DD malignant tumors

Question 1

Basal cell carcinoma subtypes

Answer 1

○ Nodular
○ Superficial (can see bleeding)
○ Infiltrative
○ Sclerosing (morpheaform)

Question 2

Most common pre-malignant skin lesion.

Answer 2

Actinic keratosis

○ Eventually develop into squamous cell carcinoma (1/1000 )

Question 3

Squamous cell carcinoma (SCC) subtypes

Answer 3

• Squamous cell carcinoma in situ (Bowen’s disease)

- Keratoacanthoma

Question 4

Melanoma ABCDE

Answer 4

Assymetry
Border
Color
Diameter
Evolving

Question 5

Melanoma subtypes

Answer 5

○ Superficial spreading
○ Nodular
○ Lentigo Maligna Melanoma
○ Acral Lentiginous

Question 6

Kaposi’s Sarcoma:

- 3 Types:

Answer 6

○ Classic
○ Lymphadenopathic
○ AIDS associated

Question 7

Smoking is a risk for what type of carcinoma?

Answer 7

• Smoking

○ Risk ONLY for SCC

Question 8

Melanoma risk factors

Answer 8

• Mutation in the BRAF gene, defective DNA repair

○ This is not inherited
○ Occurs during development of melanoma
     ○70% of the time arise de novo.

Question 9

actinic keratoses (AKs) are precursors to ______

Answer 9

squamous cell carcinoma

Question 10

BCC = patch 1 mutation

Answer 10

• The patch 1 gene is a tumor suppressor gene
○ BCC comes from pluripotent cells due to mutations in the hedgehog pathway

hedgehog pathway unable to signal PTCH1 –> PTCH1 is unable to inactivate SMO (smoothened) –> it goes on to signal tumor growth

Question 11

Vismodegib

Answer 11

cancer drug that inhibits SMO (smoothened) if PTCH1 is faulty

Question 12

BRAF mutation

Answer 12

Normal BRAF - normal cell growth
Mutated BRAF - uncontrolled cell proliferation
• Remember… this is UV damage in melanoma
• It is NOT inherited
• Mutation on the B-Raf protein (most common is V600E mutation)

Question 13

Vemurafenib

Answer 13

inhibits BRAF, causes programmed cell death in melanoma lines → MEK signaling → ↓ cell survival & proliferation

Question 14

Breslow depth

Answer 14

• Maximal thickness of tumor invasion measured by an ocular micrometer
  
  • Measured from top of granular layer of epidermis to the base of neoplasm
  • MOST IMPORTANT prognostic factor for melanoma

Question 15

Clark Level:

Answer 15

• How far melanoma has penetrated into the skin without measuring it
• Higher number (5)= deeper

1: confined to epidermis
2. invasion of papillary dermis
3. filling of papillary dermis but not extending to reticular dermis
4. invasion of reticular dermis
5. invasion of the deep, subcutaneous tissue

Question 16

Curettage

Answer 16

Looped blade scrapes tumor away from normal skin

- used for Nodular BCC and superficial BCC

Question 17

• If you have Stage IV or Recurrent melanoma:

treatment?

Answer 17

a. Immunotherapy
i. Ipilimumab to block CTLA-4 which allows T-cell activation
ii. Interleukin-2 response with high-dose regimens
b. Signal transduction inhibitors
i. Vemurafenib
c. Chemotherapy
d. Palliative local therapy