Malignant Neoplasms of the skin Flashcards
What are the malignant neoplasms of the skin?
- Actinic Keratosis
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Dysplastic Melanocytic Nevi
- Malignant Melanoma
What % of skin cancers occurs on the head and neck?
80%
What is actinic keratosis?
- Sun induced Premalignancy
- Seen in older adult pt’s
- Erythematous scaling papules or plaques
A. Feels like sandpaper - Located on sun exposed skin
Face, Neck, Dorsal hands/arms
How is actinic keratosis dx?
Clinical, Bx if unsure
How is actinic keratosis treated?
Cryo, ED&C, Topical 5FU
What is basal cell carcinoma most common in?
- MC form of primary cutaneous malignancy
- MC in older adults >40yo to sun-exposed skin
- MC in fair skin pt’s (skin types I & II)
- MC on face/scalp/ears/neck, trunk/extr’s
What are the sxs of basal cell carcinoma?
Persisting lesion, enlarging, painful/bleed/itch
What are risk factors for BCC?
High Cumulative UVR, ionizing rad.
What are the severe clinical variants of BCC?
- Nodular, Pigmented, and Micronodular (infiltrative) BCC
2. Superficial BCC and Morpheaform BCC
What is the prognosis for BCC?
95% cure rate if detected early, Metastases extremely rare
What is the tx for BCC?
Surg Exc., ED&C, Moh’s Surgery
How is BCC prevented?
Annual FBE and Educate pt on MoSSE and Sun Prot
What are the MC’s for SCC?
- 2nd MC form of primary cutaneous malignancy
- MC in older adults >40yo to sun-exposed skin
May arise from AK’s or KA’s or arise de novo - MC in fair skin pt’s (skin types I & II)
- MC on face/scalp/ears/neck, trunk/extr’s
What are the sxs of SCC?
Persisting lesion, enlarging, painful/bleed/itch
What are the risk factors of SCC?
High Cumulative UVR, ionizing rad.
What are the clinical variants of SCC?
- Clinical Variants depend on depth of invasion
A. SCC in situ (Bowens Disease) – Confined with in epidermis
B. SCC invasive – dermoepidermermal junction is breached
What is the prognosis for SCC?
- Surg exc nonmetastatic SCC PX is excellent
2. Metastatic rate for SCC is 2-6% (check LN’s!)
What is the tx for SCC?
Surg Exc., ED&C, Moh’s Surgery
How can SCC be prevented?
Annual FBE and Educate pt on MoSSE and Sun Prot
What is dysplastic malanocytic nevi?
- Atypical Nevi considered to be part of a spectrum between benign nevi and melanoma
- Believed to have incr risk for malignancy depending on the severity of the atypia
A. Controversy around the exact incidence (1-40%)
How are dysplastic melanocytic nevi managed?
- Recommended to Bx Atypical appearing lesions
A. Surg Exc (2mm margins) if shows signs of dysplasia
What are the ABCDEs for dysplastic melanocytic nevi?
A = Asymmetry B = Border Irregularity C = Color variation D = Diameter >6mm E = Enlarging/Evolving
define melanoma
Malignancy of Melanocytes and nevus cells
What are the risk factors for melanoma?
- Fair complexion (skin types I & II)
- Numerous Atypical Nevi (>50)
- Large Congenital Nevi
- PMHx or immediate FAMHx of Melanoma
Where is MM found on the body?
- MM can arise on any part of the body
A. MC on trunk for men
B. MC on lower extr for women
What are the types of MM?
- Superficial Spreading MM – MC form of MM in lighter skin
- Nodular MM – Pigmented slowly enlarging ulcerative nodule
- Acral Lentiginous MM – MC form of MM in darker skin types, hands and feet involvement
- Lentigo Maligna MM – MC form in elderly, sun exposed areas
- Amelanotic MM – nonpigment producing variant of MM
How is MM dx?
- Biopsy recommended for any suspicious lesion
A. Excisional Bx method of choice (Punch if necessary)
B. Do not Shave Bx a suspected MM (miss the vertical)
What is MM tx based on?
- Tx decisions (Margins/SLN Bx) and Prognosis
A. Based off of depth of MM invasion
-Clark’s Levels or Breslow’s Depth
B. Based off of TNM system
How is MM followed up?
- Routine f/u depends on stage of MM
A. FBE with LN evaluation q 3, 6, 12 Mo’s
B. Labs for CBC and LFT’s
C. CXR
