Malignant Tumors of the Skin

Question 1

What do basal cell carcinomas look like?

Answer 1

Then they can bleed or even hurt. Basal cell carcinomas often appear as flat, firm, pale areas or as small, raised, pink or red, translucent, shiny, waxy areas that may bleed after minor injury

Question 2

What is the most common skin cancer?

Answer 2

Basal cell

3 out of 4 skin cancers

Question 3

Can BCC metastasize?

Answer 3

Yes

It grows really slowly in areas exposed to sun, and if left untreated can metastasize (rare)

Question 4

What does squamous cell carcinoma look like?

Answer 4

More lumpy than BCC with rough, crusty looking surface

may appear as growing lumps, often with a rough surface, or as flat, reddish patches that grow slowly

Question 5

What type of person is especially susceptible to SCC?

Answer 5

immunosuppressed patients, especially organ transplant patients.

But is second most common with 1-3 out of 10 skin cancers

Question 6

What are the three subtypes of SCC?

Answer 6

1. Squamous cell carcinoma in situ (Bowen’s disease)
   - earliest form of squamous cell skin cancer. “In situ” means that the cancer is only in the epidermis where it began
2. Keratoacanthoma
   - is a cup-shaped invagination of the epidermis with keratin- filled central crater
3. Invasive squamous cell carcinoma
   - more common in SCC of the lip

Question 7

T/F: melanoma usually occurs de novo, and not from pre-existing nevus

Answer 7

True

70% of the time they are de novo

Question 8

How can you identify melanoma?

Answer 8

1. ABCDE rule
2. “ugly ducking” rule- the one that looks different
3. Nodularity: bad sign that it’s spreading

Question 9

What are three risk factors of melanoma?

Answer 9

1. family history of melanoma (with or without the presence of multiple dysplastic nevi). FAMMM syndrome dramatically increases risk
2. the presence of numerous common acquired nevi
3. history of blistering sunburns.

Question 10

T/F: skin cancer is the most common cancer?

Answer 10

True

• More than 3.5 million skin cancers in over two million people are diagnosed annually.
• more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon

Question 11

Name risk factors for skin cancer in general. Can you name 11?

Answer 11

• Ultraviolet (UV) Light
• Fair Skin
• Gender
• Chemicals
• Radiation
• Having had a skin cancer
• Phototherapy
• Genetic Skin Diseases
• Immunosuppression
• HPV Infection
• Smoking

Question 12

Men are more likely to get skin cancer than women?

Answer 12

True- probably for being out in the sun more

Men are 2x as likely as women to have basal cell cancers and 3x as likely to have squamous cell cancers.

Question 13

What is the most common pre-malignant skin lesion?

Answer 13

actinic keratoses (AKs)

• earliest identifiable lesion
• 65% of SCC and 36% of BCC were AK’s

Question 14

What mutation leads to BCC?

Answer 14

Patch1 mutations

This is a tumor suppressor gene that blocks SMO in the hedgehog pathway

Question 15

What cancer is Vismodegib used for?

Answer 15

BCC

It is small molecule inhibitor of smoothened (SMO)

Question 16

What mutation causes melanoma?

Answer 16

Mutation in BRAF gene

*this is not inherited- it is acquired during development of melanoma

Question 17

What is vemurafinib used for?

Answer 17

Melanoma

=selective BRAF inhibitor

Question 18

What is difference between Breslow Depth and Clark level?

Answer 18

Breslows: measurement of depth in mm. MOST PREDICTIVE

Clark: Layers invaded
-ie: Level I (epidermis) vs Level V (subcutis)

Question 19

What are methods to prevent skin cancer?

Answer 19

Basically avoid the sun

Limit Ultraviolet (UV) Exposure, Protect Your Skin With Clothing, wear sunscreen, wear a hat, seek shade, wear sunglasses, avoid other sources of UV, protect children, avoid chemicals

Question 20

What are options for pre-malignant skin tumors?

Answer 20

5-fluorouracil (Topical) 
Imiquimod (Topical)   ^"Mod(mop) the fluor (floor)"
Cryotherapy 
Curettage
Excision 
Mohs surgery technique
Radiotherapy

Question 21

What are options for malignant skin tumors (melanoma)?

Answer 21

Immunotherapy
Targeted therapy
Chemotherapy
Palliative local therapy

Question 22

What are some targeted immunotherapy treatments?

Answer 22

BRAF inhibitors: vemurafenib
MEK inhibitors
c-KIT inhibitors: Gleevec
PD-1 inhibitors: block cell death
CTLA-4 inhibitor

Question 23

T/F: Chemo is usually the first method to attack melanoma

Answer 23

False

can help some people with stage IV melanoma, but other treatments are usually tried first, because tumors usually grow back after chemo