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Dermatology Diploma > Cancerous Lumps and Bumps > Flashcards

Cancerous Lumps and Bumps Flashcards

1
Q

What 2 pre-cancerous lesions can evolve into Squamous Cell Cancers?

A
  • Acitinic Keratosis
  • Squamous Cell Carcinoma in Situ (e.g. Intraepidermal Carcinoma)
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2
Q

What type of pre-cancer is this?

A

Erythroplasia of Queyrat

(IEC of the glans penis)

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3
Q

Apart from BCC and SCC,

What are some other forms of skin cancer?

(Not including Melanoma)

A
  • Cutaneous Lymphoma - B or T Cell Lineage.
  • Merkel Cell Carcinoma
  • Porocarcinoma - in immunocompromised patients.
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4
Q

What is the average age of?

BCC?

SCC?

A

BCC = 60 years

SCC = 70 years

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5
Q

What is the most common NMSC?

A

BCC

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6
Q

What are the risk factors for NMSC?

A
  • Sunlight
  • PUVA
  • Arsenic
  • HPV - anogenital and periungal SCCs.
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7
Q

What NMSC comes from chronic sunexposure +/- acute episodes of sunlight?

A

SCC

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8
Q

What NMSC comes from acute episodes of suburn (especially in childhood)?

A

BCC

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9
Q

What risk factors are important for oral SCC?

A
  • Smoking
  • Poor oral hygeine
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10
Q

What condition is this?

A

Xeroderma Pigmentosum

  • Autosomal recessive
  • Defective DNA repair
  • Freckling and sunsensitivity
  • Increased risk of NMSC
  • Strict sun avoidance.
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11
Q

At what rate do Solar keratoses progress to SCC?

A

Only 2-5%

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12
Q

What % of Solar Keratoses remit?

A

25%

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13
Q

Decribe the field treatments for solar keratoses.

A
  • Efudix (5-FU) -nightly for 3-4 weeks.
  • Solaraze (Diclofenac) - nightly for 3 months
  • Aldara (5% Imiquimod) - 3 times per week for 4 weeks.
  • Picato (Ingenol Mebutate) - 3 days to face or 2 days to body.
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14
Q

Describe the treatment instructions with Efudix (5-FU) and why we would choose that?

A
  • Nightly for 3-4 weeks
  • Effective but can cause painful blisters.
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15
Q

Describe the treatment instructions with Solaraze (Diclofenac) and why we would choose that?

A
  • Nightly for 3 months
  • Gentle but less effecive than 5-FU
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16
Q

Describe the treatment instructions with Aldara (5% Imiquimod) and why we would choose that?

A
  • 3 times per week for 4 weeks.
  • Expensive
  • Gentle
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17
Q

Describe the treatment instructions with Picato (Ingenol Mebutate) and why we would choose that?

A
  • Short course of treatment
    • 3 days to face
    • 2 days to body
  • Local reactions -aggresive like 5FU
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18
Q

What is the management of IEC?

A
  • Topical 5-FU
  • Topical Imiquimod
  • Gentle cryotherapy
    • Avoid overzealous in lower leg due to risk of ulceration.
  • Curetage & Cautery
  • Excision
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19
Q

What is the treatmentfor Erythoplasia of Queyrat?

A

Refer to urologist or dermatologist

  • Medical treatments -5-FU or Imiquimod
  • Surgical - Mohs Micrographic Surgery or CO2 laser ablation.
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20
Q

SCCs are more likely to metastasise on what sites of the body?

A

Ears or lips

21
Q

If an SCC is found in a skin type of 4-6, what might this indicate?

A

Immunosuppression

22
Q

BCCs grow slowly over months to years. How do SCCs grow?

A

Quickly over 6-12 weeks.

23
Q

What type of biopsy is peferred?

A

Punch or incisional biopsy.

  • Superficial shaves give diagnostic uncertainty so therefore ensure it is deep enough if done.
24
Q

What SCCs are more likely to metastasize?

A
  • 2cm diameter are 3x more likely to metastasise.
  • Subcutis invasion
  • Poorly differentiated
  • Perineural invasion.
  • Host immunosupression
25
Q

What is the recommended margin for SCC excision?

A

4mm

26
Q

What is the follow up for high risk SCCs?

A

4 monthly for 2-3 years.

27
Q

What is this?

A

Keratocanthoma

  • Treated like an SCC - excise.
  • Though to be SCCs but can involute whereas SCCs get larger.
28
Q

What are the 3 types of BCC?

A
  • Nodular - most common
  • Superficial
  • Morphoeic
29
Q

What is the most common type of BCC?

A

Nodular BCC

30
Q

Where do nodular BCC’s usually ocur?

A

Head and neck

31
Q

Where do superficial BCC’s usually ocur?

A

Chest and Upper back

32
Q

What is Mohs Micrographic Surgery?

A
  • Intraoperative margins are looked at under a microscope in real time in order to minimise normal tissue destruction.
  • Closure can then occur at a later date.
  • It has the highest cure rate
33
Q

What are the medical options for managing BCCs?

A
  • 5-FU - superficial BCCs
    • Apply nightly for 3 weeks - apply for another 3 weeks if needed.
  • Imiquimod - superficial BCCs
    • Apply 5 times weekly for 6 weeks.
34
Q

What are some non-medical treatments for BCCs?

A
  • Radiotherapy
  • Curettage & Cautery - 2 cycles are recommended
  • Photodynamictherapy - veryuseful for Gorlin’s syndrome patients.
    • Better for small and superficial lesions.
35
Q

What is the follow up for patients with BCC?

A

Routine follow up is not usually needed.

Teach self examination and sun-protection.

36
Q

What are the more common cutaneous lymphomas:

T-Cell lymphomas,

B-Cell Lymphomas

or NK Cell Lymphomas?

A

75-80% of Cutaneous lymphomas are cutaneous T-Cell Lymphomas.

20-25% are B-Cell cutaneous lymphomas.

37
Q

What type of Cutaneous T Cell Lymphoma might this be?

A

Mycosis Fungoides

  • The most common cause of Cutaneous T-Cell Lymphoma.
38
Q

What age group and gender get Mycosis Fungoides?

A

55-60 year old

Males > Females

39
Q

Describe the progression of Mycosis Fungoides.

Why is it late to diagnose.

A
  • It progresses from a patch phase to a plaque phase over many years. And then to a tumour stage.
  • Clinicians often think it is psoriasis or eczema during the patch phase.
40
Q

During the plaque stage of mycosis fungoides, what can be concurrently common?

A

Bacterial infections

41
Q

What examinations/investigations should be done if someone is found to have Mycosis Fungoides?

A
  • Lymph node palpation.
  • CT scan of chest, Abdo and Pelvis
  • Consider a bone marrow biopsy.
42
Q

What is the treatment for mycosis fungoides?

A
  • Topical therapy - for early patch disease.
    • Emollients + Potent steroids
    • Nitrogen mustard
    • 1% Targretin - a retinoid gel
  • Phototherapy - Plaque disease
  • Radiotherapy - for thick Plaque disease and tumours.
43
Q

What is the triad of Sezary syndrome?

A
  • Erythroderma
  • Generalised lyphadenopathy
  • Neoplastic T Cells in the skin, lymph nodes and peripheral blood
44
Q

What is the treatment for Sezary Syndrome?

A

Systemic treatment

  • Prednisolone + Chlorambucil + Methotrexate & CHOP-chemotherapy.
45
Q

In dark skinned people, Mycosis fungoides can appear as….

A

Hypopigmented patches

46
Q

What is this and how does it usually present?

A

B Cell Lymphoma

  • Deep red, smooth firm nodules or tumours
  • Typically on the head & neck
47
Q

If someone is found to have a B Cell Cutaneous Lymphoma, what further investigations and treatment should be done?

A

Ensure you liase with an oncologist

  • Physical examination
  • Full Blood Count
  • CT Scan
  • Consider Bone Marrow Biopsy
48
Q

What can people develop if they have B-Cell Cutaneous Lymphoma?

A

Leonine Fasces

(Lion Face)

49
Q

What is the treatment of B-Cell Cutaneous Lyphoma?

A

Liase with Oncologist

Respond well to intralesional steroids and treated with systemic agents (though systemic agents may be over treatment)

Dermatology Diploma (39 decks)

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