Malignant Cutaneous Neoplasms

Question 1

Morphoeaform (sclerosing, desmoplastic) and infiltrative, as well as lesions with micronodular or basosquamous histopathologic changes, are more aggressive

Answer 1

T-

JAAD Feb 2019 CME

Question 2

although rare, perineural invasion in BCC indicates an aggressive variant with incr rates of metastasis and locoregional recurrence

Answer 2

T-

JAAD Feb 2019 CME

Question 3

Nodular BCC accounts for 25-40% of lesions

Answer 3

F - Nodular BCC accounts for 50-80% of lesions

JAAD CME 2019

Question 4

Micronodular BCC has no appreciable connection to overlying epidermis

Answer 4

T

Question 5

Metastatic BCC = 0.003-0.005%

Answer 5

True

Question 6

Lymph node metastasis followed by LUNG and BONE metastasis is the most common progression of metastatic BCC

Answer 6

True

Question 7

What are high risk factors for SCC Mets?

Answer 7

• tumour thickness (2.1 - 6mm have 4% mets; >6mm have 16% mets)
• poor differentiation
• immunosuppression
• Location on lips or ear
• ## SCC’s in genital region are also more aggressive

Question 8

SCC on highly sun damaged skin are more indolent and less likely to metastasise

Answer 8

True

Question 9

What is Li-Fraumeni Syndrome

Answer 9

Rare familial cancer syndrome where germline mutations in TP53 genes play an important role

• syndrome is characterised by an autosomal dominant inheritance pattern and affected individuals display early onset of various tumours;
• breast cancer, brain tumours, osteosarcoma and leukaemia
• however, skin cancer does not occur as commonly as expected given that TP53 mutations are frequently observed in BCCs and SCCs

Question 10

What is basal cell naevus syndrome ?

Answer 10

• Germline activating mutations in PTCH1 gene are found in vast majority of patients with this syndrome
• The most common inherited disorder associated with BCCs is BCN’s
• affected individuals have a wide range of developmental anomalies —> skeletal abnormalities, craniofacial dysmoprhism, macrocephaly
• multiple BCC’s with early onset are a hallmark of the syndrome, also featuring odontogenic keratolysis, palmoplantar pits, calcification of the falx cerebri
• also have incr risk of meningiomas, ovarian fibromas and ca, and cardiac fibromas

Question 11

What is Bazex syndrome?

Answer 11

Rare genodermatoses characterised by follicular atrophoderma and early onset of multiple BCC’s
- responsible gene has been linked to Xq24-27 and there is no male-to-male transmission
- X-linked dominant disorder characterized by the triad of diffuse hypotrichosis, follicular atrophoderma, and BCCs
Milia cysts,hypohidrosis, trichoepitheliomas, and facial hyperpigmentation can also be seen

Question 12

What is Rombo syndrome?

Answer 12

Rare autosomal dominant disorder presenting with acral erythema, facial vermiculate atrophoderma, multiple milia, telangiectasias, hypotrichosis and a tendency to develop milia and BCCs

Question 13

Actinic keratosis risk factors:

Answer 13

• male
• elderly
• those with lighter skin photo types
• hx of chronic sun exposure

Question 14

Lichenoid actinic keratosis can have associated pruritus or tenderness associated with onset of lichenoid infiltrate

Answer 14

T

Question 15

Atrophic AK’s have minimal surface change

Answer 15

T

Question 16

Actinic cheilitis does not resemble the classic form of AK

Answer 16

False

Question 17

Arsenic induced SCC in situ resembles the classic variety clinically

Answer 17

True, also has a marked tendency to be multifocal + arise in sunprotected areas of the trunk

Question 18

Ferguson-Smith KA’s are multiple + non-regressing

Answer 18

False - spontaneously regress

Question 19

Grzybowski KA’s erupt in a generalised fashion

Answer 19

True

Question 20

KA’s have been associated with chemical exposures, immunosuppression, BRAF inhibitors and HPV infection

Answer 20

True

Question 21

Keratoacanthoma can reach several centimetres in diameter

Answer 21

True - eg. Keratoacanthoma centrifugum marginatum

Question 22

KA can heal with prominent scarring

Answer 22

True

Question 23

Grouped KAs often resolve more quickly than solitary KA’s

Answer 23

False - other way around

Question 24

Ferguson-Smith syndrome is autosomal recessive with mutations in TGFBR1 which encodes TGF-B receptor type 1.

Answer 24

False - autosomal dominant

Question 25

Gryzbowski KA’s present as thousands of papules resembling MILIA or early eruptive xanthomas - they develop rapidly and may slowly resolve over a period of months.

Answer 25

True

Question 26

Epithelioma caniculatum is a type of verrucous carcinoma on the dorsal foot

Answer 26

False - plantar foot

Question 27

Verrucous carcinoma has 3 subtypes: 1. Epithelioma cuniculatum; 2. Giant condyloma acuminatum of genitalia, aka Buschke Lowenstein; 3. Oral florid papillomatosis (oral mucosa)

Answer 27

True

Question 28

Verrucous carcinoma are rarely associated with HPV infection

Answer 28

False - commonly

Question 29

Solar lentigines occur in Asians as a result of acute or chronic sun exposure

Answer 29

True

Question 30

Similar activating mutations to SebK’s have been found in solar lentigines (FGFR3 and PIK3CA)

Answer 30

True

Question 31

Solar lentigines do not fade even after ceasing UVR exposure

Answer 31

False - fade slightly

Question 32

Solar lentigines are an independent risk factors for developing cutaneous melanoma

Answer 32

True

Question 33

PUVA lentigines have a darker and more stellate appearance that may suggest cutaneous melanoma

Answer 33

True

Question 34

Malignant acanthosis nigricans can appear at the same time or shortly after the sign of Lesar-Trelat in approximately 20% of patients

Answer 34

True

Question 35

Bowel disease with a clonal or nested pattern has greater atypia of individual keratinocytes

Answer 35

True

Question 36

Melanoacanthoma is a type of sebK that is heavily pigmented

Answer 36

True