Neoplasms and Verrucous Lesions Questions Flashcards
Which lesions are considered benign?
SK (verrucous lesion), Nevi (moles)
Which lesions are considered pre-malignant?
Actinic Ketosis (verrucous lesion)
What lesions are considered malignant?
Neoplasms: basal cell skin cancer, squamous cell skin cancer, malignant melanoma
What is seborrheic keratosis (SK)?
A benign verrucous lesion that develops from immature keratinocyte proliferation (can be hereditary: where patients get numerous lesions)
What are the characteristics of SK?
Appears in adulthood, appearance can vary, sharply defines, raised/stuck on appearance, tan/black in color (multicolor)
Usually asymptomatic but mild itching and tenderness can occur if the lesion is irritated
(women may get them under the breast)
What is the treatment for SK?
No treatment is necessary
Yet, it is good to get a biopsy if the lesion is not a clear cut SK (rule out cancerous lesions)
If symptomatic: freezing,shaving, or slicing off the lesion may relieve itching (Sarna lotion can also help!)
What is the RED FLAG symptom of SK?
Leser-Trelat: sudden onset of numerous SK’s, may indicate cancer
Ask about other symptoms: weight loss, night sweats, fatigue, unexplained fever, tarry stool, lymph node swelling
What is Actinic Keratosis (AK)?
Considered pre-skin cancer caused by excess sun exposure (usually in childhood or teenage years)
What are the clinical features of AK?
Scaly, flaky, rough, red, pink, sensitive and common on face, ears, scalp, forearms, chest, upper back, and hands (may come and go and then be permanent), usually a clinical diagnosis
In finger could be presented as a cutaneous horn
What are the treatments for AK?
Because of the high possibility to develop into squamous cell skin cancer, usually treated, consider biopsy
Destruction of lesion using liquid nitrogen or topical chemotherapy (depending on location, #, size)
What is a nevi?
A benign mole resulting from proliferation of cutaneous melanocytes (can be pink, flesh colored, brown, raised, or flat)
What are the risk factors for developing skin cancer?
Fair skin, light hair, environment, sunburn tendency, personal history of skin cancer, family history of melanoma, 50+ moles, immunocompromised
What is basal cell skin cancer?
Most common form of skin cancer that is usually non-life threatening (caused by increased sun exposure)
Common on sun exposed skin like the face
What are the clinical features of basal cell skin cancer?
Pearly/shiny bump, scar-like appearance, red scaly crusted patch, lesions may bleed, sore throat that does not heal
**slow growing, diagnosed by biopsy
What are the treatments for basal cell skin cancer?
Dependent on size, location, and type of carcinoma
ED&C- scraping/burning
Excision- cutting out/stitching
MOHS- layer by layer targeted procedure with high cure rate and better cosmetic outcome
Excellent cure rate :) patient has to return for regular skin exams
What is squamous cell skin cancer?
Second most common form of skin cancer, common on skin that has been traumatized (burns, scars, persistent sores)
**immunosuppressed= greater risk
What are the clinical features of squamous cell skin cancer?
Thick/rough horn like lesion, warty sore, may bleed, irregular red patch that does not resolve, crater-like/meaty lesion
diagnosed by biopsy
**faster growing
What are the treatments for squamous cell skin cancer?
Depends on size, location, type
cryotherapy (freezing)
topical chemo
ED&C- scraping/burning
Excision- cutting & stitching
MOHS- layer by layer
If treatment modalities do not work, resort to radiation
What is malignant melanoma?
The most serious skin cancer
Factors: amount of sun exposure, heredity
If diagnosed early, good cure rate
If there’s a delay in diagnosis, cure rates decrease due to spreading (can be fatal)
What are the ABCD’s of melanoma?
Warning signs of melanoma (fried egg appearance, variation/change in color, getting larger)
Asymmetry
Borders
Color
Diameter
Evolving
Failure to respond to treatment
What are the four main types of melanoma?
Superficial Spreading, Lentigo Maligna, Acral Lentiginous, Nodular
What is superficial spreading melanoma? Where is it most commonly found?
Melanoma that is flat, irregular, and different shades of black/brown
Starts in situ
Commonly found on trunk in men, legs in women, upper back in both
What is lentigo maligna? Where is it most commonly found?
Melanoma that is often seen as a “sun spot” that can become cancerous, it’s usually found in the elderly that have chronically damaged skin
Starts in situ
Commonly found on the face, ears, arms, and upper trunk
What is acral lentiginous melanoma? Where is it most commonly found?
Melanoma that can advance quickly and is commonly found in African Americans and Asians
Starts in situ
Commonly found on soles of feet, palms of hands (can be seen in between toes/fingers), and fingernails
What is nodular melanoma? Where is it most commonly found?
Melanoma that starts invasive (worse of a prognosis)
Seen as a blackish blue raised area
Usually found on trunk, legs, arms, scalp of men
*Most aggressive
What is the prognosis of melanoma based on?
Depth (Breslow’s thickness), and stage of tumor
What is Breslow’s thickness?
A measurement scale that determines the depth of the tumor in mm to further diagnose stage/prognosis of cancer
in situ- epidermis
thin- less than 1mm
intermediate- 1-4mm
thick- greater than 4mm
What is stage 0?
In situ (confined to the epidermis)
What is stage I?
Confined to skin as thick as 1mm
What is stage II?
1.01mm-4mm thick, yet no spreading
What is stage III?
Spread to nearby lymph nodes/skin
What is stage IV?
Spread to internal organs, far away skin/far away lymph nodes
Metastasis commonly found in skin, soft tissue, lungs, and brain
What are the treatment options for malignant melanoma?
Lesions must be surgically excised with a certain border of normal looking skin/tissue taken with them
Margins depend on depth of lesion (breslow’s thickness)
Referral and multi-faced treatment may be necessary for more serious cases
What are good practices of sun safety?
Avoid deliberate tanning, wear protective dark clothing/eyewear, avoid mid day sun when at it’s peak
When should sunscreen be worn?
All year round
What SPF is recommended for sun safety/ when should this be applied?
SPF 30, should be applied 15 minutes before exposure and reapplied every 2 hours (lip balm also!)
