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Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions > 24 Neoplastic - Skin > Flashcards

24 Neoplastic - Skin Flashcards

1
Q

After having BCC or SCC of skin, what are chances of having another within 5 yrs

A

50%

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2
Q

What is basal cell nevoid syndrome

A

Auto Dom d/o characterized by multiple BCCs, OKCs, rib abnlities, palmar and plantar pits, and calcification of falx cerebri

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3
Q

Other genetic d/o a/w high risk of cutaneous malig

A 
xeroderma pigmentosum
albinism
epidermodysplastic verruciformis
epidermolysis bullosa dystrophica
dyskeratosis congenital
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4
Q

Which UV light is most responsible for acute actinic damage

A

UVB

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5
Q

Other than UV light and genetics, what are some other factors that increase the risk of cutaneous malignancy?

A

Long-term immunosuppression after organ transplantation, long-term tx of psoriasis with photosensitizing chemicals, chronic ulcers, and low dose RT

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6
Q

What is Marjolin’s ulcer?

A

Burn or ulcer a/w development of malig

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7
Q

What is m/c premalig skin lesion of H&N

A

Actinic keratosis

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8
Q

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?

A

Keratoacanthoma

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9
Q

What is Bowen’s disease

A

SCCIS of skin

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10
Q

T/F: adnexal carcinomas of the skin are very aggressive and have a poor prog

A

True

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11
Q

Which adnexal skin CA arises from a pluripotential basal cell within or around the hair cells

A

Merkel cell carcinoma

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12
Q

What virus is strongly a/w Merkel cell carcinoma that is known to cause CA in animals

A

Merkel cell polyomavirus

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13
Q

What is the 5 year survival of pts with MCC

A

30%

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14
Q

What test should be ordered in w/u of MCC

A

PET

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15
Q

Should the N0 neck be treated in pts with MCC

A

Yes

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16
Q

What is m/c type of skin sarcoma

A

Malignant fibrous histiocytoma

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17
Q

What are the 5 main types of basal cell carcinomas and which is m/c and which is most aggressive

A
  • Nodular (m/c)
  • Cystic
  • Superficial multicentric
  • Morpheaform
  • Keratotic (Most aggressive)
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18
Q

Which BCC type is m/c found on extremities or trunk

A

superficial multicentric

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19
Q

Which BCC type is a variant of nodular BCC and produces pigment

A

cystic

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20
Q

Which BCC type commonly resembles a scar

A

morpheaform

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21
Q

What is unique about the path of growth of BCCs

A

Follow path of least resistance, which is typically along embryonic fusion planes

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22
Q

Which areas of face are most susceptible to BCCs

A

Inner canthus, philtrum, mid-lower chin, nasolabial groove, preauricular area, retroauricular sulcus

23
Q

What proportion of incompletely excised BCCs will recur

A

1/3

24
Q

T/F: SCC arising in sun-exposed area tends to behave less aggressive than those arising de novo

A

True

25
Q

What percent of SCC arising in areas of actinic change metastasize

A

3-5%

26
Q

What percent of SCC arising de novo metastasize

A

8%

27
Q

What percent of SCC arising in areas of scar or chronic inflammation metastasize

A

10-30%

28
Q

What are the 5 histopath types of SCC

A
  • Generic
  • Adenoid
  • Bowenoid
  • Verrucous
  • Spindle-pleomorphic
29
Q

Which SCC typically arises in areas of actinic change

A

generic

30
Q

Which SCC is more common in oral mucosa

A

verrucous

31
Q

Which SCC is least common

A

spindle-pleomorphic

32
Q

What factors increase likelihood of recurrence for SCC

A

tumors of midface, diameter > 2 cm or thickness > 4 mm, PNI, regional mets

33
Q

What factors increase the likelihood of regional mets of SCC

A

Tumors arising on the ear, diameter >2 cm or >4 mm thickness, poorly differentiated histology, and recurrent tumors.

34
Q

What are the 4 types of melanoma and which is most common and which has best prognosis

A
  • Superficial spreading (m/c, best prog)
  • Lentigo maligna
  • Acral lentiginous
  • Nodular sclerosing
35
Q

What is m/c form of hereditary cutaneous melanoma

A

Dysplastic nevus syndrome

36
Q

Which type of melanoma occurs on palms, soles, nail beds, mucous membranes

A

Acral lentiginous melanoma

37
Q

What percent of melanomas occur in H&N

A

20%

38
Q

What percent of tumors are not pigmented *amelanotic

A

5%

39
Q

What mutation has been found in > 1/2 of malig melanoma

A

BRAF somatic missense mutations; a single substitution (V599E) accounts for 80%

40
Q

What cells are melanomas composed of

A

melanocytes from neural crest

41
Q

What are the RF for melanoma

A
  • 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
42
Q

Risk of melanomatous transformation of giant congenital nevi

A

14%

43
Q

What percent of pts with xeroderma pigmentosa develop melanoma

A

3%

44
Q

How should lesion suspicious for melanoma be biopsied

A

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.

45
Q

What is the most imp prog factor of melanomas

A

DOI

46
Q

What is the incidence of nodal mets if DOI > 4mm

A

> 70%

47
Q

What is incidence of nodal mets if DOI <1.5 mm

A

8%

48
Q

T/F: Women w/ melanoma have a better prognosis than men regardless of tumor depth

A

True

49
Q

What tumor factor other than depth influences regional mets in melanoma

A

Ulceration

50
Q

Involvement of which areas of the body also inc risk of mets

A

BANS - back, arms, neck, scalp

51
Q

What is chance that a pt with melanoma will develop a 2nd melanoma

A

5%

52
Q

Is melanoma radiosensitive

A

It may be sensitive to large dose fractions (600 cGy) but not to standard fractionation RT (180-200 cGy)

53
Q

What is the role of large-dose fraction RT in the MAN of melanoma

A

Decreases incidence of locoregional recurrence among N0 pts

Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions (14 decks)

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