3: Derm Malignancies Flashcards
Which type of basal cell carcinoma? Pigmented, nodular, micronodular, or morpheaform/sclerosing?
Contain melanin that appears speckled, brown, blue, or black (darker skin types), and may resemble dysplastic nevi or melanoma.
Pigmented BCC
Which type of basal cell carcinoma? Pigmented, nodular, micronodular, or morpheaform/sclerosing?
Pale white to yellow, waxy plaques with indistinct margins whose cells can extend up to 7 mm beyond the clinical border.
Morpheaform/Sclerosing BCC
What are treatment options for low-risk squamous cell carcinoma (3)?
- Screenings
- Nodal Assessment
- Wide local excision
Increasingly common malignancies of the melanocytes of the skin, eyes, and mucosa.
Malignant Melanomas
T/F Basal cell carcinoma is usually flat.
False. It can be superficial, flat, atrophic, pearly pink to red.
When does actinic keratosis require a biopsy (2)?
- Unresponsive to treatment
2. Recurrent
What are the ABCDEs of malignant melanomas?
Asymmetry Border irregularity Color variegation Diameter >6 mm Evolution
Actinic keratosis is a precursor to what cancer?
Squamous Cell Carcinoma (SCC)
T/F Squamous cell carcinoma is at risk for metastasis.
True. At risk for metastasis if large, recurrent, or poorly differentiated.
Merkel cell carcinoma should be sent for shave or punch biopsy. They often recur in _____ months, have _____, and _____.
They often recur in 8-12 months, have nodal involvement, and metastasize.
Smooth, pearly, translucent, pink lesions with telangiectasias.
Basal Cell Carcinoma
Which subtype of melanoma: superficial spreading, nodular, lentiginous, or acral?
70–80%, F>M, trunk and extremities, greater than 6 mm, flat, asymmetric, varying coloration.
Superficial Spreading Melanoma
What is the Breslow staging threshold for sending to dermatologic surgeon vs surgical oncologist with malignant melanoma?
Dermatology = Breslow <0.75 mm Onoclogy = Breslow >0.75 mm
Which subtype of melanoma: superficial spreading, nodular, lentiginous, or acral?
10–15%, extremities, raised, brown-black, rapidly growing papules.
Nodular Melanoma
Uncommon, aggressive neuroendocrine carcinomas with possible infectious component, and typically affect people over age 65.
Merkel Cell Carcinoma
What is the treatment for actinic keratosis (6)?
- Imiquimod
- Cryotherapy
- 5-fluorouracil
- Photodynamic therapy
- Laser
- Sunscreen
Actinic keratosis can spontaneously regress, but about _____% of lesions progress to SCC.
15%
Lesions can be pink, dull red, poorly defined, dome shaped, and scaly with yellow keratin.
Squamous Cell Carcinoma
Malignant melanomas are more common in people with _____ and _____ hair, and _____ and _____ eyes.
Blonde and red hair.
Blue and green eyes.
T/F Basal cell carcinoma is at risk for metastasis.
False. They rarely metastasize but are locally destructive.
Which type of basal cell carcinoma? Pigmented, nodular, micronodular, or morpheaform/sclerosing?
Microscopic islands of tumor cells beyond the clinical margins, create high risk for recurrence.
Micronodular BCC
What ethnicity has the highest rates of squamous cell carcinoma?
Caucasian
T/F Malignant melanomas can occur in both preexisting nevi or new nevi.
True. Preexisting nevi 30% of the time and new ones 70% of the time.
Which subtype of melanoma: superficial spreading, nodular, lentiginous, or acral?
M>F, elders, hands, feet, darker skin types (2% of all melanomas are amelanotic).
Acral Melanoma
Red flags for melanomas (6).
- New mole appears postpuberty that changes in color, shape, or size
- Longstanding mole changes in color, shape, or size
- Mole has three or more colors, or has lost its symmetry
- Mole itches or bleeds
- New persistent lesion that grows, is pigmented, or vascular in appearance
- New pigmented lesion in or under a nail
Which subtype of melanoma: superficial spreading, nodular, lentiginous, or acral?
10–15%, face, neck, arms, in situ (intraepidermal), flat, irregular, varied pigment.
Lentiginous Melanoma
Squamous cell carcinoma accounts for _____% of all cutaneous malignancies.
20%
What is the 5 year survival rate of merkel cell carcinoma?
40-75%
Firm, smooth, shiny, dome-shaped, skin-colored to red, nontender, 2–8 mm nodules with telangiectasia usually found on sun-exposed areas of the head and neck.
Merkel Cell Carcinoma
Who most commonly gets basal cell carcinoma (4)?
- Caucasian
- Asian
- Hispanic
- Sun exposure
Which melanoma is more common in males? In females?
Males = Acral Females = Superficial spreading
Actinic keratosis is similar to _____ and _____.
Seborrhea and rosacea
Actinic keratosis is indicative of squamous cell carcinoma when lesions are _____ or _____.
Thick or tender
Malignant lesions that arise from the innermost layer of the epidermis.
Basal Cell Carcinoma
Dysplastic and spitz nevi are indicative of melanoma when they are atypical. How would the borders, colors, and pattern look?
Border = indistinct or fading Color = variegated Pattern = fried egg
Transparent to yellow, rough scale, or plaques that resemble sandpaper, and arise within a background of uneven pigmentation, atrophy, thinning, and telangiectasis.
Actinic Keratosis
Dysplastic and spitz nevi are usually benign if under _____ mm.
6 mm
Which type of basal cell carcinoma? Pigmented, nodular, micronodular, or morpheaform/sclerosing?
Frequently bleed and ulcerate, creating a rolled border, and may resemble inflammatory papules or sebaceous hyperplasia (generally excellent cure rate).
Nodular BCC
Where are actinic keratoses normally found?
Commonly found on the scalp, ears, face, neck, and hands in people with years of cumulative UVR exposure.
Squamous cell carcinoma can result from exposure to _____, _____, _____, and _____.
Arsenic, tobacco, infections, and trauma
Invasive, primary, cutaneous malignancies arising from keratinocytes of skin and mucosa most often found on head, neck, and hands.
Squamous Cell Carcinoma
At what stages do you order lymph node biopsies with melanoma?
Stages 1B and 2
Most common population for merkel cell carcinoma.
Fair-skinned people with a hx of extensive sun exposure and chronic immune suppression.
What is the prognosis for squamous cell carcinoma?
Excellent if small. 50% of patients with 1 will develop another within 3-5 years.
What are treatment options for high-risk squamous cell carcinoma (3)?
- Surgery
- SNLB
AND/OR - Adjuvant XRT
