NMSC

Question 1

Pathophysiology of BCC

Answer 1

-inactivation of PTCH tumor suppression gene

-mutations in the patched/hedgehog intercellular signaling pathway

Question 2

Most common subtype of BCC

Answer 2

nodular

Question 3

First line treatment for BCC

Answer 3

standard excision or mohs with 4mm margins

mohs for all high risk BCC

Question 4

FDA approved use of ED&C for BCC

Answer 4

superficial BCCs at non-hair bearing areas and areas that are not high risk

Question 5

Pathophysiology of SCC

Answer 5

mutation of p53 tumor suppression gene

Question 6

“High Risk” factors of SCC

Answer 6

1. tumor diameter >2cm
2. poorly differentiated
3. perineural invasion >0.1mm
4. tumor invasion beyond fat
5. bone invasion

Question 7

transplant organs at high risk for SCC

Answer 7

heart and lung

Question 8

transplant organs at lower risk for SCC

Answer 8

kidney and liver

Question 9

immunosuppressive drug at LOWER risk for skin cancer for transplant patients

Answer 9

mTOR inhibitors

-sirolimus (lowest risk)
-everolimus

Question 10

common risk factor for Merkel Cell Carcinoma

Answer 10

polyomavirus infection

Question 11

Risk factors for Merkel Cell

Answer 11

-polyomavirus
-fair skin types
-males 2 fold higher than females
- > 70 yrs old (rare in ppl < 50)
-UV
-Weakened immune system

Question 12

clinical presentation of merkel cell

Answer 12

asymptomatic, firm, nontender solitary rapid growing nodule from 0.5-5cm

pink, violaceous, reddish brown, skin colored

overlying skin intact, may be shiny with telangiectasia or be normal in color

ulceration is uncommon

mostly head and neck region

Question 13

what should be performed before surgery for all merkel cell patients?

Answer 13

CT scan

Question 14

pathophysiology of b cell lymphoma

Answer 14

-nonhodgkin lymphoma
-begins as a reactive inflammatory lymphoproliferative process
-imbalance between apoptosis and cellular proliferation

Question 15

common predisposing factor of b cell lymphoma

Answer 15

chronic stimulation of antigens and infections (viral and bacterial)

Question 16

risk factors for b cell lymphoma

Answer 16

-immunosuppressed (organ transplants, AIDS)
-meds like MTX
-epstein barr virus
-pts receiving chemo/radiation therapy

Question 17

clinical presentation of b cell lymphoma

Answer 17

-slow growing
-face, trunk, extremities
-one or multiple smooth red/pink papule/plaque/nodule
-fever, weight loss, night sweats may be present

Question 18

w/u for b cell lymphoma

Answer 18

-lymph node exam
-cbc w diff, chemistries, LDH, flow cytometry
-chest x ray and abdominal ultrasound
-CT scan to assess spread (high incidence of spread at time of diagnosis)

Question 19

CTCL poses increased risk for secondary malignancies

which types?

Answer 19

-other nonhodgkin lymphomas
-lung
-bladder
-melanoma

Question 20

most common subtypes of CTCL

Answer 20

mycosis fungoides

sezary syndrome

Question 21

pathophysiology of CTCL

Answer 21

-mutation of T cells in the immune system (malignant T cells) that migrate to the skin

-the malignant T cells in the peripheral blood can cause decrease in healthy CD4+, CD8+, and natural killer cells in the immune system

Question 22

clinical presentation of sezary syndrome

Answer 22

-patients advance to atypical lymphocytes (Sezary cells) in their blood and erythroderma of 80-90% BSA
-skin is often erythrodermic and becomes exfoliative
-symptoms are hot, painful, sensitive, and very pruritic skin
-may include hyperkeratosis at the palms and soles, alopecia, onychodystrophy, ptosis, ectropion of the eyelids
-often diffuse lymphadenopathy

Question 23

w/u for CTCL

Answer 23

-skin biopsy but hold topical treatments for 2 weeks before biopsy
-labs:
cbc, peripheral smear for atypical serum lymphocytes (sezary cells), LFT’s, BUN, Creatinine, LDH, CD4/CD8
-CXR

Question 24

treatment for limited stage MF CTCL

(patch/plaque stage)

Answer 24

-goal is to alleviate symptoms and improve QOL

-topical steroids (clobetasol)

-topical nitrogen mustard (mechlorethamine)

-topical retinoids (bexarotene)

-NB-UVB therapy

-radiation (if localized or solitary tumor)