Malignant Tumors of the Skin Flashcards
What do basal cell carcinomas look like?
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
What is the most common skin cancer?
Basal cell
3 out of 4 skin cancers
Can BCC metastasize?
Yes
It grows really slowly in areas exposed to sun, and if left untreated can metastasize (rare)
What does squamous cell carcinoma look like?
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
What type of person is especially susceptible to SCC?
immunosuppressed patients, especially organ transplant patients.
But is second most common with 1-3 out of 10 skin cancers
What are the three subtypes of SCC?
- 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 - Keratoacanthoma
- is a cup-shaped invagination of the epidermis with keratin- filled central crater - Invasive squamous cell carcinoma
- more common in SCC of the lip
T/F: melanoma usually occurs de novo, and not from pre-existing nevus
True
70% of the time they are de novo
How can you identify melanoma?
- ABCDE rule
- “ugly ducking” rule- the one that looks different
- Nodularity: bad sign that it’s spreading
What are three risk factors of melanoma?
- family history of melanoma (with or without the presence of multiple dysplastic nevi). FAMMM syndrome dramatically increases risk
- the presence of numerous common acquired nevi
- history of blistering sunburns.
T/F: skin cancer is the most common cancer?
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
Name risk factors for skin cancer in general. Can you name 11?
- Ultraviolet (UV) Light
- Fair Skin
- Gender
- Chemicals
- Radiation
- Having had a skin cancer
- Phototherapy
- Genetic Skin Diseases
- Immunosuppression
- HPV Infection
- Smoking
Men are more likely to get skin cancer than women?
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.
What is the most common pre-malignant skin lesion?
actinic keratoses (AKs)
- earliest identifiable lesion
- 65% of SCC and 36% of BCC were AK’s
What mutation leads to BCC?
Patch1 mutations
This is a tumor suppressor gene that blocks SMO in the hedgehog pathway
What cancer is Vismodegib used for?
BCC
It is small molecule inhibitor of smoothened (SMO)
What mutation causes melanoma?
Mutation in BRAF gene
*this is not inherited- it is acquired during development of melanoma
What is vemurafinib used for?
Melanoma
=selective BRAF inhibitor
What is difference between Breslow Depth and Clark level?
Breslows: measurement of depth in mm. MOST PREDICTIVE
Clark: Layers invaded
-ie: Level I (epidermis) vs Level V (subcutis)
What are methods to prevent skin cancer?
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
What are options for pre-malignant skin tumors?
5-fluorouracil (Topical) Imiquimod (Topical) ^"Mod(mop) the fluor (floor)" Cryotherapy Curettage Excision Mohs surgery technique Radiotherapy
What are options for malignant skin tumors (melanoma)?
Immunotherapy
Targeted therapy
Chemotherapy
Palliative local therapy
What are some targeted immunotherapy treatments?
BRAF inhibitors: vemurafenib MEK inhibitors c-KIT inhibitors: Gleevec PD-1 inhibitors: block cell death CTLA-4 inhibitor
T/F: Chemo is usually the first method to attack melanoma
False
can help some people with stage IV melanoma, but other treatments are usually tried first, because tumors usually grow back after chemo
