Actinic Keratosis & Squamous Cell Carcinoma Flashcards
Who gets SCC more commonly?
white/fair skin
Where is SCC located?
head, neck, forearms, dorsal hands, (sun exposed areas)
What increases you risk of SCC?
tanning beds, heat
Which has higher motality SCC or BCC?
SCC - higher rate of metastasis
What is the cell of origin in SCC?
keratinocytes
What causes SCC?
UV expsoure, chemical carinogen exposures
What is the SCC clinical manifestation?
papule, plaque, nodule pink, red, skin colored exophytic indurated horn friable asymptomatic, pruritic/tender
What is Bowen’s disease?
in situ SCC, pink to red patch or thin plaque with scaly or rough surface >1 cm size, only epidermis
Who get SCC of the nail?
males 50-69
A premalignant neoplasm of the epidermis caused by excessive exposure to sunlight and manifesting as an ill-marginated, erythematous, scaling, rough papule or patch.
Actinic Keratosis
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.
squamous cell carcinoma
What is the initial treatment for actinic keratosis?
incisional biopsy
What does incisional biopsy show in actinic keratosis?
dermal extension of well differentiated keratinocytes, keratin pearls
What can cause SCC in non sun exposed areas?
chemical carcinogen exposure
What are the various morphologies of SCC?
papules, plaque, nodule pink red or skin colored exophytic indurated cutaneous horn
What does friable mean?
bleed with minimal trauma and then crust
How does SCC of nail present?
warty, subungual hyperkeratosis, onycholysis, oozing, destruction of nail plate
What is the best for dx SCC?
Mohs
What does invasive squamous cell carcinoma mean?
SCC cells in dermis
What is atypical squamous proliferation?
biopsy is superficial, rebiopsy may be needed
What are the surgical options for SCC?
surgical excision - best for invasive SCC
Curettage and electrodesiccation or cryosurgery
What are the non surgical treatment options for SCC?
radiation
5-fluorouracil cream, imiquimod cream, diclofenac gel, ingenol mebutate, photodynamic therapy
What is 5-fluorouracil?
antimetabolite taht interferes with DNA synthesis
1,2,5% approved for actinic keratosis treatment
5% for superficial basal cell carcinoma
What is imiquiod?
synthetic immune response modifers
2.5,3.75, 5 for actinic keratosis
5% for superficial BCC
better inflammaory response = better cure
What is diclofenac?
downregulates cyclooxygenase enzymes and increases apoptosis
3,2.5% for actinic keratosis
nonsteroidal antiinflammatory
What is ingenol mebutate?
cellular death followed by inflammatory response
actici keratosis
When do you follow up with non metastatic SCC?
3-6 mo for 2 years, 6-12 mo for 3 years, annually for life
What does AK become?
SCC
Does AK go to SCC a lot?
not really, 8%
What is the cell origin of AK?
keratinocyte
What is the actinic keratosis spectrum?
photodamaged sin –> AK –> SCC in situ –> invasive SCC
What causes AK?
cummulative and prolonged UV exposure due to p53 mutations
What are the AK individual risk factors?
increasing age, fair skin, light eyes/hair, immunosuppression, genetic syndromes (xeroderma pigmentosum and albinism)
Fitz I or II
What are the clinical manifestations of AK?
tender, located in sun exposed, background of sun damaged skin, erythematous papules or thin plaques with rough gritty scale
How does AK appear?
sandpaper
How does sun damage appear?
combination of atrophy and hyperatrophy
telangiectasia
spotty depigmentation and hyperpigmentation
lethery and prematurely aged
What are small brown macules caused by sun exposed areas, results from UV damage?
solar lentigo (lentigines)
What is easy bruising due to extravasated erythrocytes and incrased perivascular inflammation?
actinic (senile) purpura
What is actinic cheilitis?
AK of lips, most common lower lip
How does actinic cheilitis present?
erythematous patch with rough gritty scale involving the lower lip –> BIOPSY
When do AK pts follow up?
regular skin 6-12 mo, due to increase risk of all types of skin cancer
