Malignant Tumors of the skin

Question 1

incidence of skin cancer in the US

Answer 1

most common form of cancer

Question 2

risks for skin cancer

Answer 2

• UV light
• fair skin
• gender
• chemicals (esp. arsenic)
• radiation
• having had skin cancer
• phototherapy
• genetic skin diseases
• immunosuppression
• HPV infection
• smoking

Question 3

Actinic keratoses

Answer 3

(Intraepidermal neoplasia I) are the most common pre-malignant skin lesion. The actinic keratosis (AK) is the earliest identifiable lesion that can eventually develop into an invasive squamous cell carcinoma (SCC)

Question 4

BCC (mut and chemotx)

Answer 4

Patch1 mutation, vismodegib

Question 5

Melanoma (mut and chemotx)

Answer 5

BRAF mutation, vemurafinib

Question 6

Breslow depth:

Answer 6

most important indicator of prognosis measuring the maximal thickness of tumor invasion (4 mm are poor prognosis)

Question 7

Clark’s level:

Answer 7

how far a melanoma has penetrated into the layers of the skin

• I: epidermis
• II: beginning in upper dermis
• III: most of upper dermis
• IV: lower dermis
• V: subcutis

Question 8

methods of skin cancer prevention

Answer 8

• Limit UV exposure with clothing, hats, sunscreen, sunglasses and shade
• avoid tanning beds and sun lamps
• avoid chemicals like arsenic

Question 9

treatments for non-melanomas

Answer 9

• Topical 5-fluoruracil
• Topical Imiquimod
• Cryosurgery
• Electrodessication and Curettage
• Excision
• Mohs micrographic surgery
• Radiation

Question 10

treatments for melanomas

Answer 10

•	Surgical excision
–	MM in-situ:	0.5 cm with subcutaneous tissue
–	MM  1 mm: 1 cm margin to fascia
–	MM > 1 mm: 1-2 cm margins to fascia with sentinel node biopsy
•	Immunotherapy
–	Ipilumumab: human mAb 
–	Interleukin-2
•	Signal transduction inhibitors 
–	Vemurafenib: BRAF inhibitor 
•	Chemotherapy 
•	Palliative local therapy