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Clin Med 1 > L4 SK, AK, and Skin Cancer > Flashcards

L4 SK, AK, and Skin Cancer Flashcards

1
Q

What are 3 important indications for Mohs micrographic surgery?

A
  • recurrent tumors
  • tumors>0.6 cm on the face or >2.0 cm on the body and extremeties
  • high-risk anatomic locations (eyelids, nose, ears, lips, genitalia, fingers)
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2
Q

What is a solar lentigo?

A

-“age spot” “senile freckle”
-local proliferation of melanocytes
-uv damage in sun exposed areas
-very common
-well circumscribed
-small brown macule, often found in groups
No treatment required and cosmetic considerations only

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3
Q

What are Seborrheic Keratosis (SK)?

A
  • common benign epidermal lesion
  • proliferation of immune keratinocyte
  • Develop typically after age 50
  • “barnacles of aging”
  • genetic link to excess multiple Sks

Clinical presentation
* tan to black with WARTY, WAXY, “STUCK ON” appearance
-well demarcated, oval/round/irregular shape
- may have single SK or hundreds
-commonly found on chest, back, head, or neck
-Christmas tree appearance on back due to Blaschko Lines
ISK= irritated SK caused by rubbing/friction
may have pruritus, pain, or bleeding

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4
Q

What is Leser-Trelat sign of SK?

A

-sudden onset of multiple SKs with inflammatory base
+ skin tags
+ acanthosis nigricans (with diabetics around the neck)
= possible association with GI and lung cancers

-Spontaneity should be a concern

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5
Q

How do you treat SK?

A
  • reassurance: consider removing for cosmetic reasons or some ISKs
  • Treatment options: cryotherapy, shave biopsy with 15 blade, curettage elctrodessication
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6
Q

What is a Keratoacanthoma?

A

*hallmark: RAPID GROWTH over 6-8 weeks
-round, flesh colored nodule with CENTRAL KERATIN PLUG
-more commonly found in sun exposed areas +/- hair distribution
-Risk factors:
-middle-age to elderly with fair skin
-increased UV radiation or chemical carcinogens
Management
-majrity resolve spontaneously in 6-9m
-due to difficult dx, REQUIRES BIOPSY AND TREATMENT

May be considered less aggressive squamous cell carcinomas with rare metastatic potential
-your body is able to fight it off

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7
Q

What is acitinic keratosis(AK)?

A

-aka solar keratosis
-originates from keratinocyte
-CONSIDERED PRE-CANCEROUS
-may progress to SCC (8% risk per year)
Risk factors
-increasing age
-M>F
-light skin complexion
-history of sunburns
-immunosuppression
-genetic syndromes

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8
Q

What is the clinical presentation of AK?

A
  • THINK SANDPAPER
  • erythematous, scaly/gritty macule or papule
  • may be tender

Subtypes:

  • hypertropic: thickened
  • Atropic: scale absent
  • Ak with cutaneous horn
  • pigmented: normally skin colored
  • actinic cheilitis (lip) patch of dryness
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9
Q

How do you diagnose AK?

A
  • Typically by visualization and touch
  • shave or punch biopsy if unable to differentiate from SCC
  • lesion > 1 cm
  • rapid growth
  • ulceration or pain associated

*caution if lesion is > 6 mm: consider SCC in situ

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10
Q

How do you manage acitinic keratosis?

A
  • may spontaneously resolve (20-30%) but could reoccur
  • isolated lesions: cryotherapy or surgical intervention
  • multiple lesions: field treatment
  • topical fluorouracil cream: preferred
  • Photodynamic therapy (PDT): topical photosesitizer selectively destroys target cells
  • Imiquimod (i.e. aldara)
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11
Q

What are the clinical presentations of Basal cell carcinoma(BCC)?

A
  • Nodular BCC is most common subtype
  • flesh-colored or pinkish
  • PEARLY
  • TELANGIECTASIAS
  • may have central ulceration with ROLLED BORDER
  • most common on head and neck

*may also present superficial as pink patch similar to AK or SCC in situ. Pigmentation may also be present

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12
Q

How do you treat BCC?

A

Surgical: PREFERRED

  • curettage and desiccation
  • excision with 4mm margins
  • Mohs for high-risk or cosmetic reasons

Nonsurgical
-radiation for poor surgical candidates

Superficall BCC

  • Imiquimod cream
  • 5% fluorouracil cream
  • photodynamic therapy
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13
Q

What is BCC prognosis?

A
  • locally invasive
  • may recur requiring routine follow-up for surveillance
  • 6-12m x 2y then annual follow -up
  • metastasis is rare
  • higher risk for developing other non-melanoma skin cancers
  • appropriate patient education is key
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14
Q

What is squamous cell carcinoma (SCC)?

A
  • second most common skin cancer
  • originates from keritinocytes
  • Males 50-70

Risk Factors: UV exposure including tanning beds, genetic alterations, chemical carcinogen exposure
-may arise in area of previous skin injury: burns, scars, etc

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15
Q

What is the clinical presentation of Squamous cell carcinoma?

A
  • papule, plaque, or nodule
  • pink, red, or skin colored
  • often asyptomatic, may be pruritic or tender
  • Lesion appears SCALY, EXOPHYTIC(grows outward), INDURATED(hard deep thickening), and or FRIABLE
  • commonly appears warty
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16
Q

How to you treat SCC?

A

Surgical: preferred

  • wide excision: margins based on risk
  • Mohs: recommended for high risk and cosmetic considerations

Non-surgical

  • radiation: for poor surgical candidates, residual tumor
  • curettage and desiccation or cryotherapy
  • select low-risk or SCC in situ
  • less effective options include: 5-fluorouracil therapy, imiquimod cream, photodynamic therapy
17
Q

What is SCC prognosis?

A

-rate of metastasis 5%
rate increases if lesion is > 2 cm in diameter >4 mm deep, or recurrent
Surveillance every 3-6m x 2y, then 6-12m x 3y, then annually for life

18
Q

Malignant Melanoma and risk factors

A

3% of all skin cancers

  • high morbidity and mortality if not treat early
  • average age of Dx is 40 and rare in children

Risk factors

  • fair skin, blue eyes, red/blonde hair, freckling
  • > 5 atypical nevi, > 25 nevi
  • immunosuppression
  • personal or family history of melanoma: genetic predisposition in small percentage
  • prolong UV exposure: blistering sunburns and UVA exposure in tanning beds
19
Q

What are the clinical manifestations of melanoma?

A

-usually asymptomatic
-most de novo with some arising from pre-existing nevus
-pigmented papule, plague or nodule
-ABCDEs
A-asymmetry (shape or color)
B-border (irregular)
C-color (dark or variations)
D-diameter (>6mm - pencil eraser)
E-evolving (changes in above)

20
Q

What is superficial spreading melanoma?

A

-most common subtype 70%
-confined to epidermis
-often younger population
-radial spread > vertical growth
men backs
women back and legs

21
Q

What is nodular melanoma?

A
  • rapid vertical growht
  • minimal radial growth
  • AGGRESSIVE!
  • nodule is inflamed and friable
22
Q

What is lentigo maligna?

A
  • Elderly with chronic sun exposure
  • Slow progression radially with rapid vertical growth
  • Typically remains more superficial
23
Q

What is acral lentiginous?

A
  • darker skin (african/asian ancestry)
  • spreads superficial then verticle
  • M>F
  • larger lesions due to delay in dx
  • palmar, plantar or subungal
24
Q

What are two melanoma considerations?

A

Subungual

  • great toe or thumb
  • history of trauma
  • dark streak and involves proximal nail fold

Amelanotic

  • minimal or absent pigment
  • extensive ddx
  • maybe changing or evolving
25
Q

Biopsy

A
  • photograph lesion prior to biopsy
  • document size and landmark
  • dermatologist can also triage images
  • biopsy entire lesion + 1-2 mm and margin
26
Q

Melanoma prognosis

A
  • greatest risk for lethal melanoma: males over 50 living alone
  • screen high risk patients in pcp
  • screening every 6 months x 2 years then annually
  • depth = worse prognosis
Breslow thickness and 5 year survivial
<1 mm 95-100          T1
1-2 mm 80-96%       T2
2.1-4 mm 60-75%     T3
> 4 mm 37-50%       T4
27
Q

Node and metastasis

A

Node

  • N0: no reginal metastasis
  • N1: one tumore-involved node
  • N2: 2-3 tumore-involved nodes
  • N3: 4+ tumor-involved nodes

Metastasis
M0: no distant metastasis
M1: distant metastasis
a-d subsections based on location of metastasis

28
Q

How do you treat melanoma?

A

WIDE SURGICAL EXCLUSION is the gold standard with 2 CM clear margins

  • regional lymph node dissection/sentinel node biopsy
  • advanced metastatic disease
  • radiation
  • chemotherapy: may be used alone or in combo with other agents
  • immunotherapy/ targeted therapy: adjunct therapy
  • follow up every 3 months
29
Q

How to prevent melnanoma?

A
  • avoid getting burned and tanning
  • daily moisturizers with sunscreen (15+)
  • Sunscreen SPF 30+ with planned sun exposure
  • apply 30 min prior to activity and reapply every 2 hrs
  • keep infants out of the sun, sunscreen only > 6 months of age
  • sun protective clothing when in the sun (including hats and sunglasses)
  • if possible, avoid the sun 10 am -4 pm or find shade
  • avoid tanning beds
  • routine skin exams

Clin Med 1 (11 decks)

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