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clinical medicine > Neoplasms and Verrucous Lesions > Flashcards

Neoplasms and Verrucous Lesions Flashcards

0
Q

What are the clinical aspects of seborrheic keratosis?

A
  • various appearances: sharply defined, raised, tan to black in color
  • asymptomatic: mild pruritis or tender IF irritated
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1
Q

What is seborrheic keratosis (verrucous lesion)?

A
  • benign
  • develops from epidermal proliferation
  • adulthood
  • may be hereditary when numerous lesions
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2
Q

What are the treatments for seborrheic keratosis?

A
  • no tx necessary
  • consider biopsy if NOT clear cut!
  • removal by cryotherapy, or surgery
  • topical antipruritic if needed
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3
Q

What is actinic keratosis? (verrucous lesion)

A
  • pre skin cancer
  • affects 59 million americans
  • caused by sun exposure
  • face, ears, scalp, forearms, chest, upper back, hands
  • may seem to come and go at first
  • scaly, flaky, rough, red, pink, sensitive
  • 25% develop into squamous cell skin cancer
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4
Q

What is the treatment for actinic keratosis?

A
  • destruction with liquid nitrogen or topical chemotherapy or photodynamic therapy: depends on location, number, and size of lesions
  • prevention=sun safety
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5
Q

Skin cancer facts

A

most common form of cancer in US
3.5 million skin cancers dx annually
more new cases of skin cancer each year than combined incidence of breast, prostate, lung, and colon cancer
1 in 5 americans develop skin cancer in life time
melanoma most common for ages 25-29
1 person dies every hour from melanoma in US
skin cancer risk doubles with a history of 5+ blistering sunburns
risk of melanoma doubles with a history of only one blistering sunburn as child
incidence of MM increasing

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6
Q

What are risk factors for skin cancer?

A
  • fair skin, light hair and eyes
  • tendency to sun burn
  • geographic location
  • history of increased UV exposure and sunburns
  • history of radiation tx
  • personal history of skin cancer
  • family history of melanoma, especially in first degree relative
  • 50+ moles
  • chronically suppressed immune system
  • non-caucasians can develop melanoma–more deadly due to delayed diagnosis
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7
Q

What is basal cell skin cancer?

A
  • most common form of skin cancer
  • caused by sun exposure
  • not usually life threatening
  • most common on sun exposed skin
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8
Q

What are the warning signs of basal cell skin cancer?

A
  • a sore that does not heal
  • a pearly shiny bump
  • a scar like appearance
  • a red scaly crusted patch
  • the lesion may bleed
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9
Q

How is the diagnosis of basal cell skin cancer made?

A

biopsy

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10
Q

What is the treatment of basal cell skin cancer?

A
  • depends on size, location, type of basal cell carcinoma
  • cryotherapy, topical chemotherapy, ED&C, excision, MOHS surgery
  • excellent cure rate
  • regular complete skin exams important–you are at risk of developing more BCC
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11
Q

What is squamous cell skin cancer?

A
  • second most common form (700,000 cases dx each year)
  • most not serious but if untreated can metastasize (2500 deaths a yr)
  • excess sun exposure
  • sun exposed skin, LIPS*
  • injured skin–burns, scars, long standing sores
  • immune suppressed people at higher risk
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12
Q

What are the warning signs of squamous cell skin cancer?

A

-thick rough horn like lesion, wart like sore, may bleed, irregular rough red patch that persists

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13
Q

How is the diagnosis of squamous cell skin cancer made?

A

biopsy

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14
Q

What are the treatments for squamous cell skin cancer?

A
  • depends on lesion size, location, type
  • cryotherapy, topical chemotherapy, ED&C, excision, MOHS surgery
  • good prognosis
  • regular skin exams, sun safety
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15
Q

Describe malignant melanoma.

A
  • most serious skin cancer
  • 4% of all diagnosed skin cancers
  • causes most skin cancer related deaths (8790 deaths/yr)
  • if diagnosed and treated early, cure rate is nearly 100%
16
Q

What are risk factors in malignant melanoma?

A
  • sun exposure
  • heredity: first degree relative w/ melanoma –50% greater chance of developing MM than rest of general population
  • having a second degree relative with MM does increase risk but not dramatically
17
Q

What are the warning signs of malignant melanoma? (ABCD)

A 
ABCD's:
A=asymmetry
B=borders
C=color
D=diameter
E=evolving
F=failure to respond to tx
18
Q

How is diagnosis of malignant melanoma made?

A
  • biopsy: should be deep to determine depth of MM, but depth may change once pathology is performed on completely excised lesion
  • MM may become raised, lumpy, bleeding–look for lesions that are changing–can occur in longstanding lesions
19
Q

Briefly describe types of malignant melanoma.

A
  • 4 basic types
  • first 3 start in situ
  • last starts invasive:
    1. superficial spreading-most common (trunk in men, legs in women, upper back in both)
    2. lentigo maligna-elderly, chronically damaged skin, face, ears, arms, upper trunk
    3. acral lentiginous melanoma-under nails or palms of hands, soles of feet–common in african americans and asians, can advance quickly
    4. nodular melanoma-starts invasive, trunk, legs, arms, scalp of men, most aggressive
20
Q

What is the prognosis of malignant melanoma? What is Breslow’s thickness scale?

A
  • prognosis depends on depth/stage of tumor
  • Breslow’s: measures the deepest point of tumor penetration in millimeters:
  • in situ: confined to epidermis
  • thin tumors 4.0mm
21
Q

What are the stages of malignant melanoma?

A

Stage 0- in situ
Stage I- confined to skin as thick as 1mm
Stage II-1.01mm-4mm thick, still no spread
Stage III-MM spread to nearby lymph nodes or nearby skin
Stage IV-MM spread to internal organs, far away skin, far away lymph nodes

22
Q

Treatment of malignant melanoma

A
  • excise lesions
  • margin or border of normal appearing skin around lesion must be taken
  • margins are determined by depth of lesion
  • MOHS surgery sometimes done for in situ lesions
23
Q

What is the excision margin guideline for malignant melanoma?

A

in situ-5mm margin

4.0mm - 2cm margin

24
Q

Malignant melanoma - what is sentinel lymph node biopsy?

A
  • determines spread of MM
  • radioactive dye is injected and traced through lymphatic system
  • first node to pick up the dye is sentinel node, node is removed and examined
  • if melanoma cells are present other nodes in region are removed and examined
  • indicated for MM 1.0mm or greater
  • ideal to be performed before wide excision
  • most important independent prognostic factor with respect to disease progression and melanoma specific survival
25
Q

What is kaposi sarcoma?

A
  • neoplasm that manifests with multiple vascular nodules
  • skin, mucous membranes, internal organs can be affected–can occur in organs and mucosa with no skin involvement
  • can be localized nodular, locally aggressive, or generalized
  • begin as discrete red or purple patches, symmetric and initially involve lower extremities
  • patches become elevated and evolve into nodules and papules
  • human herpes virus type 8 (HHV-8) must be present for KS to develop
26
Q

Who is predisposed to kaposi sarcoma?

A

older men of mediterranean or jewish lineage
africans from uganda, congo, zambia
immunosuppressed (transplant pt)
homosexual men–AIDS associated w/ diagnosis

27
Q

What is the workup for kaposi sarcoma?

A

-diagnostic evaluation: complete physical, CBC and CMP (anemia, increased incidence of DM), HIV testing, CT Scan, CXR, skin biopsy, lymph node biopsy

28
Q

What is the treatment/complications/prognosis of kaposi sarcoma?

A

treatment-radiation, chemotherapy, excision of solitary lesion
complications- secondary malignancy and infection, lymphoma
prognosis depends on extent of disease

clinical medicine (12 decks)

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