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Multisystems > CM- Dermatologic Malignancies > Flashcards

CM- Dermatologic Malignancies Flashcards

1
Q

What are the 9 risk factors for non-melanoma skin cancers?

A
  1. exposure to UV radiation
  2. fair skin, blue eyes, blond/red hair
  3. immunosuppression
  4. exposure to ionizing radiation
  5. chemical carcinogens
  6. HPV
  7. chronic irritation/ inflammation
  8. prior skin cancer diangosis
  9. Genetics
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2
Q

What wavelengths are UVA, B and C?

Which is most damaging?

A

UVA = 400 -320nm
UVB = 320 -290nm
UVC =290 -200 nm

Shorter wavelength = more energy and the more detrimental to the skin

So from worst to best: UVC, UVB, UVA

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3
Q

What have clinical/epidemiological studies and experimental studies shown about the effects of UV on skin cancer?

A

Clinical/epidemiological:
UVB is implicated as a non-melanoma carcinogen esp. in fair-skinned individuals living in areas of intense sun exposure. The cancers are distributed on sun-exposed skin of head, neck, upper extremities and torso

Experimental:
Animal studies show UVB to be a carcinogen for non-melanoma

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4
Q

What is the most common type of skin cancer in patients with dark skin?

A

SCC

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5
Q

Cumulative UVB over time is critical for causing _______________ skin cancer. Acute sunburn episodes early in life, on the other hand, promote the development of ______________.

A

Cumulative UVB = non-melanoma skin cancer

Acute burns = melanoma

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6
Q

The increased incidence of skin cancer in fair-skinned people who tend to burn and have difficulty tanning implicates what?

A

There is a genetic role in estimating the risk of skin cancer

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7
Q

What 2 genetic disorders make people exquisitely sensitive to sun-induced disorders and the development of skin cancer at an early age?

A
  1. albinism- melanin pigment is ABSENT

2. xeroderma pigmentosum- defective repair of UV-induced DNA damage

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8
Q

In what genetic disorder do patients have a predisposition towards infections by HPV, and get skin cancers early and in increased number on sun exposed areas?

A

Epidermodysplasia verruciformis - the synergy between virus and sunlight cause skin cancer

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9
Q

What are the 7 main risk factors for melanoma?

A
  1. fair skin, blue eyes, blond or red hair
  2. UV radiation -intermittent, blistering sunburns
  3. Precursor lesion -1/3 arise from existing nevi
  4. FAMILY HISTORY
  5. Prior skin cancer
  6. immunosuppression
  7. Response to UV light [inability to tan, solar lentigines]
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10
Q

What “precursor lesions” put a person at risk for melanoma?

What percent of melanomas develop from them?

A
  1. dysplastic nevus
  2. congenital or other nevus

1/3 of melanomas develop from a precursor

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11
Q

What FHx predisposes to melanoma?

A
  1. p16 mutation
  2. nevi- melanocytic nevi
  3. dysplastic nevi syndrome with:
    - multiple nevi with atypical clinical and histologic features
    - increased incidence of developing melanoma
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12
Q

What is the most common skin cancer?
What race is most likely to get it?
What gender?
What age group?

A

Basal cell carcinoma
white, men
40-79 yrs old

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13
Q

What is the pathophys of basal cell carcinoma?
From what cell does it arise?
How does it grow?

A
  1. arise from basal keratinocytes or epidermis and adnexal structures [hair follicles]
  2. grow via direct extension into the dermis/subcutis
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14
Q

A 50 year old man presents with dome-shaped, pearly/flesh-colored papule with telangiectasia. The center looks slightly ulcerated.
You do histology and see:
- aggregates of BASALOID CELLS contiguous with the epidermis
- cells are uniform size, with large nuclei, scant cytoplasm
-cells in the periphery of tumor are PALISADING
-CLEFTS between the stroma and the neoplastic cells

What is the likely diagnosis?

A

basal cell carcinoma - nodular type

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15
Q

A 63 year old woman presents with erythematous scaly patch with irregular borders. You think it is eczema, but are not 100% sure, so you take a biopsy.

Histology shows:

  • Basaloid cells extending from under the surface of the epidermis with a broad base
  • cells growing horizontally, radially in lower levels of the epidermis/upper dermis.

What is the diagnosis?

A

BCC - superficial type

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16
Q

A patient presents with white plaque/papule scar-like lesion.
Histology shows:
- cords strands and nests of basaloid cells in a dense stroma of thickened collagen bundles
- no connection to the epidermis

What is the diagnosis?
What must you do to decrease chance of recurrence?

A

BCC- sclerotic/morpheaform type

**much more aggressive than other types of BCC and requires Mohs surgery to decrease change of recurrence

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17
Q

A patient presents with a dark-colored tumor on her face. She says it has been growing slowly and expanding to local skin.
On histology, you see:
- aggregates of basaloid cells, sometimes contiguous with the epidermis
- clefts separating the basaloid cells from the stroma
- cells in there periphery palisading
- abundant melanin

What is the likely diagnosis?

A

BCC- pigmented type

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18
Q

What race is most affected by squamous cell carcinoma?
What age group?
What gender?

A

White, 40-79, men

*SCC is the most common skin cancer in African American and Asian patients

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19
Q 
What is the pathophysiology of SCC?
What cell does it arise from?
How does it grow?
What induces most cases on the skin?
What about if it is a nailbed or genital lesion?
A

It arises from suprabasal keratinocytes in the epidermis and grows by direct extension into the dermis/subcutis.

Most cases are UV induced and occur in patients with chronic sun exposure.
Nailbed or genital lesion suggests HPV infection

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20
Q

What are the 2 precursors for SCC?

A
  1. actinic keratosis- hyperkeratotic papules/plaques in sun-exposed skin [can be easily peopled off but tend to recurr]
  2. chronic scars, ulcers, prior radiation areas
21
Q

A patient presents with a hyperkeratotic plaque on a sun-exposed area. The lesion can be readily peeled but tends to recur.
Histology shows:
1. focal areas of atypical keratinocyte proliferation
2. overlying parakeratosis [nucleated]
3. spared adnexal areas

What is the likely diagnosis?
What is this a precursor lesion for?

A

Actinic Keratosis- precursor lesion for SCC

22
Q

What are the 3 types of SCC in situ?

A
  1. Bowen’s -
  2. erythroplasia of Queyrat
  3. erythroplakia/leukoplakia
23
Q

Describe the:

  1. presentation
  2. predisposing factor
  3. distribution

Of Bowen’s disease.

A
  1. scaly plaque with scalloped borders
  2. chronic arsenic ingestion
  3. trunk, extremities, digits
24
Q

An uncircumscribed man presents with a bright, erythematous plaque that is smooth and velvety on the glans penis. What is the diagnosis?
What is this a precursor for ?

A

Erythroplasia of Queyrat

- SCC in situ

25
Q

An elderly man presents with bright erythematous velvety plaque or white hyperkeratotic plaque in the oral cavity. He said he used to “chew snuff”. What is the likely diagnosis and what is it a precursor for?

A

Red velvety = erythroplakia
White hyperkeratitic = leukoplakia

Both are forms of SCC in situ

26
Q

What 3 factors increase the likelihood that an invasive SCC would metastasize?

A
  1. mucousal membrane
  2. area previously treated with radiation
  3. chronic irritation/ inflammation
27
Q

A 70 year old woman presents with an erythematous, scaly, ulcerated plaque. She says it has been growing rapidly and has doubled in size in 2 months.

Histology shows:

  1. basal zones of full thickness atypical keratinocyte proliferation
  2. invasion into the dermis
  3. varying amounts of hyperkeratosis, parakaratosis, acantholysis.
  4. inflammatory dermal infiltrates.

What is the diagnosis?

A

Invasive SCC

28
Q

A patient presents with a well-defined hyperkeratotic nodule. You do histology and see:

  1. exo-endophytic keratinocyte proliferation
  2. central crater or fibrotic base with abscess

What is the likely diagnosis?
What does this make you concerned?

A

Keratoacanthoma

While it is benign and can resolve spontaneously, histology is tough to differentiate from SCC. It also behaves like cancer with rapid growth and destruction of surrounding tissue.
You may need to surgically remove like SCC

29
Q

What is the pathophys of melanoma?
What cell is cancerous?
What is the growth pattern?
What % are pigmented? amelanotic?

A

The melanocyte is malignant.
It begins in the epidermis, grows horizontally within the epidermis and then later grows vertically down into the dermis.
95% are pigmented

30
Q

What features do you look for when suspecting melanoma?

A
  1. Asymmetry
  2. Borders - jagged borders “coast of maine” represent horizontal extension of malignant cells
  3. color - blue/black, red, white, grey-brown coexisting reflects the presence of malignant cells
  4. Diameter - over 6mm is suspicious
  5. Evolving- growth in size, color or shape change
31
Q

What is the biphasic growth pattern of melanoma?

A
  1. horizontal within the epidermis
  2. vertically into the dermis

If you remove lesion during stage 1, metastatic risk is lower. Once it goes vertical it comes into vascular structures and has greater metastatic risk.

32
Q

What is the most important prognostic factor in melanomas?

A

Depth of the lesion

  1. melanoma in situ = restricted to epidermis
  2. invasive = extends into the dermis
33
Q

What are the 4 clinical subtypes of melanoma?

A
  1. superficial spreading -70%
  2. lentigo maligna
  3. acral lentiginous melanoma
  4. nodular melanoma
34
Q

What subtype of melanoma arises on sun-damaged, freckled skin?
What do the lesions look like?
Who is commonly affected?

A

Lentigo maligna

  • broad macular lesions
  • faces of the elderly
35
Q

A patient presents with lesions in the distal extremities, and in the subungual and periungual regions. They have longitudinal melanonychia where there are pigmented streaks in the nail plate at the cuticle and extending the length of the nail.

What is the diagnosis?

A

Acral lentiginous melanoma

36
Q

What kind of melanoma is most aggressive and ONLY grows vertically?
It develops quickly, is raised and often ulcerated.

A

Nodular melanoma

37
Q

Describe the histology of melanoma in situ.

A

broad, asymmetric poorly circumscribed neoplastic melanocytes spread through every layer of the epidermis [not just basal layer like normal]

38
Q

Describe histology of invasive melanoma.

A
  1. Atypical melanocytes involve all portions of the epidermis
  2. extension into the dermis and subcutis forming nodules and sheets
39
Q

What is Breslow depth?
Below what depth have the melanoma most likely not metastasized ?
At what depth does your 5YSR drop below 50%?

A

vertical distance in mm from base of the granular layer of the epidermis to the deepest melanoma cell in the subepidermal tissue.

4mm, your survival is less than 1/2

40
Q

What is the 5YSR if there is nodal involvement of melanoma?

Distant mets?

A

Nodal involvement = 30% survival

Mets =5% survival

41
Q

What are the Clark Levels of metastatic spread?

A
  1. epidermis
  2. invasion, but not filling papillary dermis
  3. filling papillary dermis
  4. reticular dermis invasion
  5. invasion of subcutaneous fat
42
Q

What is solar lentigo?

What % of white people over 70 have them?

A

These are “sun freckles, liver spots, age spots”
Brown macules that are on sun-exposed skin.
90% of whites over 70 have them

43
Q

What is melanocytic nevus?
When are they typically acquired?
What % of the time is melanoma found to arise from a nevus?

A

It is a mole— benign neoplasm consisting of melanocytes.
Acquired between 5 and 30.
35% of melanoma arise from nevi.

44
Q

You see a patient with flat, tan-medium brown lesion with uniform pigment and regular borders. You do histology and note melanocytes confined to the dermoepidermal junction. What type of nevus is this?

A

Junctional nevus

45
Q

You see a patient with a flesh-colored/pinkish, dome shaped/pedunculated papule with uniform pigment and regular border.
Histology shows melanocytes confined to the dermis. What type of nevus is this?

A

Intradermal nevus

46
Q

You see a patient with tan brown, dome shaped papule with uniform pigment and regular border. Melanocytes are at the dermoepidermal border and in the dermis. What is the nevus?

A

Compound nevus

47
Q

How does a congenital nevus differ from acquired?

A
  1. congenital is larger
  2. congenital is raised and pigmented
  3. congenital shows moderate growth of hair
48
Q

What is a dysplastic nevi?

A

A nevi with one or more ABCDs, but not yet melanoma.

  • “fried egg appearance”
  • increased risk of melanoma

Multisystems (29 decks)

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