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Skin tumours Flashcards

1
Q

What is the commonest sin cancer?

A

BCC

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2
Q

What is actinic keratoses?

A

Pre-malignant crumbly yellow-white scaly crust on sun-exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes

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3
Q

What can actinic keratoses progress to?

A

SCC

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4
Q

What might the following be?

A
  • Actinic keratosis
  • Bowen’s Disease
  • Psoriasis
  • BCC
  • Seborrhoeic keratosis
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5
Q

What measures would you take to prevent someone developing actinic keratosis?

A

Education

  • Sunhats
  • Suncream
  • Monitor skin
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6
Q

What options are available for managing actinic keratosis?

A

No treatment, or:

  • Emollient
  • Diclofenac gel
  • Fluorouracil
  • Imiquimod
  • Crytherapy
  • Photodynamic therapy
  • Surgical excision + curettage
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7
Q

What is bowen’s disease?

A

Intraepidermal SCC/SCC in situ - superficial well-defined slowly enlarging red scaly plaque with a flat edge. It is a full thickness dysplasia/carcinoma in situ

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8
Q

What is the cause of Bowen’s disease?

A
  • UV exposure
  • Radiation
  • Immunosuppression
  • Arsenic
  • HPV infection
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9
Q

How would you manage someone with Bowen’s Disease?

A
  • Cryotherapy
  • Topical flourouracil
  • Imiquimod
  • Photodynamic therapy
  • Curettage
  • Excision
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10
Q

What is the following?

A

Seborrhoeic keratosis

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11
Q

What is basal cell carcinoma?

A

Slow-growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older individuals

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12
Q

What are risk factors for BCC?

A
  • UV exposure
  • History of frequent/severe sunburn in childhood
  • Skin type I - (always burns, never tans)
  • Increasing age
  • Male sex
  • Immunosuppression
  • Previous history of skin cancer
  • Genetic predisposition
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13
Q

How does BCC present?

A

Various morphological types:

  • Nodular - small, skin-coloured papule or nodule with surface telangiectasia, a pearly rolled edge - may have necrotic/ulcerated centre
  • Superficial (plaque-like)
  • Cystic
  • Mephoeic (sclerosing)
  • Keratotic and pigmented
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14
Q

What could the following be?

A

BCC

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15
Q

What options are available for treating BCC?

A
  • Remove the lesion - mohs micrographic excision, cryotherapy, photodynamic, Curettage and cautery
  • Radiotherapy
  • Low risk - Topical treatment (imiquimod)
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16
Q

What are complications of BCC?

A

Local tissue invasion and destruction

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17
Q

What is squamous cell carcinoma?

A

Locally invasive malignant tumour of the epidermal keratinocytes or its appendages, which has the potential to metastasise

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18
Q

What are causes of SCC?

A
  • UV exposure
  • Pre-malignant skin conditions - actinic keratoses
  • Chronic inflammation - leg ulcers, wound scars
  • Immunosuppresion
  • Genetic predisposition
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19
Q

How does SCC present?

A

Keratotic, ill defined nodule which eventually ulcerates

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20
Q

How would you manage someone with SCC?

A
  • Surgical excision - Mohs micrographic surgery
  • Radiotherapy - large, non-resectable tumours
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21
Q

What is malignant melanoma?

A

Invasive malignant tumour of the epidermal melanocytes, which has the potential to metastasise

22
Q

What are risk factors for the development of malignant melanoma?

A
  • Excessive UV exposure
  • Skin type I (always burns, never tans)
  • History of multiple moles or atypical moles
  • Family history
  • Previous history of melanoma
23
Q

What are signs of malignant melanoma?

A

ABCDEF

  • Asymmetry in outline of the lesion
  • Border irregularity or blurring
  • Colour variation
  • Diameter > 6mm
  • Evolution/Enlargement
  • Funny looking mole

Also new or changing lesion

24
Q

What are types of malignant melanoma?

A
  • Superficial malignant melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral lentiginous melanoma
25
What are features of superficial spreading melanoma?
* **Common on lower limbs** * **Young/middle aged adults** * **Related to intermittent high-intensity UV exposure**
26
What are features of nodular melanoma?
* **Common on the trunk** * **Affects on young and middle aged** * **Related to intermittent high-intensity UV exposure**
27
What are features of lentigo maligna melanoma?
* **Common on the face** * **Affects Elderly** * **Related to long-term cumulative UV exposure**
28
What are features of acral lentiginous melanoma?
* **Common on the palms, soles and nail beds** * **Affects elderly more commonly** * **No clear relation with UV exposure**
29
What is the most common type of melanoma?
Superficial spreading melanoma70%
30
How would you manage someone with malignant melanoma?
* **Surgical excision** * **Radiotherapy** * **Chemotherapy**
31
What margin is used for excision of malignant melanoma?
* **Any unusual lesion** - 2mm margin of normal skin + cuff of subcut fat * **If malignant melanoma** - 3mm
32
What is breslow thickness?
**Thickness of tumour** - gives an idea of risk of recurrence
33
What does a breslow thickness of \<0.76mm indicate in terms of risk of recurrence?
Low risk
34
What does a breslow thickness of 0.76-1.5mm indicate in terms of risk of recurrence?
Medium risk
35
What does a breslow thickness of \>1.5mm indicate in terms of risk of recurrence?
High risk
36
What is classed as stage I malignant melanoma?
* **T \< 2mm** * **N0** * **M0**
37
What is classed as stage II malignant melanoma?
* **T\>2mm** * **N0** * **M0**
38
What is classed as stage III malignant melanoma?
* **T\>2mm** * **N \>/= 1** * **M0**
39
What is classed as stage IV malignant melanoma?
* **T\>2mm** * **N\>/=1** * **M1**
40
What might be your differential diagnosis for someone who is presenting with features of malignant melanoma?
* **Benign melanocytic lesions** * **Non-melanocytic pigmented lesion** e.g. seborrhoeic keratosis
41
What might the following be?
Acral lentiginous melanoma
42
What might the following be?
Superficial spreading melanoma
43
What might the following be?
Lentigo maligna melanoma
44
What might the following be?
Nodular melanoma
45
What is the best diagnostic test for melanoma?
Fill thickness excisional biopsy - can properly estimate thickness
46
What is the gold standard for management of malignant melanoma?
Complete excision
47
What would prompt lymph node bipopsy in malignant melanoma?
Tumour thickness \> 1 mm
48
Where are SCCs most commonly found?
Most commonly face - typically lower lip
49
What is the classic presentation of SCC?
* **Painless** * **Non-healing, bleeding ulcer**
50
How would you investigate a suspected SCC?
* **Punch biopsy** * **Wedge biopsy** * **Excision biopsy**

Dermatology (13 decks)

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