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SBM Derm > 03-07 Non-Melanoma Skin Cancer > Flashcards

03-07 Non-Melanoma Skin Cancer Flashcards

1
Q

Most common form of skin cancer? Second most common?

A

1 - Basal Cell Carcinoma #2 - Squamous Cell Carcinoma

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2
Q

What percent of skin cancers are associated w/ UV damage?

A

90%

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3
Q

6 Subtypes of BCC?

A
  1. Superficial
  2. Nodular
  3. Morpheaform
  4. Infiltrative
  5. Micronodular
  6. Pinkus Tumor
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4
Q

3 Subtypes of SCC?

A
  1. Actinic keratosis
  2. Squamous cell carcinoma in situ (SCCis)
    • Aka Bowens Disease
  3. Squamous cell carcinoma
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5
Q

Dx?

  • Typical Presentation
  • Histo ∆s
  • How malignant/concerning/Prognosis
A

Actinic Keratosis

  • Presentation: Red, scaly plaques usu in sun-exposed areas
    • Sometimes easier to feel (like sandpaper) than see
    • Rarely: horn
    • Pt may report pinprick pain or “doesn’t feel right”
    • Tender to palp is good clue
  • Histo (see image here)
    • atypical keratinocytes only in the lower epidermis
    • vs. full thickness in SCC
  • Concern: Not alarming but 10% can progress to SCC
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6
Q

Dx?

  • A.k.a.?
  • Typical Presentation
  • Histo ∆s
  • How malignant/concerning/Prognosis
A

SCCis

  • A.k.a. Bowen’s Dz
  • Typical presentation: Well defined pink/brown scaly plaques
    • Usu. on sun exposed skin
  • Histo: Full thickness epidermal keratinocyte atypia
    • vs. A.K. where atypia is only in lower epidermis
  • Concern: ~26% go onto SCC
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7
Q

Name this subtype of SCCis?

  • Etiology
  • Other subtypes of SCCis
A

This is Erythroplasia of Queyrat, an erythroplakia of the glans of the penis in uncirc’d men.

  • These sub-types are viral not UV-induced
  • Erythroplakia can occur elsewhere as can:
    • Leukoplakia (oral)
    • Bowenoid papulosis (single or multiple small, red, brown or flesh-coloured spots or patches on the genitals) [seen on vulva here]
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8
Q

Dx?

  • Typical Presentation
  • Causes what % of skin cancer?
  • Etiology
  • Histo ∆s
  • How malignant/concerning/Prognosis
A

SCC

  • Presentation: red, scaly plaque or nodule in sun-exposed area
    • scale usually central
    • painful
    • older folks
    • maybe w/ horn
    • may be erosive
  • Causes 20% of skin cancer
  • Etiology: Usually due to UV
    • 90% have TP53 mutation
    • Immunosuppression
    • HPV
    • Other causes: chronic inflammation, xrays, arsenic, BRAF inhibs, tobacco, EtOH
  • Histo:
    • hyperproliferative, eosinophilic keratinocytes
      • varying degrees of atypia
    • keratin pearls
    • varying degrees
    • can cause peri-neural invasion —> runs along nerves —> bad news
  • Concern/Prognosis worse with:
    • Location (face + ears - inner cheeks)
    • Size
      • 6mm in hi risk (grey) areas
      • 10mm med areas, white–>
      • >20mm every where else
      • Recurrent
    • Immunosuppressed
    • Prior XRT
    • Peri-neural involv
    • Neuro sx
    • Rapid Growth
    • Breslow depth > 2mm
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9
Q

Dx?

  • Presentation
    • List Subtypes
  • Causes what % of skin cancer?
  • Etiology
  • How malignant/concerning/Prognosis
A

BCC

  • Presentation (see indiv cards)
    • 60% nodular (see on opposite side)
    • 15% superficial
    • ~15 % Micronodular
    • 5% Infiltrating
    • 3% Sclerosing or morpheaform
  • Most common cause of any kind of cancer in humans
  • Etiology
      • Histo ∆s
  • How malignant/concerning/Prognosis
    • Very low mortality, but significant morbidity if allowed to grow too big
  • High risk factors:
    • Location (see H here)
    • Size >20mm (grey), 10mm (white here), 6mm (elsewhere
    • Ill defined
    • Recurrent
    • Immunosuppressed patient
    • Prior XRT
    • Peri-neural involvement
    • Subtype (?)
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10
Q

Dx?

  • How common?
  • Etio?
  • Typical Presentation
  • Histo ∆s
  • How malignant/concerning/Prognosis
A

Nodular BCC

  • 60% of BCC – most common
  • Etio: Sun exposed skin – but not always
  • Presentation: Pearly papule/plaque that can ulcerate
    • “I shaved and nicked myself and have been bleeding since.
  • Prognosis: Rarely metastasizes
  • Histology: larger tumor nests, retraction artifact, peripheral pallisading (see here)
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11
Q

Dx?

  • How common?
  • Etio?
  • Typical Presentation
  • Histo ∆s
A

Superficial BCC

  • 15% of all BCCs
  • Etio: Usu sun-exposed areas
  • Present w/ red, scaly plaque
    • BCC vs eczema
  • Histo: See here
    • clefting (from washed out mucin deposits) deep to the lesion
    • Pallasading around the edge
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12
Q

You have a patient w/ a red scaly rash recalcitrant to steroid tx. You send for biopsy and see this:

Dx?

  • Typical Presentation
  • Histo ∆s
A

Micronodular BCC

  • Presentation is exactly the same as superficial
  • Histo: nodules.
    • ddx: vs. nodular
    • this has smaller tumor rests
    • tricky dx
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13
Q

You have a patient w/ a red scaly rash recalcitrant to steroid tx. You send for biopsy and see this:

Dx?

  • Typical Presentation
  • Histo ∆s
A

Infiltrative BCC

  • Variable presentation:
    • can mimic any of the other presentations of BCC
    • Head and neck of old folk
  • Histo
    • normal epidermis
    • epidermis: vertically-oriented strings of “basaloid” cells
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14
Q

Dx?

  • Typical Presentation
  • Histo ∆s
A

Morpheaform/Sclerosing BCC

  • Scar-like presentation; very difficult to dx visually
  • Hist
    • wispy areas
    • infiltrative strands of basaloid cells
    • sclerotic stroma
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15
Q

Liquid Nitrogen Tx

  • Appropriate For?
  • MoA?
  • Technique?
  • Adverse effects?
A
  • Indicated for:
    • Tx of choice for A.K.
    • Also for: SCCis, superficial BCC
  • MoA: “Selective” Necrosis
    • Damage caused directly to cell membranes and surrounding vasculature Mostly during the “freezing” portion of the cycle
  • Technique: 15-60 freeze thaw cycles
  • Hyperpigmentation or depigmentation
    • melanocytes very reactive/sensitive
    • Die at -4°C and liquid N is -196°C !
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16
Q

Electrodessication and Curettage

  • Appropriate For?
  • MoA?
  • Technique?
  • Adverse effects?
A
  • Indication: hypertrophic AK, some SCCs, some BCCs
  • MoA: high volt, low amp current
    • gets superficial to mid-dermis lesions
  • Techique: shock then scrape w/ curette
  • Adverse effects:
17
Q

Radiation Therapy

  • Advantages
  • Drawbacks
A

Radiation Therapy
Benefits

  • No cutting
  • Good cosmetic outcome on highly contoured areas

Drawbacks

  • Many long tx’s
  • Missing work, transportation issues
  • Atrophy, scarring, dyspigmentation
  • Can only treat each area one time
  • May come back more aggressive.
    • Can grow under scars (sneaky)
    • Have to use surgery w/ bigger scar than would have had initially to remove that
18
Q

Cetuximab

  • MoA
A

chimeric (mouse/human) antibody
EGFR inhibitor

19
Q

Vismodigeb

  • Indication?
  • MoA?
  • Efficacy?
A
  • For advanced/metastatic BCC
  • Competitively inhibits “smoothened” in the hedgehog signaling pathway
  • Response rates are relatively low <50% and duration only ~7months
20
Q

Topical options for NMSC

  • Indications
  • Draw-backs?
A

For: AK, whole face for low-grade actinic ∆s

  • 5-fluorouracil
  • Imiquimod (Aldara)
  • Ingenol mebutate
  • Trichloroacetic Acid
  • Diclofenac (NSAID)

Drawbacks

  • only for superficial
  • messy, hard to tolerat
  • 5-FU causes this skin rash seen here (sign that it is working)
21
Q

Photodynamic Therapy

  • Appropriate For?
  • MoA?
  • Technique?
  • Adverse effects?
A

Efficacy ~= creams

  • Use for AK, some SBCC,
  • Technique Draw on patients’ lesion/whole face Use w/ 5-Ala to cause photo sensitive
    • Photosensitizer applied to the skin for several hours
    • Sensitized skin exposed to a given band of light to “activate” the photosensitizer (protoporphyrin IX)
  • Just blue visible spectrum
  • Low risk
  • Very effective
  • Long tx time + many txs
22
Q

Surgical Resection

  • Mohs vs. standard approach
A
  • Mohs is more expensive, takes longer, requires specially trained Mohs-surgeon
  • Std surgery has 90-95% cure rate, Mohs even higher
  • Mohs has smaller scar b/c you removing less tissue

SBM Derm (15 decks)

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