Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Q5 Dermatology > AK & SCC > Flashcards

AK & SCC Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

squamous cell carcinoma (SCC) most commonly occurs:
in who?
Where?

A

WHITE/FAIR SKIN people

SUN-EXPOSED AREAS (head, neck, forearms, dorsal hands)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SCC vs BCC mortality

A

SCC has INCREASED mortality, mostly due to high rate of metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SCC etiology

A

cell of origin: KERATINOCYTE

cumulative UV exposure->genetic alterations accumulate, provide selective growth advantage

SCC in NON sun-exposed areas may be due to chemical carcinogens (eg. arsenic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SCC morphology

A

varies:

  • papule, plaque or nodule
  • pink, red or skin colored
  • scale
  • Exophytic (grows outward)
  • Indurated (lesion feels thick, firm)
  • cutaneous horm

FRIABLE: bleed w/minimal traum then crust

(U) asymptomatic, may be pruritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SCC in situ

A

aka Bowen’s dz

circumscribed pink-to-red patch
or
thin plaque w/scaly or rough surface

keratinocyte atypia is confined to epidermis, DOES NOT invade past dermal-epidural junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Shave biopsy use

A

diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Surgical excision use

A

treatment of choice for SCC in situ

specimen must be sent to pathology to document clear margins (complete excision)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Liquid nitrogen cryotherapy use

A

to tx pre-cancerous actinic keratosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

“Invasive squamous cell carcinoma” means

A

there are SCC cells IN THE DERMIS

unrelated to metastatic potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SCC in situ means

A

there is NO DERMAL INVOLVEMENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

“Atypical squamous proliferation” means

A

often used when biopsy is too superficial

if dermis cannot be seen in the biopsy, invasive SCC cannot be excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SCC treatment options:

surgical (invasive, in-situ)

A
  1. surgical excision (invasive SCC):
    - wide local excision, Mohs -micrographic surgery
  2. curette & desiccation (in situ SCC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SCC non-surgical tx options

A

radiation therapy for poor surgical candidates

5-fluorouracil cream, imiquimod cream, photodynamic therapy-(U) used for in situ SCC when excision is suboptimal choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SCC: rates of mets

A

SCC in sun exposed area=5% rate of mets to regional lymph nodes

higher rates of metastasis if:

  1. large (diameter>2cm), deep (>4mm) and recurrent tumors
  2. tumor involvement of bone, muscle & nerve
  3. location on scalp ears nose & lips
  4. tumor arising in scars chronic ulcers, burns, sinus tracts or on genitalia
  5. Immunosuppressed patients
  6. tumors caused by arsenic ingesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SCC patient follow up

A

surveillance for the early recognition & management of:

  • tx-related complications
  • local or regional recurrences
  • development of new skin cancers

patients with a hx of SCC should have close follow-up

patients are often seen every 6 to 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Actinic Keratosis:
cell of origin
what is it
prognosis/risk

A

keratinocyte is cell of origin

AK is premalignant lesion;
almost all AKs that become CA will become SCC

1/1000 risk of malignant transformation from AK to SCC in one year

risk factors: persistence of AK, hx of skin CA, immunosuppression

17
Q

Etiology of AK

A

cumulative & prolonged UV exposure, resulting in UV-induced p53 tumor suppressor gene mutations

18
Q

Individual risk factors that can increase susceptibility to AK (4)

A
  1. increasing age
  2. fair skin, light eyes/hair (skin types I,II)
  3. immunosuprresion
  4. genetic syndromes, such as xeroderma pigmentosum and albanism
19
Q

AK clinical manifestations (5)

A
  • may be symptomatic (tender)
  • on sun-exposed areas (head neck extensor forearms, dorsal hands)
  • (U) on background of sun damages skin
  • erythematous paule or thin plaque w/rough, gritty scale
  • often dx by feel (like sandpaper)
20
Q

AK is often dx how?

A

by feel (like sandpaper)

*be cautious in lesions>6mm since they may represent SCC in situ or superficial BCC

21
Q

Skin features of chronic sun damage: (5)

A
  1. combination of atropy & hypertrophy
  2. telangiectasias
  3. spotty depigmentation & hyperpigementation
  4. wrinkles
  5. skin appears “leathery” and “prematurely aged”
22
Q

Solar Lentigo (lentigines):
cause
distribution
appearance

A

result from UV damage

sun-exposed areas

once/many small brown macules

23
Q

Cutis rhomboidalis nuchae

A

red neck with rhomboidal furrows

an effect of sun damage

24
Q

solar elastosis

A

fine nodularity pebbly surface

an effect of sun damage

25
Q

Actinic Purpura

A

aka Actinic (senile) Purpura

  • easy bruising
  • extravasated erythrocytes & increased perivascular inflammation
26
Q

Actinic chelitis

A

AK on the lips, most often the lower lip

erythematous patch w/rough gritty scale involving the lower lip (persistent ulcerations or indurated areas should prompt a biopsy to rule out malignant transformation)

27
Q

How to you treat AK?

A

choose best option after considering the #, location, thickness & other pt factors

Local therapies: tx individual lesion

  1. liquid nitrogen cryotherapy
  2. curettage +/- electrocautery
  3. shave excision

Field therapies: tx multiple AKs in one area

  1. 5-fluorouracil or imiquimod creams
  2. photodynamic therapy
28
Q

Actinic Keratosis: patient education

A

pts w/AKs have increased risk of developing other non-melanoma & melanoma skin CAs so:

  1. AK pts should have regular skin exams q 6-12 months
  2. Pts should be seen prior to regularly scheduled follow ups if they notice a concerning lesion on a self-skin exam
29
Q

Resources to educate pts abt sun safety & sin CA prevention (2)

A
  1. American Academy of Dermatology: SPOT Skin Cancer initiative
  2. American Cancer Society: Skin Cancer Prevention and Early Detection
30
Q

SPOT Skin CA patient education recommendations (5)

A
  1. SEEK SHADE when appropriate (sun strongest from 10a-2p; if shadow is shorter than you, seek shade)
  2. Wear PROTECTIVE CLOTHING(long-sleeve shirt, pants, wide brim hat, sunglasses)
  3. Generously apply broad-spectrum, water-resistant SUNSCREEN w/SPF of 30 or more q 2h even on cloudy days & after swimming & sweating
    [broad spectrum=protection from both UVA & UVB rays]
  4. EXTRA CAUTION NEAR WATER, SNOW & SAND b/c they reflect & intensify sunrays
  5. AVOID TANNING BEDS!!! they cause skin CA & wrinkling
31
Q

How to perform skin self-exam (4)

A
  1. examine body front & back in mirror, then look at right & left sides with your arms raised
  2. look at back of legs & feet, interdigital space, soles of feet
  3. bend elbows & look carefully at forearms, upper underarms & palms
  4. examine back of next and scalp with a hand mirror, part hair for closer look
32
Q

indurated erythematous lesions are

A

SCC until proven otherwise

33
Q

dx of SCC

A

shave biopsy

34
Q

SCC tx

A

surgical excision

radiation therapy is good choice in poor surgical candidates

35
Q

Actinic keratosis description

A

erythematous papules or thin plaques w/scale

feel rough on palpation but are not indurated

AK is a precancerous lesion that can evolve into SCC

36
Q

AK tx depends on

A

of lesions & pt preference

Q5 Dermatology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions