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Dermatology - Clinical Medicine IV > Actinic Keratosis & Squamous Cell Carcinoma > Flashcards

Actinic Keratosis & Squamous Cell Carcinoma Flashcards

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Dermatology Board Prep flashcards
1
Q

Who gets SCC more commonly?

A

white/fair skin

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2
Q

Where is SCC located?

A

head, neck, forearms, dorsal hands, (sun exposed areas)

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3
Q

What increases you risk of SCC?

A

tanning beds, heat

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4
Q

Which has higher motality SCC or BCC?

A

SCC - higher rate of metastasis

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5
Q

What is the cell of origin in SCC?

A

keratinocytes

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6
Q

What causes SCC?

A

UV expsoure, chemical carinogen exposures

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7
Q

What is the SCC clinical manifestation?

A 
papule, plaque, nodule
pink, red, skin colored
exophytic
indurated
horn
friable
asymptomatic, pruritic/tender
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8
Q

What is Bowen’s disease?

A

in situ SCC, pink to red patch or thin plaque with scaly or rough surface >1 cm size, only epidermis

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9
Q

Who get SCC of the nail?

A

males 50-69

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10
Q

A premalignant neoplasm of the epidermis caused by excessive exposure to sunlight and manifesting as an ill-marginated, erythematous, scaling, rough papule or patch.

A

Actinic Keratosis

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11
Q

A malignant neoplasm of keratinocytes derived from stratified squamous epithelium. These usually present as indurated, scaling, erythematous papules, nodules or plaques that occasionally ulcerate and bleed.

A

squamous cell carcinoma

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12
Q

What is the initial treatment for actinic keratosis?

A

incisional biopsy

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13
Q

What does incisional biopsy show in actinic keratosis?

A

dermal extension of well differentiated keratinocytes, keratin pearls

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14
Q

What can cause SCC in non sun exposed areas?

A

chemical carcinogen exposure

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15
Q

What are the various morphologies of SCC?

A 
papules, plaque, nodule
pink red or skin colored
exophytic
indurated
cutaneous horn
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16
Q

What does friable mean?

A

bleed with minimal trauma and then crust

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17
Q

How does SCC of nail present?

A

warty, subungual hyperkeratosis, onycholysis, oozing, destruction of nail plate

18
Q

What is the best for dx SCC?

A

Mohs

19
Q

What does invasive squamous cell carcinoma mean?

A

SCC cells in dermis

20
Q

What is atypical squamous proliferation?

A

biopsy is superficial, rebiopsy may be needed

21
Q

What are the surgical options for SCC?

A

surgical excision - best for invasive SCC

Curettage and electrodesiccation or cryosurgery

22
Q

What are the non surgical treatment options for SCC?

A

radiation

5-fluorouracil cream, imiquimod cream, diclofenac gel, ingenol mebutate, photodynamic therapy

23
Q

What is 5-fluorouracil?

A

antimetabolite taht interferes with DNA synthesis
1,2,5% approved for actinic keratosis treatment
5% for superficial basal cell carcinoma

24
Q

What is imiquiod?

A

synthetic immune response modifers
2.5,3.75, 5 for actinic keratosis
5% for superficial BCC
better inflammaory response = better cure

25
Q

What is diclofenac?

A

downregulates cyclooxygenase enzymes and increases apoptosis
3,2.5% for actinic keratosis
nonsteroidal antiinflammatory

26
Q

What is ingenol mebutate?

A

cellular death followed by inflammatory response

actici keratosis

27
Q

When do you follow up with non metastatic SCC?

A

3-6 mo for 2 years, 6-12 mo for 3 years, annually for life

28
Q

What does AK become?

A

SCC

29
Q

Does AK go to SCC a lot?

A

not really, 8%

30
Q

What is the cell origin of AK?

A

keratinocyte

31
Q

What is the actinic keratosis spectrum?

A

photodamaged sin –> AK –> SCC in situ –> invasive SCC

32
Q

What causes AK?

A

cummulative and prolonged UV exposure due to p53 mutations

33
Q

What are the AK individual risk factors?

A

increasing age, fair skin, light eyes/hair, immunosuppression, genetic syndromes (xeroderma pigmentosum and albinism)
Fitz I or II

34
Q

What are the clinical manifestations of AK?

A

tender, located in sun exposed, background of sun damaged skin, erythematous papules or thin plaques with rough gritty scale

35
Q

How does AK appear?

A

sandpaper

36
Q

How does sun damage appear?

A

combination of atrophy and hyperatrophy
telangiectasia
spotty depigmentation and hyperpigmentation
lethery and prematurely aged

37
Q

What are small brown macules caused by sun exposed areas, results from UV damage?

A

solar lentigo (lentigines)

38
Q

What is easy bruising due to extravasated erythrocytes and incrased perivascular inflammation?

A

actinic (senile) purpura

39
Q

What is actinic cheilitis?

A

AK of lips, most common lower lip

40
Q

How does actinic cheilitis present?

A

erythematous patch with rough gritty scale involving the lower lip –> BIOPSY

41
Q

When do AK pts follow up?

A

regular skin 6-12 mo, due to increase risk of all types of skin cancer

Dermatology - Clinical Medicine IV (31 decks)

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