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Year 4 Dermatology > Skin tumours > Flashcards

Skin tumours Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the different types of skin cancers

A

Non-melanoma: BCC and SCC

Melanoma

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2
Q

list precancerous lesions of SCC

A

AK

Bowen’s disease

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3
Q

what is the commonest type of skin cancer

A

BCC

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4
Q

what is AK

A

Actinic keratosis is a precancerous skin lesion from accumulative photodamage causing partial thickness dysplastic keratinocytes

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5
Q

What is Bowen’s disease

A

carcinoma in situ / full thickness dysplasia

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6
Q

appearance of AK

A

scaly, crusty, erythematous

sun exposed areas e.g. H+N, ears

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7
Q

appearance of Bowen’s disease

A

erythematous
scaly, dry plaque
lower legs of older ladies

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8
Q

list genetic conditions that can predispose to skin cancer

A

albinism
epidermolysis bullosa
Gorlin’s syndrome
Xeroderma pigmentosum

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9
Q

list iatrogenic factors that can predispose to skin cancer

A

immunosuppression - steroids, ciclosporin, biologics
phototherapy
radiotherapy

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10
Q

List risk factors for developing skin cancer

A 
increased sun exposure and burning 
sunbeds, holidays, no suncream...
age 
FH and genetics
immunosuppression - drugs 
naevi
Fitzpatrick skin type 
smoking
radiation 
chronic wound / ulcer 
chemicals
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11
Q

SCC are usually as a result from intermittent burning episodes, true or false

A

false, they result from cumulative UV exposure

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12
Q

BCC and melanomas are usually as a result from intermittent burning episodes, true or false

A

true

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13
Q

risk factors for melanoma

A 
personal/FH
number of moles 
excess sun exposure 
sunbed use 
multiple sunburns
fair skin
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14
Q

List major criteria for changing moles

A

change in shape, size and colour

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15
Q

List minor criteria for changing moles

A

diameter >6mm
bleeding
sensory change
inflammation

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16
Q

Clinical features of malignant melanoma

A 
ABCDE
Asymmetry 
irregular Border 
multiple Colours 
Diameter >6mm
fast Evolution
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17
Q

what tool can be used to examine skin lesions more closely

A

dermastocope

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18
Q

causes for changing moles

A

melanoma
psoriasis
eczema
halo naevus

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19
Q

examples of melanocytic naevi

A 
blue naevus 
congenital 
Spitz 
normal naevi 
dysplastic 
halo 
atypical
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20
Q

advise for a patient with atypical naevi

A

regular monitoring

sun protection

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21
Q

what are atypical naevi a marker of

A

patient’s tendency to develop melanoma

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22
Q

does chopping out atypical naevi reduce risk of melanoma

A

no, there is still the same genetic risk and they could appear in ‘normal’ skin

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23
Q

what are the different subtypes of melanoma

A 
superficial spreading 
acral / lentiginous 
lentigo maligna 
nodular
amelanotic
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24
Q

all types of melanoma have radial growth phase (RGP), true or false

A

false
Nodular melanoma just has VGP
the rest have RGP initially and may develop VGP

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25
Q

Do nodular melanomas have the worst prognosis?

A

yes because they have VGP from the outset therefore increased risk of metastasis

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26
Q

What is Lentigo maligna

A

discolouration of the skin which is pre malignant for lentigo maligna melanoma
more likely in sun damaged skin and in the elderly
still in radial growth phase

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27
Q

what is acral lentiginous melanoma

A

melanoma on the soles or palms or even nails and mucosal surfaces

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28
Q

What is amelanotic melanoma

A

melanoma without the brown colouration
occurs from dedifferentiation as the cells have become so advanced they have lost their original function of producing colour

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29
Q

only VGP melanomas can metastasise, true or false

A

true

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30
Q

drugs for advanced melanoma

A

chemo, radiotherapy

immunotherapy

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31
Q

what is used to determine prognosis in melanoma

A

Breslow thickness

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32
Q

define breslow thickness

A

measure of deepest tumour cell from the granular layer of the epidermis in mm
KL is very variable in different body sites which would give a false impression of the Breslow thickness

33
Q

what is the prognosis if the breslow thickness is:
<1mm
>4mm

A 
<1mm = 95% 5 year survival
>4mm = 50% 5 year survival
34
Q

in acral lentiginous melanoma, what is the name of the sign for melanoma originating from the nail matrix

A

Hutchinsons sign

35
Q

what are BCC

A

slow growing skin lesions

36
Q

describe the appearance of a typical BCC

A

raised nodular lesion with a pearly shine, rolled edges and telangiectasia
central ulceration

37
Q

prognosis of BCC

A

good prognosis as they rarely metastasise
don’t need immediate excision
however they are locally invasive and if left alone can become destructive and disfiguring

38
Q

types of BCC

A 
superficial 
infiltrative - like a tree stump, blur margins
nodular 
cystic 
multicentric 
morphoeic
39
Q

management of BCC

A

surgical excision

Mohs surgery

40
Q

what is Mohs surgery

A

surgical excision of a BCC where tissue conservation is important to attain good cosmetic outcome e.g. nose, ears, eye
tumour is removed in stages and assessed until clear margins are achieved

41
Q

non-surgical options for superficial BCC

A

imiquimod / aldara cream
PDT (superficial non life threatening skin cancers)
cryotherapy

42
Q

management of AK

A

cryotherapy for solitary lesions
mild AK - solaraze/topical diclofenac
imiquimod or 5-FU / efudix for more severe AK
sun protection

43
Q

management of Bowens disease

A

cryotherapy
imiquimod
5FU
PDT

44
Q

features of SCC

A

fast growing lesions
potential to metastasise
scaly, painful, bleeding
sun exposed areas - scalp, ears, lips

45
Q

what should be done in the case of advanced SCC

A

palpate for regional lymph nodes as there is the potential for metastasis

46
Q

Who is more at risk of mouth SCC

A

smokers

47
Q

what is a keratoacanthoma

A

fast growing lesions with a central plug of keratin that behave like SCC but regress in size spontaneously
generally they are excised as they resemble SCC and so are treated in the same way

48
Q

what skin cancer can develop over a chronic wound/ulcer

A

SCC

49
Q

what is the most common skin cancer in immunosuppressed individuals post transplant

A

SCC

More at risk of HPV strains that predispose to SCC development

50
Q

what are seborrhoeic keratoses / warts

A

basal cell papillomas
benign lesions with warty appearance
cerebreform under dermatoscope
can be brown, pink, white, yellow

51
Q

management of seborrhoeic keratoses

A

nothing

cryotherapy if bothersome

52
Q

features of lipoma

A

subcutaneous mobile swelling

53
Q

what are dermatofibromas

A

benign proliferation of fibroblasts usually in response to insult e.g. insect bite

54
Q

features of dermatofibromas

A 
limbs 
firm lumps 
pigmentation 
static 
asymptomatic 
itch
squeezing can cause dimpling
55
Q

epidermoid cyst = sebaceous cyst, true or false

A

true

56
Q

features of epidermoid cysts

A

firm well defined
pus discharge
left alone unless problematic - remove

57
Q

what are acrochordons

A

skin tags
benign
associated with metabolic syndrome
left alone or undergo cryotherapy

58
Q

what are haemangiomas

A

benign overgrowth of blood vessels

59
Q

what can haemangiomas be mistaken for initially

A

melanoma

dermatoscope helps to differentiate colour

60
Q

what is a pyogenic granuloma

A

overgrowth of vascular and granulation tissue following trauma
bleeds easily
exaggerated healing response

61
Q

management of pyogenic granuloma

A

curettage and cautery or excision
histology to exclude rare types of melanoma
risk of intense bleeding
risk of recurrence

62
Q

describe features of a merkel cell tumour

A

rare malignancy of merkel cells in the epidermis
viral origin
fast growing and poor prognosis

63
Q

cutaneous B cell lymphoma

A

new lump in an older patient

64
Q

what is Kaposi’s sarcoma

A

AIDS associated condition

vascular tumour

65
Q

pigmented BCC

A

classic BCC with a brown colour

66
Q

management of neglected, large BCC

A

radiotherapy

BCC are radiosensitive

67
Q

types of naevi

A

junctional
compound
intradermal

68
Q

what naevus has an increased risk of melanoma

A

atypical naevi

69
Q

management of atypical naevi

A

skin surveillance

70
Q

management of malignant melanoma

A

surgical excision with 2mm margins initially
+- SNLB if thicker than 1mm
genetic therapies - BRAF inhibitor
immunotherapy

71
Q

management of lentigo maligna ?melanoma

A

biopsy from more concerning looking parts
excision - ?graft if near the eye
imiquimod cream
surveillance if patient is old and frail

72
Q

acral melanomas tend to be related to genetic conditions rather than sun damage, true or false

A

true

73
Q

who is more at risk of amelanotic melanomas

A

Skin types 1+2
albinism
(not vitiligo, they have lost their melanocytes)

74
Q

new skin lesion in a man with prostate cancer with rapid growth, worrying?

A

yes

rapid onset is concerning

75
Q

Merkel cell tumour

A

fast growing
viral origin
poor prognosis

76
Q

when would you prefer not to excise a lesion?

A

multifocal lesions and poor healing site e.g. lower legs

77
Q

management of B cell lymphoma

A

radiotherapy

78
Q

Which of the following naevi are flat and raised:
junctional
compound
intradermal

A

junctional - flat
compound - raised
intradermal - raised

Year 4 Dermatology (16 decks)

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