Malignant Skin Lesions: Actinic Keratoses and Non-Melanoma Skin Cancer

Question 1

definition

epidemiology/riskfactors/causes

morphology

treatment

Answer 1

definition: ACTINIC (SOLAR) KERATOSIS. Precancerous epithelial lesions that are found on sun-exposed areas. can turn into SCC

epidemiology/riskfactors/causes: fair skinned people more at risk.

morphology: flat, scarly, rough papules with ill defined boarders; beginning as rough localized skin lesions that are easily felt but not seen. can coalesce to form plaques.
treatment: Initially may heal without treatment… Aggressive sun avoidance/protection (at least SPF 30). Cryotherapy or superficial curettage and cautery for individual lesions. 5- fluorocil 5% cream applied bid for 3 wk.

Question 2

term for actinic keratoses on the lower lips

Answer 2

actinic cheilitis

Question 3

what type of cancer can actinic keratoses turn into?

Answer 3

SCC

Question 5

Answer 5

nodular basal cell carcinoma

Question 6

BCC involves the skin cells in the ___ ____ layer.

• where on the body is it found?
• is this a metastasizing cancer?

Answer 6

skin cells in the stratum basale layer

found on sun exposed areas.

usually non-metastasizing especially if found early

Question 7

4 subtypes of BCC

Answer 7

1. nodular: pearly papule that can ulcerate, umbilicate, or have superficial telangiectasia.
2. infiltrating: invades the dermis in addition to the basale layer
3. pigmented
4. superficial: appears as a dry, flat papule or plaque that enlarges slowly and sometimes develops a raised boarder.

Question 8

name these types of BCC

Answer 8

1. nodular
2. superficial
3. pigmented

Question 9

etiology of BCC

Answer 9

sun exposure causes dysregulation in the sonic-hedgehod pathway. inactiavtion of PTCH1 gene or sporadic activation of SMO genes

Question 10

surgical treatment options for BCC

Answer 10

should be tailored to the patient.

• electrodissection and curettage
• cryosurgery
• radiation
• mohs surgery: removal until the vorder of the surgical field is cancer free. usually done if its recurrent and agressive on the head and neck

Question 11

topical treatment options for BCC

Answer 11

imiquimod

Question 12

Answer 12

BCC

Question 13

how to tell the difference between SCC and BCC lesions

Answer 13

SCC is usually a bit more ulcerated and develops a depressed center and becomes fixed to underlying areas

Question 14

Answer 14

Squamous cell carcinoma: malignancy of cutaneous squamous kertainocytes in the epidermis occurring most frequently on sun exposed areas

etiology: malignant transformation of actinic keratosis (or de novo)
morphology: erythematous, hyperkeratotic papule or nodule that may ulcerate. may be smooth or skin colored. overtime it develops a depressed center and becomes fixed to underlying areas

new masses within scars or chronic ulcerations are highly suspicious for SCC

Question 15

bowens disease

Answer 15

early stage of SCC, slow growing and superficial

Question 16

T/F: SCC on the lip is more commonly seen on the lower lip

Answer 16

true

Question 17

treatment of SCC

Answer 17

Mohs micrographic surgery and standard surgical excision with 3-4 mm margins are the first-line treatment. in cases of known or suspected nodal metastases, sentinel or formal lymph node dissection is often indicated.

Question 18

treatment of SCC for those who are not surgical candidates

Answer 18

For superficial SCCs, electrodesiccation and curettage (times 3) with margins of 3-4 mm may be used. Radiation therapy is another reasonable alternative for poor surgical candidates.

Question 19

Answer 19

ulcerated SCC