Exam 2 - Skin Tumors Flashcards
what 3 questions should be asked for approaching a patient with a skin tumor? why is this important?
what is it? where is it? how do we get rid of it?
a lot of mistakes are made in private practice because treatment is prescribed before tumor type is ever known
what is tumor grade? why is it important?
it is determined by pathology - can’t be determined by cytology
gives prognostic indicators & different grading schemes are used for different tumor types
what is tumor stage?
determining where the tumor is located - looking to see if the tumor is localized or if it has spread to other parts of the body
local, regional, or distant
what are the 3 general tumor types?
- epithelial - carcinomas
- mesenchymal - sarcomas
- round cell - hematopoietic & mesenchymal origin
where do epithelial tumors arise from?
epithelial surfaces - skin, respiratory tract, gi tract, urinary tract
glands
organs
where do mesenchymal tumors arise from?
mesenchymal & connective tissue
where do round cell tumors arise from?
hematopoietic & mesenchymal origin
what is the easiest/cheapest way for figuring out tumor type?
stick a needle in it - FNA & cytology
why do you want to know the type of tumor your patient has?
allows for treatment planning
prognosis with & without therapy
direct staging
what is the difference between an incisional & excisional biopsy for approaching a patient with a tumor that couldn’t be diagnosed with cytology?
incisional - removal of part of the tumor (tru cut, punch, & wedge)
excisional - marginal excision of the entire tumor
when may incisional biopsy be preferred over excisional? what about excisional over incisional?
incisional if the tumor is located in an area with less skin - distal limb, prepuce, anus
excisional if in an area with a lot of skin
why is it important to plan when doing a biopsy for a patient with a skin tumor?
do NOT biopsy in a manner that may prevent or interfere with a definitive or curative surgical procedure later
T/F: surgery cures more cancer than any other treatment modality
true
the best chance for a cure/best outcome of neoplasia is with the _______ ___________
first surgery
what components make up staging a skin tumor?
dependent upon the tumor type - FNA of the draining lymph node, thoracic rads, abdominal ultrasound +/- FNA & cytology of liver & spleen, or CT/MRI for large infiltrative tumors
what are the 3 treatment modalities available for skin tumors?
surgery, radiation, & chemotherapy
treating or getting rid of a tumor is dependent on what?
what the tumor type is & where the tumor is (staging)
what does in situ mean?
carcinoma that has NOT penetrated the basement membrane of the epithelium - cells are neoplastic/dysplastic
what are some common skin tumors in dogs & cats arising from the follicular epithelium?
SCC in situ & SCC
what are some common skin tumors in dogs & cats arising from the hair follicle?
trichoblastoma complex
what are some common skin tumors in dogs & cats arising from glandular structures?
sebaceous gland tumors & apocrine gland tumors
what are some common skin tumors in dogs & cats arising from the ear canal?
hemangioma/hemangiosarcoma, melanoma, histocytoma, plasma cell tumor, & lymphoma
squamous cell carcinoma in situ is primarily a disease in what animals?
cats
what is actinic keratosis in regards to SCC in situ? what clinical signs does it cause?
SCC in situ that arises secondary to UV exposure affecting lightly haired animals with pigmented skin - white kitties with light noses that like to be in the sun (noses & ear tips)
solar elastosis & fibrosis of the skin
what clinical signs are seen in SCC in situ in cats?
erosions of the epidermis, proliferation, crusted plaques, +/- pain with palpation
what is bowen’s carcinoma?
SCC in situ that is occurring in MULTIPLE SITES!!!!
happens regardless of UV exposure
what locations do bowen’s carcinoma occur? what clinical signs are associated with it?
multiple sites - haired & unhaired areas, areas with & without UV exposure
heavily scaled!!!! crusted & pigmented papules & plaques +/- erosions
T/F: in a cat with bowen’s carcinoma, you will continue to see the animal develop lesions regardless of treatment
true
what lesion is this?
SCC in situ - white kitty that loves the sun :/
what is the prognosis of SCC in situ?
it is non-invasive - so metastasis has not occurred but if left alone & untreated, it could progress & eventually met
what is the treatment of choice for SCC in situ?
surgery!!!!!!
other options include - imiquimod cream, strontium plesiotherapy, photodynamic therapy, & cryosurgery
when is strontium-90 plesiotherapy useful for SCC/SCC in situ?
very small & very superficial lesions only!!
what is cryosurgery?
destruction of tissue with controlled use of freezing & thawing - 3 cycles are usually performed
how does cryosurgery work for destruction of tissue?
development of ice crystals both intracellularly & extracellularly resulting in cell death
when is cryosurgery useful for treating SCC in situ/SCC?
when it is a superficial lesion & is <4mm in diameter
T/F: a cat will look busted after cryosurgery, so you should warn the owner
true
what are the clinical signs associated with SCC?
variable clinical presentation - erythemic, ulcerated, crusted lesions
what is linked to causing SCC in cats?
UV exposure
T/F: metastasis at the time of death in cats with SCC is 40%
true
what is the treatment of choice for SCC?
surgery!!!!
what is the most common location for SCC in labs & goldens?
nasal planum in labs & golden retrievers
what dogs are at risk for getting cutaneous SCC?
breeds with light pigmentation & thin hair coat
bloodhounds, bassett hounds, standard poodles
T/F: like cats, SCC on the nasal planum in dogs is related to sun exposure
FALSE - not related to sun exposure in dogs!!!
very invasive & locally aggressive, mets reported in 25% of cases
T/F: in cutaneous SCC in dogs, there is a can be a link to UV exposure
true
T/F: radiation therapy for nasal planum SCC is effective
false - not effective
when is radiation therapy useful for SCC?
cutaneous forms - used in more so palliative care
what is the treatment of choice for SCC in dogs?
surgery!!!
is chemotherapy useful for treating SCC in dogs?
doesn’t appear to help
what is the treatment of choice for dogs & cats with trichoblastomas?
surgery
where are trichoblastoma tumors commonly seen in dogs & cats? what dog breeds are predisposed?
head & neck - dogs
head, neck, limbs, trunk - cats
poodles & setters
T/F: trichoblastomas are very common tumors seen in dogs & cats are are benign
true
what cat breed is at risk for trichoepitheliomas?
persian cats
what is the treatment of choice for trichoepitheliomas in dogs & cats?
surgery
what dog breeds are at risk for getting trichoepitheliomas?
bassett hounds, coonhounds, english springer spaniels, & setters
what anatomic locations are trichoepitheliomas commonly seen?
limbs, neck, & back - dermal tumors that can extend into the subcutis
what is malignant trichoepithelioma?
highly invasive tumor with invasion into surrounding tissues & has lymphatic involvement
what is the treatment of choice for malignant trichoepithelioma? why?
surgery with wide excision recommended!!!!
higher mitotic index & highly metastatic to regional lymph nodes & lungs!!!!
T/F: the benefit of adjuvant or systemic therapy is unknown when treating malignant trichoepithelioma
true
sebaceous adenomas are common in what animals?
dogs - rare in the cat
what dog breeds commonly get sebaceous adenomas?
mini schnauzer, beagles, poodles, & cocker spaniels
what is the treatment of choice for sebaceous adenoma?
surgery
what animals are commonly affected with sebaceous carcinomas? where are they commonly located?
uncommon tumor with local infiltration & rare mets but affects intact males - cavies, cocker spaniels, & terrier breeds
head & neck
what is the treatment of choice for sebaceous carcinomas?
surgery with wide margins
what dog breeds are commonly affected by apocrine gland tumors? where are they commonly seen?
uncommon malignant locally invasive tumor with low met rate but seen in treeing walker coonhounds & goldens on the front legs
what is the treatment of choice for apocrine gland tumors?
wide surgical excision
what tumor is this breed associated with?
apocrine gland tumors
T/F: apocrine gland tumors are the same as anal gland apocrine gland adenocarcinoma
false - not at all the same
what dogs are at risk for developing hemangiosarcoma due to UV exposure?
dogs with minimal skin pigmentation & thin hair coats - pitties, dalmatian, whippets
what dog is the poster child for cutaneous UV-exposure induced hemangiosarcoma?
whippets
T/F: cutaneous hemangiosarcoma is more common in the dog than in cats
true
what locations are cutaneous hemangiosarcomas seen?
inguinal & axillary region
around the muzzle
T/F: cutaneous dermal hemangiosarcoma without clinical or histological evidence of sub-dermal infiltration is often considered benign which is the opposite of hemangiosarcoma in other locations which is highly metastatic & aggressive
true
what are some poor prognostic factors of ear canal tumors in cats?
mitotic index of 2 or less
presence of neurological signs
histology
extension beyond the ear canal
what are some identified poor prognostic factors of ear canal tumors in dogs?
there is extension of the tumor beyond the ear canal
what does melanoma arise from?
melanocytes
T/F: melanomas involving the haired skin not in close proximity to mucosal margins often have benign behavior which is very different than oral malignant melanoma
true
what is the treatment for melanoma?
surgical excision with 1-2cm margins - often curative
what kind of tumor is seen in the picture?
melanoma
where do histiocytomas arise from?
benign tumor that arises from epidermal dendritic or langerhan cells
what animals commonly get histiocytomas?
head & limbs of young dogs <3 years old - bulldogs, pitties, greyhounds, boxers, & bostons
what is the hallmark of the pictured tumor?
rapid growth followed occasionally by regression - but factors determining spontaneous regression are unknown
when to do surgery in an animal with a histiocytoma?
if there is:
rapid growth, ulceration/infection, location is odd, development in an older patient (very rare), cytology is not conclusive, or failure for it to resolve in a timely fashion
T/F: plasma cell tumors most commonly occur as the cutaneous form
true
what are the common locations where plasma cell tumors are seen?
limbs, heads, & ears - solitary, smooth, raised pink nodules
what dog breeds are at risk for plasma cell tumors?
cocker spaniels, WHWT, boxer, yorkie, & GSD
T/F: plasma cell tumors are typically benign
true - rare form of multiple cutaneous plasmacytoma that has a more aggressive biological behavior similar to malignant melanoma
what is the treatment for cutaneous plasma cell tumors?
surgery - considered to be curative
what clinical signs are seen in animals with cutaneous epitheliotropic T cell lymphoma?
generalized or multifocal lesions
nodules, plaques, ulcers, erythemic or exfoliative dermatitis, focal hypopigmentation, & alopecia
may have peripheral lymph node involvement seen in late stages of disease
what disease is pictured?
cutaneous epitheliotropic t cell lymphoma
what are the 3 clinical stages of disease in cutaneous lymphoma?
- scaling, alopecia, & pruritus
- erythema, thickened/ulcerated, exudative lesions
- proliferative plaques & nodules with proliferative ulceration
what treatment is used for cutaneous lymphoma?
chemotherapy - lomustine has an 80% response rate with median remission of 3 months
radiation
surgery
supportive care - antibiotics & analgesia
what tumor type is seen here?
plasma cell tumor
what tumor type is seen here?
cutaneous hemangiosarcoma
what treatment is indicated for cutaneous hemangiosarcoma when sub-dermal invasion & involvement of subcutaneous tissues & muscles is present? why?
surgical excision & adjuvant therapy is required
prognosis is worse
what is the prognosis for an animal with cutaneous hemangiosarcoma with sub-dermal invasion & involvement of subcutaneous tissues & muscles?
poor prognosis
what is field carcinogenesis?
prevalence of tumor-related alterations in normal-appearing tissues
when is surgical excision recommended as treatment for cutaneous hemangiosarcoma?
when the lesion is confined to the dermis - MST 2 years +
when there is sub-dermal invasion & involvement of subcutaneous tissues/muscles
what is the most common malignant tumor in the ear canal? what dog breeds are commonly affected?
ceruminous gland adenocarcinoma
cocker spaniels & GSD
what is the recommended approach which diagnosing a ceruminous gland adenocarcinoma?
CT scan for treatment planning because it is a locally invasive tumor & it has metastasis to local lymph nodes & the lungs
what treatment is recommended for ceruminous gland adenocarcinomas?
complete surgical excision - TECA & lateral bulla osteotomy
radiation therapy
T/F: with complete surgical excision of ceruminous adenocarcinomas, there is a low recurrence rate in dogs & approximately 25% recurrence in cats
true
what tumor type is seen in the photo?
ceruminous gland adenocarcinoma
what is the typical appearance of ceruminous gland adenomas?
exophytic, pedunculated, +/- ulcerative mass
what dogs are commonly affected by ceruminous gland adenomas?
cocker spaniels & poodles
younger than dogs with the malignant ceruminous gland adenocarcinoma
what is the appearance of ceruminous gland adenomas in cats?
darkly pigmented tumor, small <5mm, & multiple masses
what benign tumor is pictured?
ceruminous gland adenoma
what is the treatment of choice for ceruminous gland adenomas?
surgical removal
what tumors are sebaceous gland tumors? what tumors are apocrine gland tumors?
sebaceous glands & apocrine glands - adenomas & carcinomas
what dog breed is commonly affected with malignant trichoepithelioma?
bassett hounds
is this tumor type associated with UV exposure?
nope
is this tumor type associated with UV exposure?
yes
