malignant lesions Flashcards
What is the most common skin CA?
BCC
slow growing and locally destructive
where is BCC most common?
face, scalp, ears, neck
what are RF for BCC?
sun, white, sunburns before age 14, arsenic ingestion
subtypes of BCC
superficial, pigmented, morpheaform, ulcerating, sclerosing
most common variant of BCC?
pearly white or pink, translucent, dome-shaped papule w. overlying radom telangiectasias
the center eventually flattens or ulcerates, borders bcome raised or rolled, bleed, and develop crust/scale
tx of BCC
ED&C, excision, MMS for recurrent or high risk lesion
Superficial BCC
least aggressive variant
trunk/extremities,
resembles o Usually erythematous and scaly papules or plaques, but may or may not have the rolled border
o May resemble psoriasis, eczema, seborrheic keratosis, Bowen’s Disease, or tinea corporis
Pigmented BCC
resemble melanoma, contain melanen
thick hard area of variegated pigmentation
Morpheaform
least common and most subtle
white to yellow w/ poorly defined borders
ulcerated BCC
ulcer with a rolled border, often covered with a crust
sclerosing
inflitrating carcinoma, white sclerotic patch with ill defined border
SCC
potentially invasive, primary cutaneous malignancy of keratinocytes in the skin
or mucous membranes
20% of all skin cancers
SCC most common place
face, scalp, neck , and hands of older pts
SCC causes
UV, chemicals (arsenic and hydrocarbons), tobacco, chronic infx, chronic inflammation, HPV infxn
what does SCC look like?
flesh-colored, pink, yellowish, or red-colored indurated papules, plaques or nodues w. scale
+/- ulceration or erosion
SCC lymphnode metastisis?
palplate regional lymph nodes! (ear, scalp, lips, temples)
tx of SCC?
ED&C, excision, or MMS
Bowen’s Disease?
SCC in situ
presents as a slow-growin, slightly raised, red plaque w/ scale
Erythroplasia of Queyrat’s
SCC in situ of the penis
tx of Bowens?
5-FU, cryotherapy, ED&C, excision, MMS
Kaposi’s Sarcoma
indolent sarcoma due to HV 8 (think immunocompromised)
Kaposi’s sarcoma presentation
painless, pigmented nodules, usually on LE, diffuse pulmonary infiltrates, lymphedema
Kaposi’s tx
many lesions resolve after ART, systemic chemo can cause remission in many pts with symptomatic visceral dz
interferon, radiation, chem
melanoma
malignancy of melanocytes
most commonly develop as a new growth, but 30% arise w/in a preexisting mole
Melanoma appearance
flat, raise, nodular or uclerated, color is variable
usually black or dark brown, but can be fleshed colored
** should be in ddx for any new mole presenting in adulthood or any mole changing in size, shape, or color
Breslow Depth
*most important prognostic indicator
depth of lesion measured in mm
best to do a punch bx
Clark level
level of anatomic invasion!
important in areas w/ thinner skin like eyelids, ears, and genitals
most common cancer?
Females age 25-29 yo
melanoma RF
PMH or FMH of melanoma or atypical nevus, fair skin, blue eyes, blonde or red hair, UV exposure, many moles, hx of blistering sunburns
what should a skin exam always inclue?
LYMPH NODE CHECK
what is the most common cause of death from melanoma
CNS mets
types of melanoma
lentigo maligna, superficial spreading malignant, nodular malignant, acral lentiginous (palms, soles, nail beds)
most common type of melanoma
superficial spreading
what is best treatment?
prevention!!!
melanoma on nails
dark brown or black pigmentation at proximal nail fold aka (Hutchison’s sign)
pigmented streaks in nail beds?
longitudinal melanonychia- common in AA, may be sign of melanoma in caucasias
