epithelial malignancies 1 and 2

Question 1

what is the most common form of skin cancer?

how many people are diagnosed with this form per year?

Answer 1

Basal Cell Carcinoma

nearly 3 million cases diagnosed annually

Question 2

what population groups are at the highest risk for Basal Cell Carcinoma (BCC)?

Answer 2

Affected patients are typically over 40 years of age, have a fair complexion and a history of chronic sun exposure

Question 3

what percent of BCC’s are found on the head/neck region?

Answer 3

80%

Question 4

most basal cell carcinomas develop in what region?

Answer 4

middle third of the face

Question 5

what is the most common type of clinical presentation of basal cell carcinoma?

Answer 5

Nodulo-ulcerative

Question 6

what are the clinical features of a Nodulo-ulcerative BCCa?

Answer 6

Umbilicated pearly papule that may show central ulceration

Lack of adnexal skin structures (hair)

Question 7

what are the histopathological finding for Basal cell carcinoma?

Answer 7

A) Basaloid cells that appear to “drop off” of the basal cell layer of the epidermis

B) Nodulo-ulcerative - large lobules of tumor cells are characteristic

Question 8

T/F: Pigmentation of Basal cell carcinoma is relatively rare

Answer 8

False

Pigmented lesions are not rare

Question 9

Pigmented BCCa lesions can resemble what other type of lesion?

Answer 9

Resemble melanocytic nevi due to the presence of benign melanocytic colonization

Question 10

how can a pigmented BCCa be differentiated from a melanocytic nevus?

Answer 10

History of relatively short (weeks-months) duration and lack of hair should help distinguish this lesion from a nevus

Question 11

Most Basal cell carcinomas have a nodulo-ulcerative pattern, with large lobules of tumor cells invading what layer of the dermis?

Answer 11

the superficial connective tissue

Question 12

why do some BCCa’s become pigmented?

Answer 12

activation of benign melanocytes

Question 13

what is the most aggressive (and most rare) form of basal cell carcinoma?

Answer 13

Sclerosing (morpheaform) basal cell carcinoma

Question 14

what do Sclerosing (morpheaform) Basal cell carcinomas resemble clinically?

Answer 14

Clinically resemble a scar

- due to the induction of collagen formation by the tumor cells

Question 15

what are the histological characteristics of Sclerosing BCCa?

Answer 15

characterized by tiny infiltrative nests of tumor cells in a collagenous background

Question 16

T/F: it is difficult to clinically determine the borders of a Sclerosing BCCa

Answer 16

True

Very difficult to assess borders clinically because of this infiltrative growth pattern

Question 17

what treatments are available for BCCa?

Answer 17

Scalpel excision
Electrocautery and curettage
Cryotherapy
Topical agents (5-FU, imiquimod)
Mohs micrographic surgery

Question 18

over __% of patients with Basal cell carcinoma are cured after the first treatment

Answer 18

95%

Question 19

when would you perform Mohs surgery on a Basal cell carcinoma patient?

Answer 19

Larger lesions, recurrent lesions and tumors in areas of embryonic fusion

Question 20

what is the most common oral malignancy?

Answer 20

Squamous Cell Carcinoma

Question 21

T/F: Squamous Cell Carcinoma is the second most common cutaneous malignancy

Answer 21

true

Question 22

from what cell type do SCCa’s arise? in what areas of the face are UV related SCCa’s found?

Answer 22

Arises from surface epithelial cells

Skin and lower vermilion zone of the lip cancers are due to UV light exposure

Question 23

Cutaneous SCCa’s often arise from what type of pre-existing lesions?

Answer 23

Actinic Keratosis

Due to chronic sun (ultraviolet light) exposure

Question 24

what areas of the body are at highest risk for developing SCCa?

Answer 24

Face, helix of ear, dorsum of hands and arms are common sites

Question 25

T/F: actinically-induced squamous cell carcinomas are well-differentiated and grow slowly

Answer 25

true

Question 26

what % of Oral Squamous Cell Carcinomas are associated with smoking?

Answer 26

75-80%

Question 27

what areas in the mouth are at risk for SCCa in people with NO identifiable risk factors?

Answer 27

lateral tongue of younger people or gingiva of older women

Question 28

Oral squamous cell carcinoma accounts for about _____% of all cancers in the US

Answer 28

3-4

Question 29

what population groups are at highest risk for SCCa?

Answer 29

Most occur in adults over 45 years Men outnumber women by a 2.5:1 margin

Question 30

clinical features of Squamous cell carcinoma lesions:

Answer 30

A) Irregular shape, mixture of red and white clinically B) Often ulcerated C) Exophytic (growing out) or endophytic (growing in) growth pattern D) Often much firmer than surrounding tissues

Question 31

T/F: Oral SCCa is usually asymptomatic until late stages

Answer 31

True

Question 32

when would a Squamous cell carcinoma show a ragged radiolucency?

Answer 32

characteristic of lesions that involve underlying bone

Question 33

Characteristics of SCCa of the LIP:

Answer 33

1) Commonly involved site 2) Secondary to chronic sun (UV) exposure 3) Arises in the setting of actinic cheilitis 4) Slow-growing, well-differentiated lesions usually

Question 34

what is the most common location of an oral SCCa?

Answer 34

Lateral tongue | its almost always the location in patients under 40

Question 35

a history of smoking will increase the risk of oral SCCa in what areas?

Answer 35

A) lateral tongue | B) floor of mouth