L1 Derm Cancers Flashcards
stratum basalis
stratum spinosum
stratum granulosum
stratum corneum
4 layers of epidermis (or dermis?)
4 layers of epidermis (or dermis? acc’g to objectives)
stratum basalis
stratum spinosum
stratum granulosum
stratum corneum
which layer of the epidermis is the MAJOR physical barrier
stratum corneum
[epidermis (moisture homeostasis and infectious protection)]
Dermis contains
support structures (vessels, nerves) appendages (eccrine (sweat) glands, apocrine, sebaceous glands, hair follicles, nails)
support structures (vessels, nerves) appendages (eccrine (sweat) glands, apocrine, sebaceous glands, hair follicles, nails)
are contained in which layer of skin
dermis
stratum basalis
proliferation center of epidermis, cell divide and migrate twds surface
stratum spinosum
made of early keratinocytes formed in s.basalis
cell begin forming keratin filaments
stratum granulosum
continue to form keratin and become more flat
stratum corneum
anuclear keratin-filled layers (15-100 layers)
degradation enzymes destroy organelles and nuclei
MAJOR physical barrier
takes 4 weeks from s.basalis to s.corneum
Type 1 immunology
Mast cells and basophils, IgE (ER)
Eg: Hives, bronchospasm, laryngeal edema
Mast cells and basophils, IgE (ER)
Eg: Hives, bronchospasm, laryngeal edema
Type 1 immunology
Type II Immunology
Cytotoxic
IgG or IgM react with surface antigen and activate complement
Eg.:?
Cytotoxic
IgG or IgM react with surface antigen and activate complement
Eg.:?
Type II immunity
Type III immunity
- Immune complex
- antigen-antibody complexes are deposited in tissue causing inflammation (IgG or IgM) and also activate complement, chemotaxis of luekocytes, PLATELET DAMAGE and VASCULAR PERMIABILITY.
- Eg.: VASCULITIS
Type IV immunity
- delayed hypersensitivity
- cell-mediated immunity, within 24-48 hrs
- Eg.: poison ivy, candida?
- delayed hypersensitivity
- cell-mediated immunity, within 24-48 hrs
- Eg.: poison ivy
Type IV immunity
- Immune complex
- antigen-antibody complexes are deposited in tissue causing inflammation (IgG or IgM) and also activate complement, chemotaxis of luekocytes, PLATELET DAMAGE and VASCULAR PERMIABILITY.
- Eg.: VASCULITIS
Type III immunity
what is the basis for many blistering diseases?
defects in components of the Basement membrane zone (BMZ) (part of dermal-epidermal junction)
defects in components of the Basement membrane zone (BMZ) (part of dermal-epidermal junction)
are the basis for which diseases
blistering diseases
Eccrine gland
sweat
coiled GLAND in deep dermis (secretion)
straight DUCT extends to epidermis (transport)
sweat begins isotonic with plasma, but due to electrolyte reabsorption in duct, becomes HYPOTONIC
sweat
coiled GLAND in deep dermis (secretion)
straight DUCT extends to epidermis (transport)
sweat begins isotonic with plasma, but due to electrolyte reabsorption in duct, becomes HYPOTONIC
Eccrine gland
Apocrine gland
sweat
fx unknown
in axillary and anogenital regions
duct drains into follicle
subcutaneous fat serves to
- passageway for MEDIUM-sized vessels and nerves
- insulate from cold
- cushion deep tissues
- reserve E supply
viral infections
- pappiloma (HPV)
- pox (molluscum)
- herpes (HSV 1 and 2) (causes lysis and death resulting in vesciles)
- all caused by DIRECT inoculation but VARICELLA-ZOSTER
- warts and molluscum only in Upper epidermis and cause Hyperplasia (increased cell production)
all viral infections are caused by DIRECT inoculation but
VARICELLA-ZOSTER
most common fungal infections
dermatophytes
then Candida
which layer of epidermis do dermatophytes penetrate?
stratum corneum
Derm’s enzymatically digest KERATIN and penetrate s.corneum
candida affects and causes
affect mucous membranes
causes pustules
activates complement causing inflammation (then pustules)
risk factors: moisture, steroids, ABs, pregnancy
affect mucous membranes
causes pustules
activates complement causing inflammation (then pustules)
risk factors: moisture, steroids, ABs, pregnancy
candida
Seborrheic Keratosis (SK)
Etiology: due to epidermal hyperplasia and benign hyperpigmentation (can resemble melanoma)
Clin present: tan to black papule, warty, “GREASY”, scab or rough, “stuck on”;
irregular but well-circumscribed border; 2mm-3cm or +;
on trunk but can be on face, scalp and extremeties
Tx: reassure, cryotherapy (liquid nitrogen), curettage with electroautery, shave or excisional biopsy
Etiology: due to epidermal hyperplasia and benign hyperpigmentation (can resemble melanoma)
Clin present: tan to black papule, warty, “GREASY”, scab or rough, “stuck on”;
irregular but well-circumscribed border; 2mm-3cm or +;
on trunk but can be on face, scalp and extremeties
Tx: reassure, cryotherapy (liquid nitrogen), curettage with electroautery, shave or excisional biopsy
Seborrheic Keratosis (SK)
Lesler-Trelat sign
sudden appearance of multiple SK, with an inflammatory base
can be associated with many skin tags
may be internal malignancy (stomach, colon or breast)
Keratoacanthoma ?
- RAPIDLY GROWING (vs. SCC) neoplasm (new and abnormal growth of tissue) of epithilium which is biologically BENIGN but histologically resembles SQUAMOUS cell carcinoma
- round, flesh colored NODULE that grows rapidly (4-6 wks)
- resolves on its own within 6 months
- RAPIDLY GROWING neoplasm (a new and abnormal growth of tissue) of epithilium which is biologically BENIGN but histologically resembles SQUAMOUS cell carcinoma
- round, flesh colored NODULE that grows rapidly (4-6 wks)
- resolves on its own within 6 months
keratoacanthoma ?
Actinic Keratosis (AK)
- benign but often precursor to squamous cell carcinoma (SCC)
- due to SUN EXPOSURE
- more in males, age related, rare in dark skin
- 50% resolved by avoiding sun
- < 1mm - several cm
- scale or dry/rough patch
- skin colored, white or light (can be pink or darker)
- FELT more easily than seen (pts pick the scale but it keep returning)
- on SUN-EXPOSED areas (bold scalp, face, lips, ears, neck dorsum of hands/forearms)
- Tx: 5-fluorouracil (5-FU) cream (Efudex); imiquimod (Aldara) imune modulator; cryotherapy; curettage, shave, biopsy; chemical peeps, dermabrasion, lasers; low-fat diet?
- benign but often precursor to squamous cell carcinoma (SCC)
- due to SUN EXPOSURE
- more in males, age related, rare in dark skin
- ## 50% resolved by avoiding sun
Actinic Keratosis (AK)
Risk factors of skin cancer
>90% are caused by sun (UVB>UVA) risk doubles if pt has 5 or + serious sunburns fair skin (bc melanin is protective and fair ppl have less melanin) male>female prior skin cancer radiation smokers (SCC only) genetics
Basal Cell Carcinoma (BCC) description
firm/hard nodule or papule, often with depressed center
“PEARLY” or “WAXY”
pink, red, pale yellow or translucent
can be ulcerated with ROLLED BORDERS
+/- TELEANGIECTASIAS
few mm - 1 cm
bleed with min trauma, oozing or crusting
firm/hard nodule or papule, often with depressed center
“PEARLY” or “WAXY”
pink, red, pale yellow or translucent
can be ulcerated with ROLLED BORDERS
+/- TELEANGIECTASIAS
few mm - 1 cm
bleed with min trauma, oozing or crusting
Basal Cell Carcinoma (BCC)
Basal Cell Carcinoma (BCC)
3 out 4 skin cancers
from basal layer
slow growth, rarely metastasizes but can invade local tissue
may recur in same place after tx
35-50% develop new skin cancer within 5 yrs of dx
often mimics other skin conditions
3 out 4 skin cancers
from basal layer
slow growth, rarely metastasizes but can invade local tissue
may recur in same place after tx
35-50% develop new skin cancer within 5 yrs of dx
often mimics other skin conditions
Basal Cell Carcinoma (BCC)
Basal Cell Carcinoma Tx
Nodular subtype is most common Tx: biopsy if ? about Dx, refer to Derm for any skin cancer cure is 85-99% curettage/electrodessication excisional biopsy MOHS microgrphic surgery (highest cure rate for BCC and SCC/ tx for recurrent) cryotherapy topical chemo (5-FU, Imiquimod)
Nodular subtype is most common Tx: biopsy if ? about Dx, refer to Derm for any skin cancer cure is 85-99% curettage/electrodessication excisional biopsy MOHS microgrphic surgery (highest cure rate for BCC and SCC/ tx for recurrent) cryotherapy topical chemo (5-FU, Imiquimod)
Basal Cell Carcinoma Tx
Squamous Cell Carcinoma (SCC)
2nd most common, more aggressive than BCC but still low risk for met
HEAD and FACE lesions most likely to metastasize, FAST GROWTH??
!!!! AK can often LEAD to SCC !!!!; M>F (legs of Fs)
Same risk factors + exposure to arsenic/hydrocarbons, history of HPV/immune deficiency; PUVA tx for psoriasis (all have higher met risk)
Can be caused by leukoplakia
Can occur where injure: burns, scars, long-term sores
AK (Actinic Keratosis) can often lead to what type of skin cancer
Squamous Cell Carcinoma (SCC)
Squamous Cell Carcinoma (SCC) can often be caused by
Actinic Keratosis (AK)
SCC clin
- dramatic variation
- skin-colored, erythematous or yellowish
- indurated (hard) plaques, papules or nodules (may be ULCERATED)
- can be flat patches
- often rough surface with thick hyperkeratotic (thickening of stratum corneum) scales
- SUN EXPOSED SKIN (face, ears, lips)
SCC tx
SOC is simple surgical resection, cure >90%
If >2 cm, recurrent or on face/genitals, MOHS
Eletrodessication with curettage
Cryotherapy
If not all tumor removed/difft area/mat’ed, may need radiation/chemo
SCC follow-up
Always derm referral and close f/u
F/u q 3 mo X 1yr, then q 6 mo X 1 yr, then q 1 yr X 5 yrs
40% new tumor w/i 2 yrs
Malignant Melanoma
3% but high morbidity (disease state/disability of ind+incidence of dis. in popn)
5th most common in men, 6 in F
Met’s to lung, brain, lymph and anywhere
Starts in MELANOCYTES (produce melanin - most BROWN or BLACK)
M>F; 40 yr is avg age, rare in kids
Darker skin is more protected
Malignant Melanoma risk factors
SUN EXPOSURE (-sunburns in childhood; cumulative from outdoors x4; tanning booths) Fair skin, red/blond hair Family hx of melanoma (x10) PERSONAL HX OF MELANOMA PMH of SCC or BCC Atypical moles and dysplastic nevi (x10) Compormised Imm system
Dermis
Contains vessels and nerves
1 mm - >4 mm
made of collagen, elastic fibers and ground substance (derived from fibroblast)
Melanocytes
melanin pigment helps protect skin against UV radiation
All same # of melanocytes but color depends on size and distribution of melanosomes
made from tyrosine and packaged in melanosomes
Superficial Spreading Melanoma
Most common MM 70%
Younger popn
In previously benign mole
RADIAL spread precedes VERTICAL growth
1st appears as flat or slightly raised, discolored patch, with irr.borders
Tan, brown, black, red, blue or white
Trunk in men, legs and upper back in women or upper back in both? but anywhere
Lentigo Maligna
Long period of horizontal growth followed by rapid vertical invasion
In situ (in its original place) cancer but if turns invasive, is Lentigo MM
Older, due to chronic sun
Face, ears, arms, upper trunk
Many shades of brown
Flat or mildly raised, or may be mottled (with spots/smears of color)
In situ cancer (cancer that has stayed where it began and hasn’t spread)
Subtype of MM
Acral Letiginous Melanoma (ALM)
Common in AA or dark skin
M>F, higher risk with age
Black/brown discoloration under nails or on soles or palms
Spreads superficially before vertically
Common in AA or dark skin
M>F, higher risk with age
Black/brown discoloration under nails or on soles or palms
Spreads superficially before vertically
Acral Letiginous Melanoma (ALM)
Long period of horizontal growth followed by rapid vertical invasion
In situ (in its original place) cancer but if turns invasive, is Lentigo MM
Older, due to chronic sun
Face, ears, arms, upper trunk
Many shades of brown
Flat or mildly raised, or may be mottled (with spots/smears of color)
In situ cancer (cancer that has stayed where it began and hasn’t spread)
Subtype of MM
Lentigo Maligna
Nodular Melanoma
Rapid vertical growth (wks to mos) but little or no radial growth
MOST AGGRESSIVE TYPE OF MM (10-20% of MM)
Highly invasive at time of Dx
Inflamed or friable (?) nodule
Black or any color
Looks like Superficial Spreading M; previous Hx of M
Melanoma Tx
Wide surgical excision with .5-3 cm clear margins,
Elective regional lymph node dissection/sentinel node biopsy
Chemotherapy - DTIC Dacarbazine only FDA approved
Immunotherapy: interferon-alpha is only systemic drug (FDA) - improves 5 yr survival of state III pts
Gene therapy
F/u q 3 mo
ABCDs of Melanoma
A - assymetry B- border irregularity C - color (uneven colors) D - diameter > 6 mm Other signs: new nodule, color spreads into surrounding skin, redness or swelling beyond the mole, tenderness, itching, bleeding, oozing
depth of penetration of melanoma
controls prognosis
what controls the prognosis of melanoma?
depth of penetration (pathological staging)
Ulcerated melanomas
worse prognosis
Sampling of melanoma
!!!! ALWAYS require a full thickness biopsy so as to not lose part of depth (for Breslow depth staging).
!!!! Do NOT cauterize or shave biopsy
Prevention of Melanoma
SPF 30+ 1 ounce per app Moisture with SS Everywhere and chapstick Clothing infants >6 mos: SS and hats or don't take infant in the sun
Breslow depth based on thickness of tumor (very thin 4)
ULCERATION at any depth WORSENS prognosis
Clark’s level based on skin layers penetrated:
level V - subcutaneous fat has large vessels
Level of DEPTH = prognosis
aha
Mycosis Fungoides (AKA Cutaneous T Cell Lymphoma)
Localized erythematous PATCHES or plaques on trunk > 5cm
Itchy, may see lymph node swelling
Looks like any other lesion
BIOPSY (may see Sezary cells in blood in late stages)
Diff DX: psoriasis, tinea, drug eruption, eczema
Tx: refer to oncology/derm
Localized erythematous PATCHES or plaques on trunk > 5cm
Itchy, may see lymph node swelling
Looks like any other lesion
BIOPSY (may see Sezary cells in blood in late stages)
Diff DX: psoriasis, tinea, drug eruption, eczema
Tx: refer to oncology/derm
Mycosis Fundgoides (AKA - Cutaneous T Cell Lymphoma)
