasise?
Vertical - can metastasise
Horizontal
Name the 4 types of melanoma (+ most common) and which growth phases they go through.
Superficial (most common), acral/mucosal and lentigo = grow horizontally then vertically
Nodular = grows vertically
Which scale is used for cancer referrals + when do you refer?
Glasgow scale
> 3 points or 1 if suspicious
What are the 7 categories of the Glasgow scale?
Size Shape Colour Inflammation Crusting/bleeding Sensory change > 7mm
What is used after skin biopsy to determine severity of cancer + where is the measurement to and from?
Breslow thickness
Granular layer to deepest tumour cell
What is pTis and survival rate + what does pT”b” mean?
CIC
100%
Ulceration
What is the 5-year survival rate for pT1, pT4 and metastasis?
95-100%
50%
6%
Treatment for melanoma if < 1 mm deep + > 1mm deep or mitoses?
< 1mm = removal with 1-2cm margin
> 1mm = removal + sentinal node biopsy + lymphadenectomy (if +VE)
Chemotherapy (if needed)
Name 2 B-Raf inhibitors + an MEK inhibitor.
Dabrafenib and vemurafenib
Trametinib
What is the most common skin cancer + what is it?
BCC
Cancer of the basal keratonocytes
What is BCC in terms of mutation, speed, metastasis, and general appearance?
PTCH1
Slow progressing
No metastasis
Nodular with ulceration and arborizing blood vessels
Name 4 types of BCC.
Superficial
Pigmented
Nodular
Locally invasive
2 histological signs of BCC?
Groups of basal cells in dermis
Peripheral palisading
What is the treatment for nodular + superficial BCC?
Surgical removal
Imiquimod/5-fu/liquid nitrogen
Which drug blocks the PTCH1 hedgehog pathway?
Vismodegib
What is SCC and what is it in terms of speed, metastasis and general appearance?
Cancer of the superficial keratinocytes
Fast growing
Metastasis in 5%
Warty, hyperkeratotic lump
Which 3 places of SCC have a poorer prognosis?
Lip, ear and scalp
Treatment for SCC?
Surgical removal + radiotherapy
What does one + 2 defective copies of the MCR1 gene cause?
1 = freckles (ephilides) 2 = red hair + freckles
What are actinic/solar lentigines known as + cause + histology?
Age or liver spots
Increased melanin via sun exposure
Elongated rete ridges
Name 3 types of naevus + where they are + who they are seen in + how they form.
Junctional = DEJ = kids
Compound = DEJ + dermis = teen
Intradermal = dermis = adult
Keratinocyte: melanocyte ratio breaks down leading to dense clusters of melanocytes
What is the treatment for congenital naevi + why?
Surgical removal
Risk of melanoma
What are the 2 superficial signs of a dysplastic naevus>?
> 6 mm
Atypical colour/borders
Name 3 rare types of naevus + their associated cells.
Halo = lymphocytes Blue = pigmented spindle cells Spitz = spindle or epitheliod cells
