Common Skin Cancers

Question 1

What is the most common form of cancer in the United States.

Answer 1

Skin Cancer. more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.

Question 2

What are the 3 Common Skin Cancer Types

Answer 2

1. basel cell, 2. squamous cell, 3. Melenoma

Question 3

Non-melanoma Skin Cancer RISK FACTORS

Basal Cell Carcinoma

Answer 3

• fair skinned individuals in geographic areas with higher UV exposure
• Mostcommon malignancy in the US
• UV radiation is the most common cause of BCC
• Anestimated 2.8 million are diagnosed annually in the US
• Also occur after ionizing radiation, arsenic or polycyclic hydrocarbon exposure

Question 4

Most common malignany in US

Answer 4

BCC. Rarely fatal

Question 5

What are the known mutations that lead to BCC?

Answer 5

loss of function of PTCH1 which normally acts to block smoothened (SMO) a transmembrane protein. Treat w/ Vismodegib, an inhibitor of smoothened. [hedgehog]

Question 6

the most common precancer leading to BCC?

Answer 6

Actinic Keratosis

Question 7

List Actinic Keratosis treatment options

Answer 7

-Cryosurgery
-Topical5-fluoruracil
• TopicalImiquimod
• TopicalDiclofenac
• Photodynamictherapy
• Sunprotection

Question 8

List skin malignancies in order of most common to least common

Answer 8

BCC>SCC>Melanoma

Question 9

What kind of pts have SCC?

Answer 9

immunosuppressed pts, especially organ transplant pts

Question 10

SCC risk factors

Answer 10

UV damage, thermal injury, radiation, HPV, burn scars (Marjolin’s ulcer) and chronic injury (i.e. EB)

Question 11

BCC subtypes

Answer 11

Nodular (75%): Micronodular, Pigmented (6%). Superficial (15%). Infiltrative (5%). Sclerosing/
Morpheaform (3%).

Question 12

SCC subtypes

Answer 12

SCCinsitu(Bowen’sdisease) • Keratoacanthoma

• InvasiveSCC

Question 13

Keratoacanthoma clinical features

Answer 13

Distribution- primarily sun-exposed skin
• Rapid growth over 6-8 weeks
• Size- 1-3 cm
• Crateriform endophytic and exophytic nodule with central keratin plug
• Complications- deep invasion without regression in 10-20%

Question 14

SCC in situ characteristics

Answer 14

Only in epidermis, HPV link (genitalia), scaly, reddish patches/plaques. NOT pigmented. Typically found on chronically exposed sun; less commonly on genitalia.

Question 15

Non-melanoma Skin Cancer treatment

Answer 15

CryoRx, 5-FU, Imiquimod, Curettage(cautery), Excision, Mohs Surgery, RadioRx.

Question 16

Malignant Melanoma ABCD guidelines

Answer 16

ABCDE=assymetry, border irregularity, color variation, diameter>6mm, evolution(changes over time).

Question 17

T or F: One person dies of melanoma every hour

Answer 17

true

Question 18

T or F: Of the 7 most common cancers in the US, melanoma is the only one whose incidence is increasing (1.9% annually)

Answer 18

true

Question 19

Melanoma distribution

Answer 19

Distribution
– Blacks- acral and mucosa
– Men- back
– Women- legs (torso in females age 15-29, perhaps due to tanning)

Question 20

Breslow Depth, what is it?

Answer 20

Tumor invasion in millimeters

Question 21

List Clarks Levels

Answer 21

I Epidermis
II Papillary Dermis 
III Mid Dermis
IV Reticular Dermis 
V Subcutaneous fat

Question 22

Malignant Melanoma Treatment options?

Answer 22

M in situ: excision w 5mm margins.

M w 1mm depth: sentinel node bx to determine prognosis w 10-20mm margin. >4mm: adjuvant Rx (IE INF)

Question 23

What are the mutations in melanoma?

Answer 23

Frequency of Mutations in Melanoma: -BRAF 50% (tx: Vemurafeni b, BRAF inhibitor)
-NRAS 20%

Question 24

T or F: Ultraviolet radiation (UVR) is a proven human carcinogen classified as Group 1

Answer 24

True

Question 25

T or F: Just one indoor tanning session increases risk of melanoma by 20%; each additional session increases the risk 2%

Answer 25

True

Question 26

Skin Cancer Prevention methods

Answer 26

– Sun avoidance (stay inside and play videogames)
– Sun protective clothing (Long-sleeved shirt) – Shade
– Sunscreen
– Sombrero (Wide-brimmed Hat)…why?
– Sunglasses

Question 27

T or F: Windows protect against UVB, but do not filter UVA.

Answer 27

true

Question 28

Will sunscreens limit the amount of vitamin D I get?

Answer 28

Individuals concerned about not getting enough vitamin D should discuss with their doctor the options for obtaining vitamin D through foods and/or a vitamin supplement