Derm part 1: cancers Flashcards
What is squamous cell carcinoma?
Carcinoma rising from epidermal cells
What are the most common sites of squamous cell carcinoma?
Head
Neck
Hands
RFs for squamous cell carcinoma
Sun exposure Pale skin Chronic inflammatory process Immunosuppression Xeroderma pigmentosum Arsenic
What is a precursor skin lesion to squamous cell carcinoma?
Actinic keratosis
S/sx of squamous cell carcinoma
Raised, slightly pigmented skin lesion
Ulceration/exudate
Chronic scab
Itching
How is the diagnosis of squamous cell carcinoma made?
Small lesion- excisional bx
Large lesions- incisional bx
What is the tx for squamous cell carcinoma?
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)
What is the sign of metastasis of squamous cell carcinoma?
Palpable LNs (remove involved LN basin)
What is Marjolin’s ulcer?
Squamous cell carcinoma that arises in an area of chronic inflammation
What is the prognosis of squamous cell carcinoma?
Excellent if totally excised
Most pts with pos LN metastasis eventually die from metastatic disease
What is the tx for solitary metastasis in squamous cell carcinoma?
Surgical resection
What is basal cell carcinoma?
Carcinoma arising in the germinating basal cell layer of epithelial cells
RFs of basal cell carcinoma
Sun exposure Fair skin Radiation Chronic dermatitis Xeroderma pigmentosum
What are the most common sites of basal cell carcinoma?
Head
Neck
Hands
S/sx of basal cell carcinoma
Slow-growing skin mass (chronic, scaly) Scab Ulceration With or without pigmentation Often described as pearl-like
How is the diagnosis of basal cell carcinoma made?
Excisional or incisional bx
What is the tx of basal cell carcinoma?
Resection with 5 mm margins (2 mm margin in cosmetically sensitive areas)
What is the risk of metastasis in basal cell carcinoma?
Very low (recur locally)
What is melanoma?
Neoplastic disorder produced by alignant transformation of the melanocyte
Which pts are at greatest risk for melanoma?
White pts with blonde/red hair Fair skin Freckling Hx of blistering sunburns Blue/green eyes Actinic keratosis F>M
What are the three MC sites of melanoma?
Skin
Eyes
Anus
What is the MC site of melanoma in AAs?
Palms of the hands
Soles of the feet
What characteristics are suggestive of melanoma?
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
What are the ABCDs of melanoma?
Asymmetry
Border irregularity
Color variation
Diameter >6 mm and dark lesion
Associated RFs of melanoma
Severe sunburn before age 18 Giant congenital nevi FHx Race (white) UV radiation (sun) Multiple dysplastic nevi
How does location of melanoma differ in men and women?
Men get more lesions on the trunk
Women on the extremities
What locations of melanoma are more unusual?
Noncutaneous regions, such as mucous membranes of the vulva/vagina, anorectum, esophagus, and choroidal layer of the eye
What is the MC site of melanoma in women?
Legs
What is the MC site of melanoma in men?
Back
What are the four major histologic types of melanoma?
Superficial spreading
Lentigo maligna
Acral lentiginous
Nodular
Superficial spreading melanoma
Occurs in both sun-exposed and non-exposed areas
Most common of all melanomas
Lentigo maligna melanoma
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
Acral lentiginous melanoma
Occurs on the palms, soles, subungual areas, and mucous membranes
Most common melanoma in AA pts
Nodular melanoma
Vertical growth pedominates
Lesions are usually dark
Most aggressive type/worst prognosis
Amelonotic melanoma
Melanoma from melanocytes but with obvious lack of pigment
What are the common sites of metastasis of melanoma?
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
How is dx made of melanoma?
Excisional bx (complete removal leaving only normal tissue) or incisional bx for very large lesions
What is the role of shave bx in melanoma?
No role
When is elective LN dissection recommended in melanoma?
Controversial- possible advantage in melanomas 1-2 mm in depth but jury still out
Sentinel node bx if >1 mm is becoming very common
What is the melanomin tumor marker?
S-100
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?
0.5 cm margin
1 cm margin
2 cm margin
3 cm margin
What is the tx for digital melanoma?
Amputation
What is the tx of palpable LN metastasis in melanoma?
Lymphadenectomy
What factors determine the prognosis of melanoma?
Depth of invasion and metastasis are the most important factors
What is the workup to survey for metastasis in the pt with melanoma?
PE
LFTs
CXR (bone scan/CT scan/MRI reserved for sx)
What is the tx of intestinal metastasis in melanoma?
Surgical resection to prevent bleeding/obstruction
What is FDA-approved adjuvant therapy for melanoma?
Interferon alpha-2b (for stages IIB/III)
What is the tx of unresectable brain metastasis in melanoma?
Radiation
What is the tx of isolated adrenal metastasis in melanoma?
Surgical resection
What is the tx of isolated lung metastasis in melanoma?
Surgical resection
What is the MC symptom of anal melanoma?
Bleeding
What is the tx of anal melanoma?
APR or wide excision
