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Disease and Defense III > Malignant Skin Cancer > Flashcards

Malignant Skin Cancer Flashcards

1
Q

Most common form of cancer in US

A

Skin

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2
Q

skins cancers and people diagnosed annually

A

3.5 and 2 million respectively

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3
Q

Most common cause of BCC

A

UV radiation

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4
Q

In addition to UV radiation NMSC can also occur after (3)

A

ionizing radiation
arsenic
polycyclic hydrocarbon

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5
Q

Most common malignancy in US

A

BCC

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6
Q

BCC annually

A

2.8 million

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7
Q

BCC subtypes (4)

A

superficial (15%)

nodular (75%)

  • micronodular
  • pigmented (6%)

infiltrative (5%)

Sclerosing / morpheaform (3%)

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8
Q

The majority of BCC due to?

A

loss of function of PTCH1 which normally acts to block smoothened (smo) a transmembrane protein that accelerates growth

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9
Q

What is vismodegib?

A

an inhibitor of smoothened - used for the treatment of advanced BCC

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10
Q

Most common precacner affecting more than 58 million Americans?

A

Actinic keratosis

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11
Q

Actinic keratosis treatment?

A 
cryosurgery (liquid N)
Topical 5-fluorouracil
Topical imiquimod
Topical Diclofenac
Photodynamic therapy 
Sun protection
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12
Q

Second most common malignancy

A

SCC

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13
Q

SCC occurs more often in

A

immunosuppressed

especailly organ translplant

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14
Q

risk factors SCC

A 
UV damage
thermal injury 
radiation 
HPV
burn scars 
Marjlin's ulcer
chronic injury (EB)
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15
Q 
SCC 
subtypes (3)
A

SCC in situ (Bowen’s)
Keratoacanthoma
Invasive SCC

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16
Q

SCC can be induced by HPV –>

A

SCC in situ on genitals :)

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17
Q

SCC in situ means only in the

A

epidermis

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18
Q 
Keratoacanthoma
clinical features?
- distribution
- growth 
- size
- appearance 
- complications
A

distribution - primarily sun exposed
rapid growth over 6-8 weeks
size 1-3cm
crateriform endophytic and exophytic nodule with central keratin plug
complications - deep invasion without regression in 10-20%

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19
Q

SCC

typical apperance?

A

hyperkeratotic papule with variable size and thickness

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20
Q

SCC

Local?

A

chronically sun damaged skin

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21
Q

SCC

metastasis?

A

0.3-5%

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22
Q

SCC

mestasis more common where?

A

lip (10-30%)

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23
Q

is metastasis more common in SCC or BCC

A

SCC

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24
Q

SC and transplant patients

A

SCC - 65X
BCC - 10X
Melanoma 3.4x
Kaposi’s - 84X

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25
SC and transplant patients | risk factors
age / skin type / uv exposure genetic HPV (in 65-90% of SCC)
26
SC and transplant patients | level of immunosuppression and risk
cd4 count | meds
27
SC and transplant | more at risk tranplants?
heart>kidney>liver
28
Non transplant SCC:BCC
1:4
29
Transplant BCC:SCC
1:4
30
Does the risk of skin cancer increase or decrease with number of years post-transplant
incidence increases with number of years post-transplant | sun exposed more at risk (i.e. Australians vs Dutch)
31
NMSC treatment
``` Topical 5-fluoruracil Topical Imiquimod Cryosurgery Electrodessication and Curettage Excision Mohs micrographic surgery Radiation ```
32
Malignant melanoma ABCDE
``` A = Asymmetry B = Border irregularity C = Color variegation D = Diameter greater than 6 mm E = evolution (change) ```
33
fraction of melanoma arising from existing moles?
1/3
34
majority of normal moles have mutation in
BRAF
35
mutation that persists following malignant transformtion
BRAF
36
Increased risk MM fair skin
2-3
37
increased risk MM excessive sun
3-5
38
increased risk MM immunosuppression
2-8
39
increased risk MM first degree relative
2-8
40
increased risk MM whites
12
41
increased risk MM large congenital nevus (20cm)
17-21
42
increased risk MM sporadic dysplastic nevus syndrome
7-70
43
increased risk MM familial atypical mole and malignant melanoma
148
44
MM is the most common form of caner for which demographic / and second most common?
25-29 most common | 15-29 second most
45
new cases and deaths
76,100 new 9,700 death 1/hr
46
MM lifetime risk overtime
has dramatically increased
47
MM only cancer _____
whose incidence is increasing anually
48
MM colorado year
1400
49
MM age group
all ages | 53 median
50
MM | distribution
Blacks - acral and mucosa men - back women - legs / torso
51
MM variants (4)
superficial spreading 70% nodular 15-30% lentigo maligna 5% acral letiginous 2-10%
52
Clark level vs Breslow depth
Breslow better predictor
53
What is Breslow depth
tumor invsion in mm
54
``` Clark levels I II III IV V ```
``` I Epidermis II papillary dermis III mid dermis IV reticular dermis V sub-cu ```
55
MM in situ treatment
surgical excision 0.5cm with sub-cu
56
MM
surgical excision with 1cm margin to fascia
57
MM >1mm treatment
surgical excision with 1-2cm margins to fascia with sentinel lymph node biopsy
58
can you have melanoma in eye
yes, ocular melanoma - refer to opthomology
59
Frequent mutations in melanoma
BRAF 50% NRAS 20% Kit 2% GNAQ 2%
60
Which drug block BRAF?
vemurafenib | dabrafenib
61
MEK inhibitors
Trametinib Cobimetinib used in combo with BRAF
62
C-kit inhibitors
imatinib | nilotinib
63
Targeted immunotherapy for melanoma?
PD-1 inhibitors | CTLA-4 inhibitors
64
PD-1 inhibitors
immunotherapy melanoma pembrolizumab nivolumab immune checkpoint blockade - many tumor cells express PD-L1 and immunosuppressive PD-1 ligand - inhibition of this action can enhance T cell anti-cancer acitivity
65
CTLA-4 inhibitor
ipilimumab block ctla-4 receptor on t cells allowing stronger immune response
66
skin cancer due tanning vs lung cancer and smoking
skin cancer may be higher
67
UVR is a proven human carcinogen and is classified as group 1 which includes ____________________
plutonium and cigerettes
68
one indoor tanning session increases risk of melanoma by
20%
69
after the first indoor tanning session each additional session increases risk by
2%
70
of melanoma cases among 18-29 year olds who had tenned indoors, what % were attributable to tanning bed use?
76
71
The 6 Ss of sun cancer avoidance
``` sun avoidance (avoid mid-day sun) sun protective clothing shade sunscreen sombrero sunglasses ```
72
SPF
Sun protective factor | screen UVB
73
What does it mean to have SPF 15
Prolongs burning time by a factor of 15 --> would take 15 times longer to develop a sunburn than without session
74
Whe should sunscreen be used?
every day to sun exposed skin - not just if going out in sun
75
do windows protect against UVR?
UVB not UVA
76
What % of sun UV rays pass through clouds
80%
77
sand reflects % | snow reflects %
sand 25 | snow 80
78
When should sunscreen be applied?
15-30 minutes before going outdoors
79
how much sunscreen
1 ounce shotglass should cover exposed areas
80
how often should sunscreen be reapplied?
every 2 hours or after swimming/sweating
81
"water-resistant" sunscreen lose their effectiveness after ___ minutes in water
40
82
Kaposi's sarcoma
endothelial cell malignancy HHV-8 Usually appears on skin or mucosal surfaces (mouth) but can also develop in lymph nodes / lungs / or GI tract immunosuppressed
83
4 types of KS?
Classic Lymphadenopathic Iatrogenic AIDS
84
Classic KS?
Mediterranean | occurs primarily in elderly emn on Eastern European descent - often lower leg?
85
Lymphadenopathic KS?
Endemic to Africa Aggressive form primarily in equatorial Africa Affects young men and is rapidly fatal
86
Iatrogenic KS
Transplant related | due to chronic immunosuppression
87
AIDS KS
Associated Epidemic | incidence is declining with better antivirals
88
KS therapy (4)
radiation exicison interferon chemo
89
Stage IV melanoma treatment?
``` surgery radiation therapy immunotherapy targeted therapy chemotherapy ```

Disease and Defense III (11 decks)

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