Dermatologic Surgery

Question 1

Most common cancer in the US

Answer 1

Skin Cancer, 80% of which are BCC (basal cell carcinoma)

Question 2

Which skin cancer is responsible for the most fatalities?

Answer 2

Myeloma

-only 4% of new cancer diagnoses, but are the most lethal

Question 3

Is BCC or SCC more likely to metastasize?

Answer 3

BCCs basically never metastasize => SCC can

Question 4

What is the mortality from nonmelanoma skin cancers?

Answer 4

Super low- like 1-2% (most of which are from metastatic SCC)

> 95% cure rate if BCC/SCC are detected and treated early

Question 5

Distinguish cumulative skin exposure vs. sun bursts and which skin cancer they’re associated with?

Answer 5

Cumulative skin exposure = accumulation over time (so older pts) w/ tons of sun exposure is associated w/ BCC

While sun bursts = short time in the sun causing blistering sun burn is associated w/ MM (malignant melanoma)

Question 6

What are the 3 most common locations for NMSC?

Answer 6

Nonmelanoma skin cancers (BCC and SCC) most commonly on sun-exposed areas

> 80% on upper limbs, head, and neck

Question 7

Risk factors for all skin cancers besides sun exposure

Answer 7

Fair complexion, light hair, light eyes

Question 8

Why are BCCs removed?

Answer 8

Basal cell carinomas won’t metastasize, but can be very locally invasive and disfiguring => remove while they’re small

Question 9

What environmental factor is responsible for a peak in deaths from BCC in young women

Answer 9

Tanning beds

Question 10

Describe the appearance of a BCC

Answer 10

Basal cell carcinoma: pearly white papule w/ slightly elevated border and indented center
-telangectases

Question 11

Pearly white

Answer 11

Hallmark/buzz word for basal cell carcinoma

Question 12

Hyperkeratinized

Answer 12

Hallmark/buzz word for squamous cell carcinoma

Question 13

What is a subtype of BCC that is more invasive than pearly ulcerated lesions?

Answer 13

Morpheaform = ‘scar like’ basal cell carcinomas

• poorly defined borders
• less frequent, but are usually more aggressive/deeper

Question 14

What are the

(a) 1st
(b) 2nd

most common cutaneous malignancies

Answer 14

Most common cutaneous malignancies

a) 1st = BCC (basal cell carcinoma
(b) 2nd = SCC (squamous cell carcinoma)

Question 15

What is the name for precancerous skin lesions?

Answer 15

Actinic Keratoses (AK)

Question 16

What does presence of actinic keratoses indicate?

Answer 16

Identifies high risk pts that are predisposed to other skin cancers (ex: SCC and BCC)
-often marker of sun exposure

Question 17

What percent of actinic keratoses transform into malignancy?

Answer 17

8% of actinic keratoses progress to SCC

Question 18

Prognosis of actinic keratoses

Answer 18

99% cure rate w/ cryosurgery (liquid nitrogen )

-often use photodynamic or laser therapy for a more systemic form of treatment

Question 19

Why is it so important to catch malignant melanomas quickly?

Answer 19

Once it’s spreads it’s not very responsive to chemo or radiation, so once it metastasizes => dismal prognosis

-if caught early: can be caught out easily under local anesthesia

5 year prognosis
-99% if detected and treated before spreading

Question 20

What epidemiological factor separates malignant melanomas from the other most common causes of cancer in the US?

Answer 20

Malignant melanoma = 6th most common cancer in the US

-only one of the 7 most common that is increasing incidence

Question 21

Dysplastic nevi increase risk of which skin cancer?

Answer 21

Dysplastic nevi are a risk factor unique to melanoma

• tons of atypical moles (dysplastic nevi) = risk factor for malignant melanoma
• nevi themselves can become melanoma or the skin in general is at an increased risk

Question 22

What clinical feature is the best prognostic indicator for malignant melanoma?

Answer 22

Prognosis is directly proportional to thickness of melanoma

Question 23

ABCDEs of malignant melanoma

Answer 23

A = asymmetrical
B = border irregularity 
C = color variability
D = diameter (not really used anymore)
E = evolution

Question 24

Where do African Americans commonly get melanomas?

Answer 24

Between toes or on soles of feet

Question 25

What is a nodular melanoma?

(a) Appearance
(b) Distinguishing features

Answer 25

Nodular melanoma = black nodule

-tend to be very deep and invasive, high rate for metastasis

Question 26

What is cryosurgery

Answer 26

Liquid nitrogen

Question 27

What is Mohs surgery?

Answer 27

skin cancer surgery: remove skin cancer w/ about 1 cm margin, do margin to see if margins are clear, then reconstruct

Question 28

What is selective photothermolysis?

Answer 28

Laser therapy: brief irradiation w/ laser light pulse

Question 29

Indications for laser therapy

Answer 29

• benign pigmented lesions: birthmarks, freckles
• vascular lesions: hemangiomas, telangectasias
• tattoo removal
• wart ablation
• hair removal
• photorejuvenation/acne scaring

Question 30

Indications for botox

Answer 30

Wrinkles, sweating, migraines