24 Neoplastic - Skin Flashcards
After having BCC or SCC of skin, what are chances of having another within 5 yrs
50%
What is basal cell nevoid syndrome
Auto Dom d/o characterized by multiple BCCs, OKCs, rib abnlities, palmar and plantar pits, and calcification of falx cerebri
Other genetic d/o a/w high risk of cutaneous malig
xeroderma pigmentosum albinism epidermodysplastic verruciformis epidermolysis bullosa dystrophica dyskeratosis congenital
Which UV light is most responsible for acute actinic damage
UVB
Other than UV light and genetics, what are some other factors that increase the risk of cutaneous malignancy?
Long-term immunosuppression after organ transplantation, long-term tx of psoriasis with photosensitizing chemicals, chronic ulcers, and low dose RT
What is Marjolin’s ulcer?
Burn or ulcer a/w development of malig
What is m/c premalig skin lesion of H&N
Actinic keratosis
What is the name of the skin lesion, most commonly located on the nose, characterized by rapid growth with a central area of ulceration followed by spontaneous involution?
Keratoacanthoma
What is Bowen’s disease
SCCIS of skin
T/F: adnexal carcinomas of the skin are very aggressive and have a poor prog
True
Which adnexal skin CA arises from a pluripotential basal cell within or around the hair cells
Merkel cell carcinoma
What virus is strongly a/w Merkel cell carcinoma that is known to cause CA in animals
Merkel cell polyomavirus
What is the 5 year survival of pts with MCC
30%
What test should be ordered in w/u of MCC
PET
Should the N0 neck be treated in pts with MCC
Yes
What is m/c type of skin sarcoma
Malignant fibrous histiocytoma
What are the 5 main types of basal cell carcinomas and which is m/c and which is most aggressive
- Nodular (m/c)
- Cystic
- Superficial multicentric
- Morpheaform
- Keratotic (Most aggressive)
Which BCC type is m/c found on extremities or trunk
superficial multicentric
Which BCC type is a variant of nodular BCC and produces pigment
cystic
Which BCC type commonly resembles a scar
morpheaform
What is unique about the path of growth of BCCs
Follow path of least resistance, which is typically along embryonic fusion planes
Which areas of face are most susceptible to BCCs
Inner canthus, philtrum, mid-lower chin, nasolabial groove, preauricular area, retroauricular sulcus
What proportion of incompletely excised BCCs will recur
1/3
T/F: SCC arising in sun-exposed area tends to behave less aggressive than those arising de novo
True
What percent of SCC arising in areas of actinic change metastasize
3-5%
What percent of SCC arising de novo metastasize
8%
What percent of SCC arising in areas of scar or chronic inflammation metastasize
10-30%
What are the 5 histopath types of SCC
- Generic
- Adenoid
- Bowenoid
- Verrucous
- Spindle-pleomorphic
Which SCC typically arises in areas of actinic change
generic
Which SCC is more common in oral mucosa
verrucous
Which SCC is least common
spindle-pleomorphic
What factors increase likelihood of recurrence for SCC
tumors of midface, diameter > 2 cm or thickness > 4 mm, PNI, regional mets
What factors increase the likelihood of regional mets of SCC
Tumors arising on the ear, diameter >2 cm or >4 mm thickness, poorly differentiated histology, and recurrent tumors.
What are the 4 types of melanoma and which is most common and which has best prognosis
- Superficial spreading (m/c, best prog)
- Lentigo maligna
- Acral lentiginous
- Nodular sclerosing
What is m/c form of hereditary cutaneous melanoma
Dysplastic nevus syndrome
Which type of melanoma occurs on palms, soles, nail beds, mucous membranes
Acral lentiginous melanoma
What percent of melanomas occur in H&N
20%
What percent of tumors are not pigmented *amelanotic
5%
What mutation has been found in > 1/2 of malig melanoma
BRAF somatic missense mutations; a single substitution (V599E) accounts for 80%
What cells are melanomas composed of
melanocytes from neural crest
What are the RF for melanoma
- FMH
- Multiple atypical or dysplastic nevi
- Hutchinson’s freckle
- Large congenital nevi
- Blond or red hair
- Marked freckling on upper back
- H/o 3 or more blistering sunburns < 20 yo
- Actinic keratoses present
Risk of melanomatous transformation of giant congenital nevi
14%
What percent of pts with xeroderma pigmentosa develop melanoma
3%
How should lesion suspicious for melanoma be biopsied
A sample should be taken of the tumor and the underlying tissue so that depth can be ascertained; a shave biopsy should never be performed.
What is the most imp prog factor of melanomas
DOI
What is the incidence of nodal mets if DOI > 4mm
> 70%
What is incidence of nodal mets if DOI <1.5 mm
8%
T/F: Women w/ melanoma have a better prognosis than men regardless of tumor depth
True
What tumor factor other than depth influences regional mets in melanoma
Ulceration
Involvement of which areas of the body also inc risk of mets
BANS - back, arms, neck, scalp
What is chance that a pt with melanoma will develop a 2nd melanoma
5%
Is melanoma radiosensitive
It may be sensitive to large dose fractions (600 cGy) but not to standard fractionation RT (180-200 cGy)
What is the role of large-dose fraction RT in the MAN of melanoma
Decreases incidence of locoregional recurrence among N0 pts
