Cutaneous Onoclogy

Question 1

Name two genetic conditions that may pre-dispose youth cutaneous cancer.

Answer 1

basal cell nevus syndrome (loss of tumor suppression)

xeroderma pigmentosum (impaired DNA repair)

note the immune system plays a major role in promoting/ controlling cancer

Question 2

Describe conditions on the spectrum of malnocytic lesions.

Answer 2

common nevi (junctional, compound, dermal), small and medium congenital nevi and dysplastic nevi, 
melanoma

Question 3

What are the clinical features of benign melanocytic nevi?

Answer 3

groups of melanocytes in the skin,
distribution and number related to genetics
number of nevi associated with melanoma risk
3 types junctional, compound and dermal
born with few, gain more from late childhood to mid 30’s; should be oval to round and well-circumscribed

Question 4

Compare and contrast junctional, compound and dermal nevi.

Answer 4

junctional: flat dark mark (1st/2nd decade)
compound: occur at the junction at the dermis, appear lighter and raised
dermal are within the dermis and are domed pink papules

Question 5

What are the treatments for common nevi?

Answer 5

reassurance that it is not cancerous, discuss photo protection, excise (if changing or atypical, repeatedly traumatized or cosmetic)

Question 6

What are the clinical presentation of congenital nevi?

Answer 6

present at birth
small, medium or large
frequently cobbled and develop coarse hair
giant congenital nevi have an increased risk of melanoma

Question 7

What is the clinical presentation of dysplastic nevi?

Answer 7

nevi with atypical cells and abnormal nevus architecture, variegated tan, brown or pink, irregular shape, indistinct borders and frequently >5mm that continue to develop throughout life not normally apparent until puberty, common on trunk; excision is warranted in giant nevi or with serverely displastic nevi

Question 8

Describe the prevalence and risk factors of melanoma.

Answer 8

malignant proliferation of melanocytes accounts for 75% of cancer deaths although it it not the most common kind
risk factors include:
numerous, large, dysplastic nevi, history of melanoma, tanning, sunburn, higher SE, genie DNA repair defects and immunosuppression

Question 9

Describe the development of melanoma.

Answer 9

⅓ arise from nevi, ⅔ arise de novo, melanocytes lose their normal growth regulation and grow out radially then grow enter a vertical growth phase (most important marker is Breslow depth

Question 10

What doe the ABCDE of melanoma stand for?

Answer 10

asymmetry, borders, color, diameter and evolving

Question 11

What are the 4 subtypes of melanoma?

Answer 11

superficial spreading(60-70%, long radial growth phase), nodular (15-30%, shortest radial growth phase, fastest growing), lentigo maligna (5-15%), older adults, longest radial growth phase, flat asymmetric color variation, common on the face) a and acral lentiginous (5-10% common with darker skin types, palmar, plantar or subugual location)

Question 12

What is a Hutchinson sign?

Answer 12

blacken patch that spreads to the proximal nail fold

Question 13

What is the standard treatment for melanoma?

Answer 13

wide excision with appropriate margins, setinal lymph node biopsy for melanomas (1-4 mm depth), close follow-up with skin exams and lymph node surveillance

Question 14

What is the single greatest predictor of survival of melanoma prognosis?

Answer 14

Breslow depth, lymph node or distant metastases make the disease more difficult to treat

Question 15

What are often difficult to differentiate from melanoma?

Answer 15

dysplatic nevi

Question 16

What is an epidermoid cyst?

Answer 16

trapped epidermal cells caused by injury to the skin or blocked hair follicle which becomes a pocket of macerated keratin.

Question 17

What is the clinical presentation of an epidermoid cyst?

Answer 17

domed nodule (compressible and mobile subcutaneous mass attached to epidermis), foul-smelling, ricotta cheese like keratin may be expressed, rupture may lead to inflammation but true infection is rare

Question 18

What is the treatment for a epidermoid cyst?

Answer 18

intralesional steroids or oral antibiotics if inflamed, if excised, must excise entire cyst if recurrently inflamed (do not excise when actively inflamed)

Question 19

What is a seborrheic keratosis/ clinical presentation?

Answer 19

benign overgrowth of the epidermis which is common is 40s or 50s which can be flesh-colored, tan, brown or black most common to appear no the trunk (grow on top of skin)

note: pseudohorn cysts grow with pearls of keratin

Question 20

How are seborrheic keratosis treated?

Answer 20

inflamed lesions can be scrapped up (curettage) or frozen off cyrotherapy and reassurance

Question 21

What is actinic keratosis/ clinical presentation?

Answer 21

sun-induced, pre-cancerous lesions of the epidermis where DNA damage causes dysregulation of the cell cycle and differentiation. presents as pink to red sandpapery papules (better felt than seen) on sun-exposed areas

Question 22

Are actinic keratosis dangerous?

Answer 22

only 1-2% convert to squamous cell carcinoma, but be suspicious is lesion: persists after treatment, rapidly grows, becomes indurated or ulcerated/mucosal

Question 23

Squamous cell carcinoma is the second most common skin cancer and is 3x more likely than BCC to affect people who are _____. SCC affects which areas?

Answer 23

immunocompromised; affects sites lined with squamous epithelium (skin, mouth, esophagus, penis, anal mucosa with high risk for metastasis with lips, ears, perianal/genital regions and hand)

Question 24

What might cause pathogenesis of SCC?

Answer 24

DNA disruption (UV or HPV, chemical carcinogens), chronic inflammation (ulcers or burns) or may progress from actinic keratosis

Question 25

What is the clinical presentation of SCC?

Answer 25

well demarcated, thin plaque, resembling a superficial BCC, AK, eczema or psoriasis

Question 26

What is Bowen’s carcinoma?

Answer 26

in- situ SCC

Question 27

What differentiates a squamous cell carcinoma?

Answer 27

invasive SCC is an erythematous plaque or nodule, that is scaly, has an indurated base and may become ulcerated

Question 28

What is the treatment for SCC?

Answer 28

low risk sites can be treated with excision, high risk or large tumor should be treated with Mohs (prognosis with metals is very poor)

Question 29

Where is basal cell carcinoma most common?

Answer 29

malignant tumor of the basal keratinocyte, it is the most common cancer in the US, 90% is found on the head and neck (nose being most common and is more likely with immunocompetent patients

Question 30

What are the 3 subtypes of basal cell carcinoma?

Answer 30

nodular (50-80%), superficial (15%) and morpheaform (5%)

Question 31

Describe the clinical presentation of basal cell carcinoma.

Answer 31

nodules of basaloid cells in the dermis, appears pearly or translucent, often with talangectasias, rolled border and friable (may have a central erosion or ulceration

Question 32

Describe the clinical presentation of superficial basal cell carcinoma.

Answer 32

erythmatous thin plaque with an overlying scale which is slow glowing which favors the trunk, caused by a basaloid tumor cells budding directly into the epidermis (subtlies- translucency, friability/crusting, rolled border)

Question 33

Describe the clinical presentation of basal cell carcinoma morfeaform.

Answer 33

most aggressive subtype, presents with depressed, atrophic, scar-like hypo pigmented papules with indistinct margins (occurs with infiltration of surrounding skin)

Question 34

What is the prognosis for BCC?

Answer 34

very rarely metastasizes, untreated can lead to significant local tissue destruction; higher risk if in the mask area of the face

Question 35

Define Mohs micrographic surgery. What type of cancer is it used for?

Answer 35

systematic and methodical way of removing skin cancers and sectioning the tissue which achieves a smaller margin of normal skin with greater assurance of a cure; for high-risk non-melaonma skin cancers in critical sites

allows for examination of all margins that were in contact with the patient

Question 36

What are the disadvantages of Mohs micrographic surgery?

Answer 36

time consuming and expensive (controversial for some tumors ie. melanoma)