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111 Cards in this Set
- Front
- Back
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t/f?
sunscreen decreases the risk of melanoma |
false
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t/f?
recreational exposure to the sun is assocatied with melanoma |
true
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list some key risk factors for melanoma
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family history
ethnic origin total number of naevi presence of atypical (dysplastic) naevi being caucasian, pale skin, poor tanner Hx of solar keratosis and non melanoma skin cancer (risk ratio of 4) |
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what is the most importnat RF for melanoma
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the number of naevi one has
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how does the use of sunscreen in children effect melanoma
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it does not decrease the risk of melanoa but it does decrease the risk of new naevi
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do congenital naevi radically increase the risk of melanoma
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not for small or medium but for large congenital naevi (>20cm) relative risk increases by 101 to 4.5-8.5% life time risk
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t/f
Most naevi do not present untill the 5th decade |
false
most naevi appear prior to age 40 |
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What are the Differentials for a rapidly changing lesion
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Melanoma
Seborrheic keratoses dermatofibroma pigmented BCC ?Naevus - if <40y |
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What are the differentials for a pigmented skin lesion?
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melanoma
banal melanocytic naevus haemangioma pigmented BCC solar lentingo ephelis blue naevus |
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what are 3 key non-pigmented skin lesions
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SCC
Keratocanthoma BCC - but has a VERY characteristic pearly appearance |
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What is Seborroeic keratoses?
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A Benign overgrowth of epiderman keratinocytes
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What does Sebborroeic keratoses look like?
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warty like lesion from black to skin colour
may be varigated in colour has a prolife above the skin - can appear flal often requires a dermoscope to distinguish from melanocytic lesion scaly and rough to touch |
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what type of seborrhoeic keratoses can be difficult to distinguish from malanocytic lesion
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the flat variety
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what is the treatment for seborrhoeic keratoses
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cryotherapy to remove, usually for cosmetic purposes
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which skin cancers have a stong relationship with latitude?
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SCC and BCC
the relationship is less strong with melanoma |
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If Jun migrated to australia at the age of 10 has her risk of melanoma decreased?
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yes.
Migrating to australia after the age of 10 decreases the risk of melanoma |
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Which skin cancer shows a stong relatinoship to total personal sun exposure but NOT intermittent/recreational sun exposure and sunburn?
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SCC
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Which skin cancer has NO relationship with total sun exposure, a weak relationship with occupational sun exposure and a strong relationship to recreational/intermittent sun burn exposure?
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BCC
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which skin cancer hasa weak relationship to all forms of sun exposure?
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none.
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Melanomas sun exposure risk profile is what?
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weak link to total exposure
strong link to recreational/intermittent and sundurn. |
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What is the typical desription of a Dermatofibroma?
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Hard, may be pigmented and are itchy. they are slow growing or stationary
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where is the most common presentation of a dermatofibroma?
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on the legs of a woman
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what is a common preceeding event to dermatofibroma?
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an inflammatory reaction e.g., an insect bite
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how is a dermatofibroma diagnosed?
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Positive pinch test = the lesion depresses below the skin when pinched
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What is the concern if a suspected dermatofibroma suddenly incrsases in size.
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Should excise to excluse a dermal sarcoma
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Describe a Haemangioma
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Red Blue solitary homogenous colour with red/blue lacunes
common in middle ages and elderly found on the trunk |
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What is a haemangioma?
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composed of dilated vascular channels direcly delow the epidermis
it is benign with NO malignant potential |
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If a haemangioma increases in size suddenly what is the differential?
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it could be an extremely rare cutaneous angiosarcoma
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What are the Ddx's for a large pigmented area?
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1. Ephelis: freckle - uniform in architecture and colou
2. solar lentigo; usually uniform in architecture and colour - may transfrom into seborroeic keratoses 3. Seborrhoeic keratoses; can be flat, may be arigated in colour scaly and rough to touch 4. Lentigo Maligna; more varigasted with range of presentations, sometimes black, but various shades of brown possible |
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Where does Lentigo Maligna typically occur?
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in chronically sun exposed areas
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what does lentigo maligna have the potential to transform into?
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potentially could become an invasive melanoma
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What is Lentigo Maligna
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it is an in situ melanoma with malignant melanocytes confined to the dermis; can not metastisise unless there is transformation
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and is the mechanism for transformation of Lentigo Maligna?
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invade beyond the epidermis = lentigo maligna melanoma --> develop metastatic potential
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What are the positive findings on the dermascope for lentigo maligna
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absent pigmented network AND
-arborising vessesl - maple leaf area - spoke wheel area - blue-grey nest - brown goblets - ulceration |
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what is a naevus?
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proliferative lesions of melanocytes - altered melanocytes becomes naevus cells
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what are the 3 categories of naevus?
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Junctional; nests of enlarged rounded melanocytes at the dermoepidermal junction (~flat)
Compound; occur in the dermis and the epidermis - become clinicall raised Dermal; in the dermus, may begin to lose pigment (coble stone appearence) as cells are neutrolised and may disappear |
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at what age to naevi typically start reducing in number?
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>35
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what colour and shape are Naevi typically?
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1 or 2 shades of beown, oval or round
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what are naevi the precursor for?
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melanoma. 18-33% of melanoa come from a naevus - however rarely do naevi become melanoma
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what is a blue naevus?
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resutls from melanocytes that fail to reach the epidermis, blu/black, flat (may be nodular)
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what is the management of naevus?
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if they are suspicous/change
A punch biopsy is NOT suicient as any small part of naevus could lead to melanoma short term digital dermoscopy monitoring |
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In 3 months what percentrage of benign naevi show no change?
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84%
also 99.2% of unchanged naevi are benign at 3 months |
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What does a typical dysplastic naevus look like
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similar to melanoma on dermoscopy
asymmetrical, heterochromic, but present for many years - not rapid in growth or change Often has 1 of the ABCD of melanoma |
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What is the ABCD of melanoma
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A: asymmetry
B: boarders C: -chromic (hetero-) D: diameter change |
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do dysplastic naevi have positive dermocope findings?
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no the majority dont. should be excised if there are positivefindings
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what genetic relationship is there of dysplastic naevi with melanoma?
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little.
they have less oncogenes and TSG defects whan melanoma graded as intermediate genetic instability and intermediate histological profile. |
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what is the prevalence of dysplastic naevi?
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2-19% up to 21% in australian 15yo
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what percentage of melanoma arises from dysplastic naevi?
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26%
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describe the architectual atypia of dysplastic naevi
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bridging of nests of naevus cells, across adjacent rete ridges and increases cytologic atypic of the cell.
there is lymphoid infiltrate and fibrosis on superfical dermis also present often |
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What is Dysplastic Naevi Syndrome?
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defined as:
>100 naevi at least 1 >8mmD and 1/+ with dysplastic features is autosomal recessive and phenotypic expression related to sun exposure |
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How do you manage dysplastic naevi syndrome?
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because it increases risk of melanoma and a family Hx of melanoma --> 82% lifetime risk of melanoma
f/u yearly or 6monthly if there is Hx of melanoma required for life |
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What does an invasive melanoma look like of dermascope?
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pseudo pods, blue-white veil, polychimasis, braodened network, peripheral black globules
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what are the 2 main types of melanoma?
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superfical spreading melanoma
Nodular melanoma |
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which melanoma has the classic ABCD signs
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superficial spreading
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describe nodular melanoma?
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lacks ABCS and often amelanotic
grows rapidly frequently thick and found in older men. worse prognosis |
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describe superfical spreading melanoma
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ABCD features, slower growing, may be hypomelanotic or amelanotic
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what is the pathogenesis of SSmelanoma?
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melanocytes have loss of intracellular adhesion and invade the superfical parts of the epidermis: this is the in situ growth phase
-will clinicall appear as flat irregular macule --> invade the dermis = potential for met |
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how does malignant melanoma differ from benign naevi?
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architectual disorder
cytological atypia - increased cell size - nuclear variablity - nuclear hypochromasis, - nucleolar prominence - icreases nuclear to cytoplasm ratio - increased mitotic activity |
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What are the key prognostic factors in melanoma?
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1. tumour thickness (most important);
- Breslow thickness measures the verticle depth from stratum granulosum of epidermis to deepest melanoma cell 2. Ulceration 3. mitotic rate (thought to be more important than ulceration now) 4. age, male, axial cancec |
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What is the management of melanoma
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Excision
>1cm margin if breslow thickness is <1.0mm maximum of 2.0cm margin if in situ may be 5mm margin suficient |
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what is the prognosis of melanoma treatment
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f/u required is 6monthly for 5y if stage 1
3-4monthly if stage 2-3 chances of another melanoma ~12% in first 10 years a second primary higher risk than a recurrence. |
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What is the indication for sentinal node biopsy in melanoma?
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prophylactic lymph node dissection does NOT alter survival
offer to pt's with beslow thickness of <1mm - a positive sentinal node biopsy = 20% have other positive nodes - some offered dissection to reduce local burden of disease no evidence fo adjuvent chemo |
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what is the Ddx for brown nails
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longitudinal melanouchia
subungal melanoma pseudomonas aeriginosa infection spsoriasis keratoderma blennorrhagica (with reactive arthritis or Reiter's syndrome) Lichen planus allergy |
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describe melanoma in the nail bed
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begin in the nail bed and produces parallel lines of melanin tha grow longitudinally
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What is Longitudinal Melanoychia
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melanocytes in the nail matrix which are proliferating and producing excess pigment
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what can cause longitudinal melanochyia?
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subungal melanoma
lentigo ethnic pigmentation - common in dark skinned (20%) drug induced naevi |
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what is the indication for care in longitudinal melanochyia?
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Most subungal melanoma are benign -
Observe fro 3 months, if they: - widen - involve surrounding nail bed - irregular width ad pigment of dermascope then cause for nail bed matrix. lack of nail dystrophy favours non-invasive melanoma |
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what does a subungal melanoma look like?
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may be red-blue pigment in globular pattern, sparing of the proximal nail fold
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What are congenital naevi?
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present at birth in around 1% of children
small: <1.5cm medium: 1.5-19.9 large >20cm or =/> 5% body SA |
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What is becker's naevi?
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pigmented hairy epidermal naevi; non-melanocytic and appear with increased hair
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What is Spilus Naevi?
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Occur as tan patches with numerous scattered darker naevi thoughout the surface - rare;y transform into melanoma
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What is a Cafe au lait spot?
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congential, light-dark brown evenly pigmented macule with sharply defined boarder 0.3% caucasions and 18% africans
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if a pt has more than 6 cafe au lait spots what should you consider?
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neurofibromatosis
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t/f
small or medium congenital naevi lead to increased melanoma risk |
false
only large congenital naevi have an association with melanoma |
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Describe a Halo Naevi?
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macular discoid lesion surrouded by white halos
- frequntly on the trunk of adolescent and young adults central naevus disappears spontaneously leaving depigmented area which may persist Benign |
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what is a Spitz lesion
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enlarging unmelanotic lesion
benign in the young grows rapidly over a short period heavily hyperpigmented amelanotic nodule common in children diffiuclt to distingush from melanoma despite a histologic criteria for definition rapid propensity for change despite being benign |
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What is the typical met type of melanoma
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canon ball metastises
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t/f?
the majority of patients with metastatic melanomo present with more than 1 organ involved. |
true
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is the use of surgery in metastatic melanoma appropriate?
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Not usually.
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what is the standard chemo/palliation Rx in metastatic melanoma
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a single agent of:
- Decacarbazine - fotemustine - Temozomide |
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what % of patients with metastatic melanoma on chemo have a response
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5% have complete response
25% have partial response however most of both these have recurrence within 6months |
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what is the 5 year survival of disseminated melanoma
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<10%
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What is Solar Keratosis?
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from chronic sun exposure, is a premalignant state
erythematous flat lesion with scales (hyperkeratosis) |
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what is the rate of transformation of solar keratosis to SCC each year
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1/1000/year
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what 2 factors are important in transformation of solar keratoses to SCC
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1. thicking on lateral palpation
2. Tenderness on lateral palpation |
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where do solar keratoses occur most
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dorsum of foreamrs and hands and the head and neck
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What is the management of solar Keratosis
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single freezy cryotherapy usually enough.
but hyperkeratinotic thicker lesions required double cycles hyperkeratotic or suspicious lesions may also be treated with curettage and desctructive treatment at the base - get a histological assessment. |
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what topical treatment is there for widespread solar keratoses
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5-flurouracil
imiquimod diclofenac photptherapy |
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is there a relationship between SPF 15+ suncscreen and solar keratoses?
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yes. reduces the prevalence
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What is Bowen's disease:
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In situ SCC (intraepidermal)
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what are the Ddx for Bowen's disease:
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Psoriasis - usually features a shorter x
Superfical BCC - less scales and a pearly smooth surface Invasive SCC - usually not a true plaque with a uniformly flat surface Solar keratosis - usually less well demarkated and not plawues |
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is a punch biopsy appropriate for bowen's disease.
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yes. through the thickest area for hsito evaluation
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what is the Rx for Bowen's disease?
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surgical excision
Cryotherapy also good but with eldery there is a associate with extended ulceration |
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What are risk factors for SCC
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geographic latitude.
personal sun exposure occupational sun exposure fair skin chronic immunosuppresion |
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what does an SCC look like
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flesh or erythematous couloured flat scaly nodule
it will enlarge over a period of months |
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are SCC tender?
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yes
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how may an SCC present
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as a flat ulcer as they tend to ulcerate early
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what are some helpful features at distinguishing SCC
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induration and tenderness
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what is management of SCC?
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elliptical incision with 4mm margins
unfavourable lesion may require 10mm margin |
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what are some poor indicators in SCC
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diameter of lesion,
depth ulceration immunocompromise |
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what is keratokanthoma?
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benign form of well differentiated SCC; grows over 8 weeks and then usually spontaneously resolves over 6-12 weeks.
failure to resolve requires intervention |
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what does keratokanthoma look like
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flesh coloured erethematous nodule
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what are the 2 most common types of BCC?
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superficial BCC and
nodular BCC |
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what are the hallmarks of superficial BCC?
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well demarkated, bright pink ~flatish shiny lesion
90% lack pigment remail stable for years found on the trunk |
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what are the hallmarks of nodular BCC?
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pearly nodular appearance with overlying telangiectasia
no scale, no pigment occur on head and neck |
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t/f?
there is no relationship between total sun exposure and BCC |
true
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t/f?
there is a weak relationship between occupational exposure and to some extend recreational/intermittant sunc exposure and sunburn AND BCC? |
true
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a favourable BCC is defined as?
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<3.7cm, well defined boundaries and is superfical or nodular
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the unfavourable BCCs are?
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morpheic
infiltrative micronodular these are not common |
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what is the management of BCC?
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surgical excision with3mm margins and with SC fat
for Superfical use freeze thaw cycles with a 5mm margin except when on the head and neck |
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how does Morpheic BCC look?
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appears as infiltrative tongues of tumour with dense fibrous stroma, scar like appearence with il defined margins
induration common |
