8 - Premalignant And Malignant Tumors Flashcards
What is actinic keratosis?
SCC confined to the epidermis
Caused by chronic UVB exposure in fair skinned people
Morphology of actinic keratosis?
Starts as area of increased vascularity
Rough feeling to skin
Erythema with scale
Hyperkeratotic lesion on ears and dorsum of hand
Sharp, adherent, yellow scale as lesion progresses
May present as subcutaneous horn with underlying AK, SCC, or wart
What is actinic keratosis on the lower lip called?
Actinic cheilitis
If you see a lesion of actinic keratosis on the superior aspect of the pinna, think:
Chondrodermatitis Nodularis Helicis (CDNH)
A degeneration of underlying collagen
Excise it
Special pillow for sleeping
Management of actinic keratosis?
Photoprotection (discuss with patient)
Complete skin exam - risk factors for BCC and SCC
Liquid nitrogen for small lesions (TOC)
5-FU for multiple lesions (Imiquimod as alternative)
Thicker crust or indurated lesions - excision (shave)
Prognosis for actinic keratosis?
10-20% will develop SCC over 10-20 yrs (aren’t those numbers convenient)
AK is a PRE-malignancy - it’s SCC of the epidermis only - once it invades the dermis, oh shit we got real cancer now boyyyyyy
What is Bowen’s Disease?
AKA “SCC in situ”
Later in life, sun-exposed skin
Unlike AK, it can extend down into follicles
Morphology and location of Bowen’s disease (SCC in situ)
Well-defined borders
Slightly elevated, red, scaly plaques
Very slow lateral growth
Women - lower extremities
Men - scalp and ears
What is Erythroplasia of Queyrat?
Squamous cell carcinoma in situ of the glans of uncircumcised male, labia or female, or oral mucosa
A sub-type (?) of Bowen’s disease
Elderly folks
Moist, smooth, red, slightly raised plaque
Associated with HPV-8
Txt - 5-FU or Imiquimod or LASERS
Management of Bowen’s Disease?
Small lesions? Elecrodessication and curettage (ED and C)
OR
Cryosurgery (LN2)
Larger lesions? Excisional surgery, 5-FU cream
Prognosis of Bowen’s Disease?
Low-grade malignancy, follow-up Q 6 mos
Slow growth, recurrences common, can degenerate into SCC
What is the second most common skin CA?
Squamous cell carcinoma
What is the MC precursor to SCC?
Actinic keratosis
Risk factors for SCC
UVA and UVB AK Bowen’s Thermal or radiation burns Chronic irritation HPV Inflammation Arsenic exposure Immunosuppression
Morphology of SCC?
Red, scaly, persistent
Usually with deeper involvement
With or without ulceration
Hypertrophic lesion with ulcer or hyperkeratosis (cutaneous horn)
Lip: ulcer with induration
Typical SCC patient
Sun exposed areas on an older, asymptomatic dude
Can occur younger in smokers
Management of SCC?
Small lesions arising from AK? ED and C
Larger lesions and those on lip? Excision with margins
Examine lymph nodes
F/U Q 12 mos FOR LIFE
Emphasize photo-protection
Prognosis for SCC?
It’s malignant - must treat adequately
Aggressiveness varies with cell differentiation
The longer the hx of unprotected sun exposure, the higher the likelihood of mets
Overall, tho, SCC carries low potential for mets
What is the most common invasive skin CA?
BCC
Origin of BCC?
Malignant proliferation in basal layer of epidermis
Most important risk factor is inability to tan (just workin’ on my base, bro)
Morphology and location of BCC?
Nodular BCC (most common form) - head/neck/NOSE (MC site)
Superficial BCC - trunk
Slow-growing, asxs, pearly, firm, dome-shaped papule
Evolved, becomes telangiectatic, ulcerates and has rolled borders (“rodent ulcer”)
Typical BCC pt:
Over 40
Complaining of bleeding or scabbing sore that heals and then recurs
Looseness and friability
Malignancy potential for BCC?
Advances by direct extension and destroys normal tissue
Untreated, it can destroy whole side of face, even subcutaneous tissue, bone, and invade brain
Management of BCC?
If detected early - excise
If detected late - excise, but refer to derm and plastics (possible Mohs Micrographic surgery)
