Cutaneous Malignancies Flashcards
Most common invasive malignant cutaneous neoplasm
Basal cell carcinoma
Most common presenting complaint with BCC
Bleeding or scabbing sore that heals and recurs
BCC advances by ______ ______ and destroys normal tissue
Direct extension
The average lifetime risk for Caucasians to develop BCC is 30%. It most commonly occurs in adults, especially in the _____ population
Elderly
Risk factors for BCC
Main risk factor is UVB radiation exposure
Fair skin, blonde or red hair, light eye color, poor tanning ability, and sun-damaged skin
Pathogenesis of BCC
Arise from epidermal basal keratinocytes and adnexal structures (e.g., hair follicles, eccrine sweat glands)
UVB radiation damages DNA and its repair system and alters the immune system
Grows by direct extension, appears to require the surrounding stroma to support its growth
85% of BCC appear in head and neck region, with the most common site being the _____
Nose
Most common form of BCC
Nodular BCC
What type of skin lesion begins as a pearly white or pink, dome-shaped papule that then extends peripherally, may remain flat, have prominent telangiectatic vessels, irregular growth pattern that may become multilobular, and frequently shows ulceration at the center?
BCC (nodular)
If you see a lesion that seems like it might be squamous, but has more ulceration, umbilication, or multinodularity to it, what is it more likely to be?
Basal cell carcinoma
Which is more likely to metastasize — BCC or SCC?
SCC!
Unlike BCCs, cutaneous SCCs are associated with a substantial risk of metastasis
SCCs are often separated into 2 major groups based on their malignant potential — what are the 2 groups?
High frequency of metastasis = SCC arising in areas of prior radiation or thermal injury, in chronic draining sinuses, and in chronic ulcers
Less likely to metastasize = SCC originating in actinically damaged skin
Like BCC, SCCs are most common in sun-exposed areas. However, distribution of SCC is different, as these are found in areas where BCC is rarely found — where are these areas?
Scalp
Backs of the hands
Superior surface of the pinna
When comparing SCC and BCC in terms of sun-exposure as a risk factor, _______ is more dose dependent (thus it may be found in younger patients) while _________ is more based on cumulative exposure (thus it is found in older patients)
BCC; SCC
Is a flat, scaly lesion more likely to be BCC or SCC?
SCC
Describe clinical presentation of SCC
SCCs arising from actinic keratosis may have thick, adherent scale that is often red and inflamed
Tumor is soft and freely moveable
Cutaneous horns may begin as actinic keratosis and degenerate into SCC
Which of the following is the most common type of melanoma, which begins with initial radial growth phase before invasion?
A. Superficial spreading
B. Lentigo maligna
C. Acral lentiginous
D. Nodular
A. Superficial spreading
Which of the following types of melanoma has a generally poor prognosis because of invasive growth from onset?
A. Superficial spreading
B. Lentigo maligna
C. Acral lentiginous
D. Nodular
D. Nodular
Which of the following types of melanoma has a long growth phase before invasion and is most common in elderly and in sun-exposed areas?
A. Superficial spreading
B. Lentigo maligna
C. Acral lentiginous
D. Nodular
B. Lentigo maligna
Which of the following types of melanoma is the most common form in darkly pigmented patients, occurs on palms and soles, mucosal surfaces, nail beds, etc., and has aggressive biologic behavior?
A. Superficial spreading
B. Lentigo maligna
C. Acral lentiginous
D. Nodular
C. Acral lentiginous
Suspicion for melanoma should be raised by a pigmented skin lesion that is _____ in diameter, asymmetric, has an irregular surface or border, or has variation in color
> 6 mm
ABCDs of malignant melanoma recognition
Asymmetry
Border irregularity
Color variation
Diameter enlargement
In terms of the ABCDs of malignant melanoma recognition, changes in _____ and ______ are important early signs and shoul always increase suspicion, while _____ and ______ are late signs
Shape; color; ulceration; bleeding
What change in color of a melanoma indicates pigment deep in dermis and is a sign of increasing depth of tumor?
Blue
What change in color of melanoma indicates areas of regression or inflammation?
White
Growth phases of melanoma
Initial phase = months to years (flat, not palpable, slight color variation, indistinguishable from other early melanomas)
Radial growth phase = months to 10 years (irregular border, areas of regression with angular notching)
Vertical growth phase = months to years (numerous patterns, tumors palpable, plaque-like elevation with nodules in center, areas of ulceration and scaling)
T/F: Melanoma diagnosis, biopsy, or excision MUST BE REFERRED
True
Diagnosis of melanoma is made by excisional biopsy. What is the most important prognostic factor?
Depth of invasion (thickness)
[note that diagnostic excisional biopsy of suspected cutaneous melanoma must include 1-2 mm margin of normal skin and some subcutaneous fat]
What are some skin procedures for removing lesions?
Shave biopsy - most common
Punch biopsy
Excision and incision/wedge biopsy
Electrosurgery devices
Destructive techniques — cryotherapy, curettage, electrodessication
Many cancers can present with skin manifestations that are not due to metastases.
________ may be a presenting feature of lymphoma, leukemia, and CNS tumors
Pruritis
Many cancers can present with skin manifestations that are not due to metastases.
________ may precede cancers by many years and is particularly associated with gastric cancer
Acanthosis nigricans
Many cancers can present with skin manifestations that are not due to metastases.
________ may be associated with malignant melanoma and is possibly due to an immune response to melanocytes
Vitiligo
Many cancers can present with skin manifestations that are not due to metastases.
________ may occur in lymphoma, Kaposi’s sarcoma, and thymic tumors
Pemphigus
Many cancers can present with skin manifestations that are not due to metastases.
________ associated with celiac disease may precede tumor development by many years, and is associated with GI lymphoma
Dermatitis herpetiformis
Skin lesion with malignant potential that is characterized by scaly, erythematous macule or patch of skin that develops in sun-exposed areas of elderly and fair skinned individuals, and can expand slowly, becoming raised and crusty and may form hyperkeratotic horns or ulcers
Actinic (solar) keratosis
Localized patch of neoplastic cells that are confined to epidermis; appear as flat, erythematous and scaly plaque that is well demarcated but irregularly shaped. Can occur anywhere on the skin but typically sun-exposed areas, especially the legs. Slow growing only 3-5% progress to invasive disease more characteristic of an SCC
In situ or intra-epidermal SCC (Bowen’s disease)
In situ SCC affecting the glans penis or vulva is known as ___________________ and is associated with _______ infection
Erythroplasia of Queyrat; HPV
