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Surgery Rotation > Derm part 1: cancers > Flashcards

Derm part 1: cancers Flashcards

1
Q

What is squamous cell carcinoma?

A

Carcinoma rising from epidermal cells

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2
Q

What are the most common sites of squamous cell carcinoma?

A

Head
Neck
Hands

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3
Q

RFs for squamous cell carcinoma

A 
Sun exposure
Pale skin
Chronic inflammatory process
Immunosuppression
Xeroderma pigmentosum
Arsenic
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4
Q

What is a precursor skin lesion to squamous cell carcinoma?

A

Actinic keratosis

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5
Q

S/sx of squamous cell carcinoma

A

Raised, slightly pigmented skin lesion
Ulceration/exudate
Chronic scab
Itching

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6
Q

How is the diagnosis of squamous cell carcinoma made?

A

Small lesion- excisional bx

Large lesions- incisional bx

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7
Q

What is the tx for squamous cell carcinoma?

A 
Small lesion (<1 cm): excise with 0.5 cm margin
Large lesion: (>1 cm): resect with 1-2 cm margins of nl tissue (large lesions may require skin graft/flap)
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8
Q

What is the sign of metastasis of squamous cell carcinoma?

A

Palpable LNs (remove involved LN basin)

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9
Q

What is Marjolin’s ulcer?

A

Squamous cell carcinoma that arises in an area of chronic inflammation

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10
Q

What is the prognosis of squamous cell carcinoma?

A

Excellent if totally excised

Most pts with pos LN metastasis eventually die from metastatic disease

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11
Q

What is the tx for solitary metastasis in squamous cell carcinoma?

A

Surgical resection

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12
Q

What is basal cell carcinoma?

A

Carcinoma arising in the germinating basal cell layer of epithelial cells

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13
Q

RFs of basal cell carcinoma

A 
Sun exposure
Fair skin
Radiation
Chronic dermatitis
Xeroderma pigmentosum
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14
Q

What are the most common sites of basal cell carcinoma?

A

Head
Neck
Hands

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15
Q

S/sx of basal cell carcinoma

A 
Slow-growing skin mass (chronic, scaly)
Scab
Ulceration
With or without pigmentation
Often described as pearl-like
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16
Q

How is the diagnosis of basal cell carcinoma made?

A

Excisional or incisional bx

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17
Q

What is the tx of basal cell carcinoma?

A

Resection with 5 mm margins (2 mm margin in cosmetically sensitive areas)

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18
Q

What is the risk of metastasis in basal cell carcinoma?

A

Very low (recur locally)

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19
Q

What is melanoma?

A

Neoplastic disorder produced by alignant transformation of the melanocyte

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20
Q

Which pts are at greatest risk for melanoma?

A 
White pts with blonde/red hair
Fair skin
Freckling
Hx of blistering sunburns
Blue/green eyes
Actinic keratosis
F>M
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21
Q

What are the three MC sites of melanoma?

A

Skin
Eyes
Anus

22
Q

What is the MC site of melanoma in AAs?

A

Palms of the hands

Soles of the feet

23
Q

What characteristics are suggestive of melanoma?

A 
Usually a pigmented lesion with an irregular border, irregular surface, or irregular coloration
Other clues:
Darkening of a pigmented lesion
Development of pigmented satellite lesions
Irregular margins or surface elevations
Notching
Recent or rapid enlargement
Erosion or ulceration of surface
Pruritis
24
Q

What are the ABCDs of melanoma?

A

Asymmetry
Border irregularity
Color variation
Diameter >6 mm and dark lesion

25
Q

Associated RFs of melanoma

A 
Severe sunburn before age 18
Giant congenital nevi
FHx
Race (white)
UV radiation (sun)
Multiple dysplastic nevi
26
Q

How does location of melanoma differ in men and women?

A

Men get more lesions on the trunk

Women on the extremities

27
Q

What locations of melanoma are more unusual?

A

Noncutaneous regions, such as mucous membranes of the vulva/vagina, anorectum, esophagus, and choroidal layer of the eye

28
Q

What is the MC site of melanoma in women?

A

Legs

29
Q

What is the MC site of melanoma in men?

A

Back

30
Q

What are the four major histologic types of melanoma?

A

Superficial spreading
Lentigo maligna
Acral lentiginous
Nodular

31
Q

Superficial spreading melanoma

A

Occurs in both sun-exposed and non-exposed areas

Most common of all melanomas

32
Q

Lentigo maligna melanoma

A

Malignant cells that are superficial, found usually in elderly pts on the head or neck
Called Hutchinson’s freckle if noninvasive
Least aggressive type; very good prognosis
Accounts for <10% of all melanomas

33
Q

Acral lentiginous melanoma

A

Occurs on the palms, soles, subungual areas, and mucous membranes
Most common melanoma in AA pts

34
Q

Nodular melanoma

A

Vertical growth pedominates
Lesions are usually dark
Most aggressive type/worst prognosis

35
Q

Amelonotic melanoma

A

Melanoma from melanocytes but with obvious lack of pigment

36
Q

What are the common sites of metastasis of melanoma?

A

Nodes (local)
Distant: lung, liver, bone, heart, and brain
Melanoma has a specific attraction for small bowel mucosa
Brain metastases are a common cause of death

37
Q

How is dx made of melanoma?

A

Excisional bx (complete removal leaving only normal tissue) or incisional bx for very large lesions

38
Q

What is the role of shave bx in melanoma?

A

No role

39
Q

When is elective LN dissection recommended in melanoma?

A

Controversial- possible advantage in melanomas 1-2 mm in depth but jury still out
Sentinel node bx if >1 mm is becoming very common

40
Q

What is the melanomin tumor marker?

A

S-100

41
Q 
What is the recommende size of surgical margin for depth of invasion:
Melanoma in situ?
Less than or equal to 1 mm thick?
1-4 mm thick?
>4 mm thick?
A

0.5 cm margin
1 cm margin
2 cm margin
3 cm margin

42
Q

What is the tx for digital melanoma?

A

Amputation

43
Q

What is the tx of palpable LN metastasis in melanoma?

A

Lymphadenectomy

44
Q

What factors determine the prognosis of melanoma?

A

Depth of invasion and metastasis are the most important factors

45
Q

What is the workup to survey for metastasis in the pt with melanoma?

A

PE
LFTs
CXR (bone scan/CT scan/MRI reserved for sx)

46
Q

What is the tx of intestinal metastasis in melanoma?

A

Surgical resection to prevent bleeding/obstruction

47
Q

What is FDA-approved adjuvant therapy for melanoma?

A

Interferon alpha-2b (for stages IIB/III)

48
Q

What is the tx of unresectable brain metastasis in melanoma?

A

Radiation

49
Q

What is the tx of isolated adrenal metastasis in melanoma?

A

Surgical resection

50
Q

What is the tx of isolated lung metastasis in melanoma?

A

Surgical resection

51
Q

What is the MC symptom of anal melanoma?

A

Bleeding

52
Q

What is the tx of anal melanoma?

A

APR or wide excision

Surgery Rotation (19 decks)

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