Question 1
Question
The skin is the body’s largest organ.
Question 2
Question
Skin cancer is the most [blank_start]common[blank_end] cancer in New Zealand. New skin cancers total about 82,000 per year, compared
to a total of 16,000 for all other types of cancer. Our skin cancer rates are the [blank_start]highest[blank_end] in the world.
Question 3
Question
Risk factors for skin cancer:
• [blank_start]Light[blank_end] skin color, hair color, eye color, freckles
• Genetics
• Certain types of [blank_start]moles[blank_end]
• Long-term [blank_start]sun[blank_end] exposure
• History of childhood [blank_start]sunburns[blank_end]
Question 4
Question
Skin Cancer Basics = an abnormal change in the skin resulting from uncontrolled cellular growth.
• Pre-Cancerous skin cancer » [blank_start]Actinic keratosis[blank_end]
• There are three main types of skin cancer:
» [blank_start]Basal[blank_end] Cell Carcinoma (BCC)
» [blank_start]Squamous[blank_end] Cell Carcinoma (SCC)
» [blank_start]Melanoma[blank_end]
Answer
-
Actinic keratosis
-
Basal
-
Squamous
-
Melanoma
Question 5
Question
Causes of Skin Cancer?
• [blank_start]Ultraviolet[blank_end] (UV) radiation is the main cause. NZ UV radiation is 40% [blank_start]higher[blank_end] during summer compared to northern
hemisphere. The [blank_start]low[blank_end] ozone levels here – the ozone layer absorbs a good deal of UVB ultraviolet light from the Sun.
• Artificially-produced UV radiation
• Chemicals (rare)
Question 6
Question
Actinic (solar) Keratosis:
•A [blank_start]pre[blank_end]-cancerous condition of thick, scaly [blank_start]patches[blank_end] of sun-damaged skin.
• Benign but can progress to invasive malignant disease if left [blank_start]untreated[blank_end]
• Cryosurgery or topical treatment (more soon)
Question 7
Question
Basal Cell Carcinoma (BCC):
- Basal Cells form the [blank_start]deepest[blank_end] layer (basal layer) of the epidermis, and function as the precursors of all the skin cells above them.
- BBC is the [blank_start]least[blank_end] dangerous of the skin cancers, grows [blank_start]slowly[blank_end], and rarely [blank_start]spreads[blank_end] beyond original location.
• Easily [blank_start]detected[blank_end] and treated
• Seldom life-threatening
- Appearance:
• Open [blank_start]sores[blank_end], reddish patches, [blank_start]shiny[blank_end] bump, pink growth, [blank_start]scar[blank_end] like area, lump that bleeds and crusts
Answer
-
deepest
-
least
-
slowly
-
spreads
-
detected
-
sores
-
shiny
-
scar
Question 8
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Two in every three NZers will develop a non-melanoma skin cancer.
Question 9
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Squamous Cell Carcinoma (SCC)
- Squamous Cells arethe most [blank_start]abundant[blank_end] cells in the skin, located primarily in the [blank_start]epidermis[blank_end]
- About SCC: Can spread to other areas (metastasize) and cause death, but this is [blank_start]rare[blank_end]. Most cases are not dangerous if detected and treated early. Considered “more aggressive” than basal cell carcinoma, although they are both highly [blank_start]treatable[blank_end]. [blank_start]20[blank_end]% of skin cancers are SCC.
- Appearance:
• [blank_start]Wart[blank_end]-like growth,
• [blank_start]scaly[blank_end] red patch(es),
• open sore(s) that persist
• Often appear as [blank_start]elevated[blank_end] growths with a central
depression
Answer
-
abundant
-
epidermis
-
rare
-
treatable
-
20
-
Wart
-
scaly
-
elevated
Question 10
Question
BCC and SCC can usually be removed by:
• [blank_start]Surgical[blank_end] excision
• [blank_start]Freezing[blank_end] tumor (cryosurgery)
• Topical treatments ([blank_start]fluorouracil + imiquimod[blank_end])
• Radiation is used in [blank_start]some[blank_end] cases
Answer
-
Surgical
-
Freezing
-
fluorouracil + imiquimod
-
some
Question 11
Question
Topical Tx:
1. Fluorouracil 5% cream (20g subsidised tube.) MoA: incorporates into [blank_start]RNA[blank_end] inhibiting [blank_start]DNA[blank_end] replication. Application likely to cause [blank_start]redness, tenderness, ulceration[blank_end], etc, which repairs afterwards.
2. Imiquimod cream 5% (sold as 12 satchets). MoA: Immune response modification, [blank_start]local cytokine inductor[blank_end]. Can cause [blank_start]itching, flaking,[blank_end] and painful erosions on mucus [blank_start]membranes[blank_end].
Question 12
Question
Melanoma (MM): A skin cancer that arises in a [blank_start]pigment[blank_end] producing cell.
- 80-96% is caused by [blank_start]UV[blank_end] exposure
- One of the most common types of cancer for [blank_start]25–44[blank_end] year olds
- [blank_start]Deadliest[blank_end] form of skin cancer
– Can be found [blank_start]anywhere[blank_end] on the body
– Melanoma was the [blank_start]6th[blank_end] most common cancer that people died from in New Zealand
Answer
-
pigment
-
UV
-
25–44
-
Deadliest
-
anywhere
-
6th
Question 13
Question
(Appearance) Melanoma can:
• appear as a [blank_start]new[blank_end] spot
• be an existing spot, freckle or mole that [blank_start]changes[blank_end] colour, size or shape
• sometimes be [blank_start]itchy[blank_end] or bleed
• look different to other spots
• appear [blank_start]anywhere[blank_end] on the body (even on parts that aren’t usually exposed to the sun, such as the soles of your feet or under your toenails)
• be [blank_start]raised[blank_end] ('sticky out') and look [blank_start]shiny[blank_end] in appearance
• appear quickly
Answer
-
new
-
changes
-
itchy
-
anywhere
-
raised
-
shiny
Question 14
Question
Detection:
• [blank_start]Self[blank_end]-examination
• Apps
• Mole [blank_start]maps[blank_end]
• Healthcare visits
• [blank_start]Early[blank_end] detection is KEY
ABCDEs of Melanoma Screening:
- [blank_start]AYSMMERTRY[blank_end] (bad)
- [blank_start]BORDERS[blank_end] (round = healthy)
- [blank_start]COLOURS[blank_end] (uniform colour = healthy)
- [blank_start]DIAMETER[blank_end] (>[blank_start]6mm[blank_end] = bad)
- [blank_start]ELEVATION[blank_end] (raised/flat combined = bad)
Answer
-
Self
-
maps
-
Early
-
AYSMMERTRY
-
BORDERS
-
COLOURS
-
DIAMETER
-
6mm
-
ELEVATION
Question 15
Question
Prognostic features - melanoma: based on "Breslow" depth.
1. Good prognosis – Breslow [blank_start]< 1mm[blank_end].
2. Intermediate prognosis – Breslow [blank_start]1-4mm[blank_end]. (10 year survival rate 100% - [blank_start]59[blank_end]%.)
3. Bad prognosis – Breslow [blank_start]>4mm[blank_end]. (10 year survival rate [blank_start]36[blank_end]%.)
Question 16
Question
Sentinel lymph node biopsy for MM: Recommended for MM with Breslow [blank_start]1-4[blank_end]mm.
– Lymphadenectomy for [blank_start]positive[blank_end] nodes
• Powerful [blank_start]prognostic[blank_end] feature for disseminated disease... (bad sign...)
• It does not affect [blank_start]survival[blank_end] of patients
Answer
-
survival
-
prognostic
-
positive
-
1-4
Question 17
Question
Treatment of Melanoma:
- Surgical excision (Mohs*)
• In situ = [blank_start]5 mm[blank_end] margin
• Invasive= [blank_start]1-3[blank_end] cm depending on [blank_start]Breslow’s[blank_end] depth
- Immunotherapy
e.g. [blank_start]Keytruda[blank_end] (Pembrolizumab)
- Radiotherapy
Can specifically [blank_start]target[blank_end] areas
Mohs surgery (a certain method invented by a mr mohs) yields higher [blank_start]clearance[blank_end] rates than standard excision, and smaller wounds - therefore better [blank_start]cosmetic[blank_end] results. Widely accepted as treatment of first choice for [blank_start]neck and face[blank_end] melanoma and [blank_start]high risk[blank_end] basal cell carcinoma and squamous cell carcinoma.
Answer
-
5 mm
-
1-3
-
Breslow’s
-
Keytruda
-
target
-
clearance
-
cosmetic
-
neck and face
-
high risk
Question 18
Question
Prevention
• Avoid Artificial Sun
– [blank_start]Tanning[blank_end]/sun lamps
- Limit Sun Exposure:
• Avoid [blank_start]midday[blank_end] sun
• Apply [blank_start]sunscreens[blank_end] often (at least [blank_start]30[blank_end] SPF)
• Use UVA/UVB blocking [blank_start]SUNGLASSES[blank_end]
Answer
-
Tanning
-
midday
-
sunscreens
-
30
-
SUNGLASSES
Question 19
Question
Sand, water, snow, and ice magnify UV exposure.
Question 20
Question
Clouds reduce UV exposure.