2.08 Premalignant and Malignant Tumors

Question 1

What is a SCC confined to the epidermis?

Answer 1

Actinic Keratosis

Question 2

Patient presents with: Persistent localized rough feeling to skin – starts as area of increased vascularity, Pink or erythema with scale, Hyperkeratotic lesion to ears and dorsum of hand. Sharp, adherent, yellow scale as lesion progresses.

Answer 2

Actinic Keratosis

Question 3

Chronic UVB , Fair skinned more prone, Superficial atypical squamous cells, limited to epidermis are origins of what disease.

Answer 3

Actinic Keratosis

Question 4

What a degeneration of underlying collagen that is on superior aspect of pinna and tender?

Answer 4

Chondrodermatitis Nodularis Helicis

Question 5

How do you manage and treat actinic keratosis?

Answer 5

Manage - photo-protection & Complete skin exam Few/individual lesions - Liquid Nitrogen (Tx of Choice) Multiple lesions: 5-FU, Efudex cream (standard) Thicker crusts &/o Indurated lesion - Excision (shave)

Question 6

What is AKA “SCC in situ”?

Answer 6

Bowen’s Disease

Question 7

Patient presents with: Slowly growing red scaly patch/plaque. Solitary, sharply demarcated border Slightly elevated. Surface fissures and foci of pigmentation. Resembles eczema, psoriasis, AK, SCC, SK, MM. Most commonly women’s LE or men’s scalp and ears.

Answer 7

Bowen’s Disease

Question 8

What is Erythroplasia of Queryrat?

Answer 8

SCC in situ of mucous membranes.

Question 9

How to treat Bowen’s Disease?

Answer 9

Small lesions - Electrodessication & curettage (ED&C), Cryosurgery, Excisional surgery

Larger lesions - Excisional surgery, 5-FU (Efudex) cream, Aldara

Question 10

What do you think with uncircumcised, elderly males, vulva of elderly females and/or oral mucosa. Presents with moist, red, smooth, slightly raised plaque. Assoc. with HPV-8? How do you treat?

Answer 10

Erythroplasia of Queyrat – SCC in situ of mucous membranes. Treatment - 5-FU or Imiquimod (Aldara), Laser

Question 11

What is the 2nd most common skin cancer.

Answer 11

Squamous Cell Carcinoma (SCC)

Question 12

Patient presents with: Red scaly, Persistent, Usually with deeper involvement, With or without ulceration, Hypertrophic lesion with ulcer or hyperkeratosis (cutaneous horn). Possible Lip-ulcer with induration.

On sun exposed – scalp, backs of hands, superior surface of pinna.

Answer 12

Squamous Cell Carcinoma (SCC)

Question 13

What is the most common presursor of Squamous Cell Carcinoma (SCC)?

Answer 13

Actinic Keratosis

Question 14

How do you manage Squamous Cell Carcinoma (SCC)? Small lesion? Large lesion? Follow-up?

Answer 14

1) Small lesions arising from AKs – ED&C
2) Larger lesions & those on lip - Excision with margins
§Examine for nodes
§F/U q12 mo’s for life
§Stress Photo-protection

Question 15

What is the most common invasive skin cancer?

Answer 15

Basal Cell Carcinoma (BCC)

Question 16

Patient presents with: “shiny, pearly papule with telangiectasias and central ulceration” (rodent ulcer) with rolled borders. Most common on nose; 85% on head/neck

Answer 16

Basal Cell Carcinoma (BCC)

Question 17

What is the most common skin cancer & most common malignant neoplasm in humans?

Answer 17

Basal Cell Carcinoma (BCC)

Question 18

What is the most common presenting complaint of basal cell carcinoma?

Answer 18

bleeding or scabbing sore heals and recurs

Question 19

How does basal cell carcinoma advance (malignancy)?

Answer 19

1) BCC advances by direct extension and destroys normal tissue
2) Longstanding lesions replace vital structures through spreading
3) Untreated, it can destroy whole side of face & even SubQ tissue, bone and invade brain

Question 20

What is the most important risk factor for Basal Cell Carcinoma (BCC)?

Answer 20

Inability to tan

Question 21

How do you manage basal cell carcinoma; early detection vs late detection?

Answer 21

Detect early - excision with small defect
Detect late – excision, but referral to derm, plastics