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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
Q

SC and transplant patients

risk factors

A

age / skin type / uv exposure
genetic
HPV (in 65-90% of SCC)

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26
Q

SC and transplant patients

level of immunosuppression and risk

A

cd4 count

meds

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27
Q

SC and transplant

more at risk tranplants?

A

heart>kidney>liver

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28
Q

Non transplant SCC:BCC

A

1:4

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29
Q

Transplant BCC:SCC

A

1:4

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30
Q

Does the risk of skin cancer increase or decrease with number of years post-transplant

A

incidence increases with number of years post-transplant

sun exposed more at risk (i.e. Australians vs Dutch)

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31
Q

NMSC treatment

A 
Topical 5-fluoruracil
Topical Imiquimod
Cryosurgery
Electrodessication and Curettage
Excision
Mohs micrographic surgery
Radiation
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32
Q

Malignant melanoma ABCDE

A 
A = Asymmetry
B = Border irregularity 
C = Color variegation 
D = Diameter greater 	than 6 mm
E = evolution (change)
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33
Q

fraction of melanoma arising from existing moles?

A

1/3

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34
Q

majority of normal moles have mutation in

A

BRAF

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35
Q

mutation that persists following malignant transformtion

A

BRAF

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36
Q

Increased risk MM fair skin

A

2-3

37
Q

increased risk MM excessive sun

A

3-5

38
Q

increased risk MM immunosuppression

A

2-8

39
Q

increased risk MM first degree relative

A

2-8

40
Q

increased risk MM whites

A

12

41
Q

increased risk MM large congenital nevus (20cm)

A

17-21

42
Q

increased risk MM sporadic dysplastic nevus syndrome

A

7-70

43
Q

increased risk MM familial atypical mole and malignant melanoma

A

148

44
Q

MM is the most common form of caner for which demographic / and second most common?

A

25-29 most common

15-29 second most

45
Q

new cases and deaths

A

76,100 new
9,700 death
1/hr

46
Q

MM lifetime risk overtime

A

has dramatically increased

47
Q

MM only cancer _____

A

whose incidence is increasing anually

48
Q

MM colorado year

A

1400

49
Q

MM age group

A

all ages

53 median

50
Q

MM

distribution

A

Blacks - acral and mucosa
men - back
women - legs / torso

51
Q

MM variants (4)

A

superficial spreading 70%
nodular 15-30%
lentigo maligna 5%
acral letiginous 2-10%

52
Q

Clark level vs Breslow depth

A

Breslow better predictor

53
Q

What is Breslow depth

A

tumor invsion in mm

54
Q 
Clark levels 
I
II
III
IV
V
A 
I Epidermis
II papillary dermis
III mid dermis
IV reticular dermis
V sub-cu
55
Q

MM in situ treatment

A

surgical excision 0.5cm with sub-cu

56
Q

MM

A

surgical excision with 1cm margin to fascia

57
Q

MM >1mm treatment

A

surgical excision with 1-2cm margins to fascia with sentinel lymph node biopsy

58
Q

can you have melanoma in eye

A

yes, ocular melanoma - refer to opthomology

59
Q

Frequent mutations in melanoma

A

BRAF 50%
NRAS 20%
Kit 2%
GNAQ 2%

60
Q

Which drug block BRAF?

A

vemurafenib

dabrafenib

61
Q

MEK inhibitors

A

Trametinib
Cobimetinib

used in combo with BRAF

62
Q

C-kit inhibitors

A

imatinib

nilotinib

63
Q

Targeted immunotherapy for melanoma?

A

PD-1 inhibitors

CTLA-4 inhibitors

64
Q

PD-1 inhibitors

A

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
Q

CTLA-4 inhibitor

A

ipilimumab
block ctla-4 receptor on t cells
allowing stronger immune response

66
Q

skin cancer due tanning vs lung cancer and smoking

A

skin cancer may be higher

67
Q

UVR is a proven human carcinogen and is classified as group 1 which includes ____________________

A

plutonium and cigerettes

68
Q

one indoor tanning session increases risk of melanoma by

A

20%

69
Q

after the first indoor tanning session each additional session increases risk by

A

2%

70
Q

of melanoma cases among 18-29 year olds who had tenned indoors, what % were attributable to tanning bed use?

A

76

71
Q

The 6 Ss of sun cancer avoidance

A 
sun avoidance (avoid mid-day sun)
sun protective clothing
shade
sunscreen 
sombrero 
sunglasses
72
Q

SPF

A

Sun protective factor

screen UVB

73
Q

What does it mean to have SPF 15

A

Prolongs burning time by a factor of 15 –> would take 15 times longer to develop a sunburn than without session

74
Q

Whe should sunscreen be used?

A

every day to sun exposed skin - not just if going out in sun

75
Q

do windows protect against UVR?

A

UVB not UVA

76
Q

What % of sun UV rays pass through clouds

A

80%

77
Q

sand reflects %

snow reflects %

A

sand 25

snow 80

78
Q

When should sunscreen be applied?

A

15-30 minutes before going outdoors

79
Q

how much sunscreen

A

1 ounce shotglass should cover exposed areas

80
Q

how often should sunscreen be reapplied?

A

every 2 hours or after swimming/sweating

81
Q

“water-resistant” sunscreen lose their effectiveness after ___ minutes in water

A

40

82
Q

Kaposi’s sarcoma

A

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
Q

4 types of KS?

A

Classic
Lymphadenopathic
Iatrogenic
AIDS

84
Q

Classic KS?

A

Mediterranean

occurs primarily in elderly emn on Eastern European descent - often lower leg?

85
Q

Lymphadenopathic KS?

A

Endemic to Africa
Aggressive form primarily in equatorial Africa
Affects young men and is rapidly fatal

86
Q

Iatrogenic KS

A

Transplant related

due to chronic immunosuppression

87
Q

AIDS KS

A

Associated Epidemic

incidence is declining with better antivirals

88
Q

KS therapy (4)

A

radiation
exicison
interferon
chemo

89
Q

Stage IV melanoma treatment?

A 
surgery 
radiation therapy 
immunotherapy 
targeted therapy 
chemotherapy

Disease and Defense III (11 decks)

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