Malignancies of surface epithelial origin Flashcards
most common skin cancer?
BCC - affects over 1 million people in the U.S annually
risk factors BCC
40+ yo
fair complexion
hx of chronic sun exposure
where does BCC normally affect?
middle 1/3rd of the face
BUT any cutaneous areas of the head and neck can be affected
what are the 3 types of BCC?
nodulo-ulcerative
pigmented and sclerosing
what is the most common BCC clinical presentation?
nodulo-ulcerative
appearance nodulo-ulcerative bcc
umbilicated papule that may show central ulceration
LACK of adnexal skin structures (hair)
histopathology noduloulcerative BCC
basaloid cells that appear to “drop off” of the basal cell layer of the epidermis
*large lobules into the superficial CT of tumor cells are characteristic
pigmented bcc resembles
melanocytic nevi
*due to benign melanocytic colonization
how to distinguish nevus from pigmented bcc?
short duration and lack of hair
what is the least common type of BCC?
sclerosing
what is the most aggressive form of BCC?
sclerosing
what is another name for sclerosing bcc?
morpheaform
what does a sclerosing bcc resemble clinically?
a scar (cicatrix) *due to collagen formation induced by tumor cells
histopathology sclerosing bcc?
tiny infiltrative nests of tumor cells in a collagenous background
*hard to assess borders clinically due this infiltrative growth pattern
tx bcc
scalpel excision electrodesiccation and curettage mohs curgery (pathology and surgery) cryotherpy radiation
prognosis bcc
generally excellent - 95% of patients cured after 1st tx
metastasis is RARE
what lesions require mohs surgery?
larger, recurrent lesions and tumors in areas of embryonic fusion that are more aggressive
what is the most common oral malignancy?
SCC
SCC is the ___ most common cutaneous malignancy
2nd
areas that are most affected by scc
skin and lower vermillion zone of the lip (on the face)
face, helix of the ear, dorsum of hands and arms are common sites
causes od cutaneous SCC
chronic sun (UV) exposure or after medical ionizing radiation to a specific site
** arises from pre-exisiting actinic keratosis in many instances
tx of cutaneous scc
surgical excision
actinically induced scc growth
well differentiated and grow slowly
prognosis of scc
generally good if identified early in course
what percent of scc are usually associated with tobacco (with or without) alcohol
75-80%
20-25% of scc are not associated with identifiable risk factors, where are they located?
lateral tongue of younger people and gingiva of older owmen
oncogenic HPV subtypes usually show up where when they turn to scc?
base of tongue and tonsils
what type of hpv is implicated in oropharyngeal scc?
type 16
does oropharyngeal scc have a better change when it is or is not associated with hpv?
better prognosis if HPV +
what percent of cancers does oral scc account for?
3-4
oral scc epidemiology
older adults
men 2: 1 to women
risk factors oral scc
same as leukoplakia and erythroplakia
* alcohol??? or synergistic effect with tobacco
NOT alcoholic mouthwash
appearance of oral scc?
irregular shape, mixture of red and white clinically
often ulcerated
exophytic (growing out) or endophytic (growing in) growth pattern
FIRMER than surrounding tissues
oral scc appearance on an X-ray
ragged moth-eaten radiolucency with ill-defined borderes **bone involvement, so fracture is possible
when does oral scc exhibit pain?
late, early lesions are usually asymptomatic
prognosis of scc on the lip?
lower lip - good
upper lip - high risk for lymph node metastasis
oral scc can develop from what?
- leukoplakia
- erythroplakia
- proliferative verrucous leukoplakia
proliferative verrucous leukoplakia
leukopakia that grows laterally and involves multiple sites
prolifertive verrucous leukoplakia female predilection
4: 1
* only 1/3 have traditional risk factors
mean age of females and males with proliferative verrucous leukoplakia
65 yo female and 49 yo male
oral scc common sites
tongue, esp post lateral/ventral floor of the mouth (esp near the frenum) gingiva labial and buccal mucosa hard palate
what is the most common site of oral scc involvement on the tongue
lateral tongue
where does oral scc typically seen in pts that are young and have no risk factors
tongue
oral scc in the floor of the mouth is usually where?
near the midline ** about at common as tongue ca
is it common to have gingiva/alv mucosa oral scc?
no, but double as common in women at this site
**usually in people with no risk factors (i.e no smoking etc..)
if oral scc in the hard palate often?
no, usaully arises on the lateral soft palate
**hard to determine if lesion developed in mx sinus and invaded through the floor
clincial differential diagnosis of scc
non-specific ulcer
specific infections (tb, syphillis, deep fungal)
immune-mediated conditions (wegner, crohn)
histopath scc
microscopically, invasive cords and nests of malignant sq. epithelial cells arise from dysplatic surface epi
*tumor cells show an increased nuclear/cytoplasmic ratio, cellular and nuclear pleomorphism an mitotic activity
varying degrees of keratin production may be seen ( well vs. poorly diff)
oral scc tx
wide surgical excision and/or radiation therapy
chemo does NOT show any impact
neoadjuvant therapy to shrink the tumor initially
molecular-based targeted therapy are anticipated for the future
prognosis oral scc
poor because pts present in stage III or IV and metastasis to regional lymph nodes
5 year survival rate for oral scc?
60%, one of the worst prognoses of any major cancer
is oral scc follow up necessary?
yes
what percent of patients will develop aerodigestive tract malignancies if carcinogenic habits dont stop after oral scc?
10-25%
verrucous carcinoma
less aggressive, relatively uncommon FORM of scc
when does veruc ca develop
elderly male pts
ver carcinoma show a correlation with smokeless tobacco?
No, mentioned as a contributing factor, but no association
appearance verruc ca?
diffuse white or mixed red and white plaqiue
frequent sites for verruc ca?
alveolar mucosa, hard palate and buccal mucosa
verruc ca growth pattern
lateral
verruc ca histology
very bland, often misdiagnosed
**Dx based on overall architecture of the tumor rather than the appearance of individual cells
verruc ca tx
surgical excision
radiation discouraged b/c sporadic reports of transformation of verrucous ca to a more aggressive scc?? –> differing new info
what percent of verruc ca (upon COMPLETE excision) shows foci of transformation to routine scc
20-25%
