Exam 2 - Skin Tumors

Question 1

what 3 questions should be asked for approaching a patient with a skin tumor? why is this important?

Answer 1

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

Question 2

what is tumor grade? why is it important?

Answer 2

it is determined by pathology - can’t be determined by cytology

gives prognostic indicators & different grading schemes are used for different tumor types

Question 3

what is tumor stage?

Answer 3

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

Question 4

what are the 3 general tumor types?

Answer 4

1. epithelial - carcinomas
2. mesenchymal - sarcomas
3. round cell - hematopoietic & mesenchymal origin

Question 5

where do epithelial tumors arise from?

Answer 5

epithelial surfaces - skin, respiratory tract, gi tract, urinary tract

glands

organs

Question 6

where do mesenchymal tumors arise from?

Answer 6

mesenchymal & connective tissue

Question 7

where do round cell tumors arise from?

Answer 7

hematopoietic & mesenchymal origin

Question 8

what is the easiest/cheapest way for figuring out tumor type?

Answer 8

stick a needle in it - FNA & cytology

Question 9

why do you want to know the type of tumor your patient has?

Answer 9

allows for treatment planning

prognosis with & without therapy

direct staging

Question 10

what is the difference between an incisional & excisional biopsy for approaching a patient with a tumor that couldn’t be diagnosed with cytology?

Answer 10

incisional - removal of part of the tumor (tru cut, punch, & wedge)

excisional - marginal excision of the entire tumor

Question 11

when may incisional biopsy be preferred over excisional? what about excisional over incisional?

Answer 11

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

Question 12

why is it important to plan when doing a biopsy for a patient with a skin tumor?

Answer 12

do NOT biopsy in a manner that may prevent or interfere with a definitive or curative surgical procedure later

Question 13

T/F: surgery cures more cancer than any other treatment modality

Answer 13

true

Question 14

the best chance for a cure/best outcome of neoplasia is with the _______ ___________

Answer 14

first surgery

Question 15

what components make up staging a skin tumor?

Answer 15

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

Question 16

what are the 3 treatment modalities available for skin tumors?

Answer 16

surgery, radiation, & chemotherapy

Question 17

treating or getting rid of a tumor is dependent on what?

Answer 17

what the tumor type is & where the tumor is (staging)

Question 18

what does in situ mean?

Answer 18

carcinoma that has NOT penetrated the basement membrane of the epithelium - cells are neoplastic/dysplastic

Question 19

what are some common skin tumors in dogs & cats arising from the follicular epithelium?

Answer 19

SCC in situ & SCC

Question 20

what are some common skin tumors in dogs & cats arising from the hair follicle?

Answer 20

trichoblastoma complex

Question 21

what are some common skin tumors in dogs & cats arising from glandular structures?

Answer 21

sebaceous gland tumors & apocrine gland tumors

Question 22

what are some common skin tumors in dogs & cats arising from the ear canal?

Answer 22

hemangioma/hemangiosarcoma, melanoma, histocytoma, plasma cell tumor, & lymphoma

Question 23

squamous cell carcinoma in situ is primarily a disease in what animals?

Answer 23

cats

Question 24

what is actinic keratosis in regards to SCC in situ? what clinical signs does it cause?

Answer 24

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

Question 25

what clinical signs are seen in SCC in situ in cats?

Answer 25

erosions of the epidermis, proliferation, crusted plaques, +/- pain with palpation

Question 26

what is bowen's carcinoma?

Answer 26

SCC in situ that is occurring in MULTIPLE SITES!!!! happens regardless of UV exposure

Question 27

what locations do bowen's carcinoma occur? what clinical signs are associated with it?

Answer 27

multiple sites - haired & unhaired areas, areas with & without UV exposure heavily scaled!!!! crusted & pigmented papules & plaques +/- erosions

Question 28

T/F: in a cat with bowen's carcinoma, you will continue to see the animal develop lesions regardless of treatment

Answer 28

true

Question 29

what lesion is this?

Answer 29

SCC in situ - white kitty that loves the sun :/

Question 30

what is the prognosis of SCC in situ?

Answer 30

it is non-invasive - so metastasis has not occurred but if left alone & untreated, it could progress & eventually met

Question 31

what is the treatment of choice for SCC in situ?

Answer 31

surgery!!!!!! other options include - imiquimod cream, strontium plesiotherapy, photodynamic therapy, & cryosurgery

Question 32

when is strontium-90 plesiotherapy useful for SCC/SCC in situ?

Answer 32

very small & very superficial lesions only!!

Question 33

what is cryosurgery?

Answer 33

destruction of tissue with controlled use of freezing & thawing - 3 cycles are usually performed

Question 34

how does cryosurgery work for destruction of tissue?

Answer 34

development of ice crystals both intracellularly & extracellularly resulting in cell death

Question 35

when is cryosurgery useful for treating SCC in situ/SCC?

Answer 35

when it is a superficial lesion & is <4mm in diameter

Question 36

T/F: a cat will look busted after cryosurgery, so you should warn the owner

Answer 36

true

Question 37

what are the clinical signs associated with SCC?

Answer 37

variable clinical presentation - erythemic, ulcerated, crusted lesions

Question 38

what is linked to causing SCC in cats?

Answer 38

UV exposure

Question 39

T/F: metastasis at the time of death in cats with SCC is 40%

Answer 39

true

Question 40

what is the treatment of choice for SCC?

Answer 40

surgery!!!!

Question 41

what is the most common location for SCC in labs & goldens?

Answer 41

nasal planum in labs & golden retrievers

Question 42

what dogs are at risk for getting cutaneous SCC?

Answer 42

breeds with light pigmentation & thin hair coat bloodhounds, bassett hounds, standard poodles

Question 43

T/F: like cats, SCC on the nasal planum in dogs is related to sun exposure

Answer 43

FALSE - not related to sun exposure in dogs!!! very invasive & locally aggressive, mets reported in 25% of cases

Question 44

T/F: in cutaneous SCC in dogs, there is a can be a link to UV exposure

Answer 44

true

Question 45

T/F: radiation therapy for nasal planum SCC is effective

Answer 45

false - not effective

Question 46

when is radiation therapy useful for SCC?

Answer 46

cutaneous forms - used in more so palliative care

Question 47

what is the treatment of choice for SCC in dogs?

Answer 47

surgery!!!

Question 48

is chemotherapy useful for treating SCC in dogs?

Answer 48

doesn't appear to help

Question 49

what is the treatment of choice for dogs & cats with trichoblastomas?

Answer 49

surgery

Question 50

where are trichoblastoma tumors commonly seen in dogs & cats? what dog breeds are predisposed?

Answer 50

head & neck - dogs head, neck, limbs, trunk - cats poodles & setters

Question 51

T/F: trichoblastomas are very common tumors seen in dogs & cats are are benign

Answer 51

true

Question 52

what cat breed is at risk for trichoepitheliomas?

Answer 52

persian cats

Question 53

what is the treatment of choice for trichoepitheliomas in dogs & cats?

Answer 53

surgery

Question 54

what dog breeds are at risk for getting trichoepitheliomas?

Answer 54

bassett hounds, coonhounds, english springer spaniels, & setters

Question 55

what anatomic locations are trichoepitheliomas commonly seen?

Answer 55

limbs, neck, & back - dermal tumors that can extend into the subcutis

Question 56

what is malignant trichoepithelioma?

Answer 56

highly invasive tumor with invasion into surrounding tissues & has lymphatic involvement

Question 57

what is the treatment of choice for malignant trichoepithelioma? why?

Answer 57

surgery with wide excision recommended!!!! higher mitotic index & highly metastatic to regional lymph nodes & lungs!!!!

Question 58

T/F: the benefit of adjuvant or systemic therapy is unknown when treating malignant trichoepithelioma

Answer 58

true

Question 59

sebaceous adenomas are common in what animals?

Answer 59

dogs - rare in the cat

Question 60

what dog breeds commonly get sebaceous adenomas?

Answer 60

mini schnauzer, beagles, poodles, & cocker spaniels

Question 61

what is the treatment of choice for sebaceous adenoma?

Answer 61

surgery

Question 62

what animals are commonly affected with sebaceous carcinomas? where are they commonly located?

Answer 62

uncommon tumor with local infiltration & rare mets but affects intact males - cavies, cocker spaniels, & terrier breeds head & neck

Question 63

what is the treatment of choice for sebaceous carcinomas?

Answer 63

surgery with wide margins

Question 64

what dog breeds are commonly affected by apocrine gland tumors? where are they commonly seen?

Answer 64

uncommon malignant locally invasive tumor with low met rate but seen in treeing walker coonhounds & goldens on the front legs

Question 65

what is the treatment of choice for apocrine gland tumors?

Answer 65

wide surgical excision

Question 66

what tumor is this breed associated with?

Answer 66

apocrine gland tumors

Question 67

T/F: apocrine gland tumors are the same as anal gland apocrine gland adenocarcinoma

Answer 67

false - not at all the same

Question 68

what dogs are at risk for developing hemangiosarcoma due to UV exposure?

Answer 68

dogs with minimal skin pigmentation & thin hair coats - pitties, dalmatian, whippets

Question 69

what dog is the poster child for cutaneous UV-exposure induced hemangiosarcoma?

Answer 69

whippets

Question 70

T/F: cutaneous hemangiosarcoma is more common in the dog than in cats

Answer 70

true

Question 71

what locations are cutaneous hemangiosarcomas seen?

Answer 71

inguinal & axillary region around the muzzle

Question 72

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

Answer 72

true

Question 73

what are some poor prognostic factors of ear canal tumors in cats?

Answer 73

mitotic index of 2 or less presence of neurological signs histology extension beyond the ear canal

Question 74

what are some identified poor prognostic factors of ear canal tumors in dogs?

Answer 74

there is extension of the tumor beyond the ear canal

Question 75

what does melanoma arise from?

Answer 75

melanocytes

Question 76

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

Answer 76

true

Question 77

what is the treatment for melanoma?

Answer 77

surgical excision with 1-2cm margins - often curative

Question 78

what kind of tumor is seen in the picture?

Answer 78

melanoma

Question 79

where do histiocytomas arise from?

Answer 79

benign tumor that arises from epidermal dendritic or langerhan cells

Question 80

what animals commonly get histiocytomas?

Answer 80

head & limbs of young dogs <3 years old - bulldogs, pitties, greyhounds, boxers, & bostons

Question 81

what is the hallmark of the pictured tumor?

Answer 81

rapid growth followed occasionally by regression - but factors determining spontaneous regression are unknown

Question 82

when to do surgery in an animal with a histiocytoma?

Answer 82

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

Question 83

T/F: plasma cell tumors most commonly occur as the cutaneous form

Answer 83

true

Question 84

what are the common locations where plasma cell tumors are seen?

Answer 84

limbs, heads, & ears - solitary, smooth, raised pink nodules

Question 85

what dog breeds are at risk for plasma cell tumors?

Answer 85

cocker spaniels, WHWT, boxer, yorkie, & GSD

Question 86

T/F: plasma cell tumors are typically benign

Answer 86

true - rare form of multiple cutaneous plasmacytoma that has a more aggressive biological behavior similar to malignant melanoma

Question 87

what is the treatment for cutaneous plasma cell tumors?

Answer 87

surgery - considered to be curative

Question 88

what clinical signs are seen in animals with cutaneous epitheliotropic T cell lymphoma?

Answer 88

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

Question 89

what disease is pictured?

Answer 89

cutaneous epitheliotropic t cell lymphoma

Question 90

what are the 3 clinical stages of disease in cutaneous lymphoma?

Answer 90

1. scaling, alopecia, & pruritus 2. erythema, thickened/ulcerated, exudative lesions 3. proliferative plaques & nodules with proliferative ulceration

Question 91

what treatment is used for cutaneous lymphoma?

Answer 91

chemotherapy - lomustine has an 80% response rate with median remission of 3 months radiation surgery supportive care - antibiotics & analgesia

Question 92

what tumor type is seen here?

Answer 92

plasma cell tumor

Question 93

what tumor type is seen here?

Answer 93

cutaneous hemangiosarcoma

Question 94

what treatment is indicated for cutaneous hemangiosarcoma when sub-dermal invasion & involvement of subcutaneous tissues & muscles is present? why?

Answer 94

surgical excision & adjuvant therapy is required prognosis is worse

Question 95

what is the prognosis for an animal with cutaneous hemangiosarcoma with sub-dermal invasion & involvement of subcutaneous tissues & muscles?

Answer 95

poor prognosis

Question 96

what is field carcinogenesis?

Answer 96

prevalence of tumor-related alterations in normal-appearing tissues

Question 97

when is surgical excision recommended as treatment for cutaneous hemangiosarcoma?

Answer 97

when the lesion is confined to the dermis - MST 2 years + when there is sub-dermal invasion & involvement of subcutaneous tissues/muscles

Question 98

what is the most common malignant tumor in the ear canal? what dog breeds are commonly affected?

Answer 98

ceruminous gland adenocarcinoma cocker spaniels & GSD

Question 99

what is the recommended approach which diagnosing a ceruminous gland adenocarcinoma?

Answer 99

CT scan for treatment planning because it is a locally invasive tumor & it has metastasis to local lymph nodes & the lungs

Question 100

what treatment is recommended for ceruminous gland adenocarcinomas?

Answer 100

complete surgical excision - TECA & lateral bulla osteotomy radiation therapy

Question 101

T/F: with complete surgical excision of ceruminous adenocarcinomas, there is a low recurrence rate in dogs & approximately 25% recurrence in cats

Answer 101

true

Question 102

what tumor type is seen in the photo?

Answer 102

ceruminous gland adenocarcinoma

Question 103

what is the typical appearance of ceruminous gland adenomas?

Answer 103

exophytic, pedunculated, +/- ulcerative mass

Question 104

what dogs are commonly affected by ceruminous gland adenomas?

Answer 104

cocker spaniels & poodles younger than dogs with the malignant ceruminous gland adenocarcinoma

Question 105

what is the appearance of ceruminous gland adenomas in cats?

Answer 105

darkly pigmented tumor, small <5mm, & multiple masses

Question 106

what benign tumor is pictured?

Answer 106

ceruminous gland adenoma

Question 107

what is the treatment of choice for ceruminous gland adenomas?

Answer 107

surgical removal

Question 108

what tumors are sebaceous gland tumors? what tumors are apocrine gland tumors?

Answer 108

sebaceous glands & apocrine glands - adenomas & carcinomas

Question 109

what dog breed is commonly affected with malignant trichoepithelioma?

Answer 109

bassett hounds

Question 110

is this tumor type associated with UV exposure?

Answer 110

nope

Question 111

is this tumor type associated with UV exposure?

Answer 111

yes