NMSC Flashcards
Pathophysiology of BCC
-inactivation of PTCH tumor suppression gene
-mutations in the patched/hedgehog intercellular signaling pathway
Most common subtype of BCC
nodular
First line treatment for BCC
standard excision or mohs with 4mm margins
mohs for all high risk BCC
FDA approved use of ED&C for BCC
superficial BCCs at non-hair bearing areas and areas that are not high risk
Pathophysiology of SCC
mutation of p53 tumor suppression gene
“High Risk” factors of SCC
- tumor diameter >2cm
- poorly differentiated
- perineural invasion >0.1mm
- tumor invasion beyond fat
- bone invasion
transplant organs at high risk for SCC
heart and lung
transplant organs at lower risk for SCC
kidney and liver
immunosuppressive drug at LOWER risk for skin cancer for transplant patients
mTOR inhibitors
-sirolimus (lowest risk)
-everolimus
common risk factor for Merkel Cell Carcinoma
polyomavirus infection
Risk factors for Merkel Cell
-polyomavirus
-fair skin types
-males 2 fold higher than females
- > 70 yrs old (rare in ppl < 50)
-UV
-Weakened immune system
clinical presentation of merkel cell
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
what should be performed before surgery for all merkel cell patients?
CT scan
pathophysiology of b cell lymphoma
-nonhodgkin lymphoma
-begins as a reactive inflammatory lymphoproliferative process
-imbalance between apoptosis and cellular proliferation
common predisposing factor of b cell lymphoma
chronic stimulation of antigens and infections (viral and bacterial)
risk factors for b cell lymphoma
-immunosuppressed (organ transplants, AIDS)
-meds like MTX
-epstein barr virus
-pts receiving chemo/radiation therapy
clinical presentation of b cell lymphoma
-slow growing
-face, trunk, extremities
-one or multiple smooth red/pink papule/plaque/nodule
-fever, weight loss, night sweats may be present
w/u for b cell lymphoma
-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)
CTCL poses increased risk for secondary malignancies
which types?
-other nonhodgkin lymphomas
-lung
-bladder
-melanoma
most common subtypes of CTCL
mycosis fungoides
sezary syndrome
pathophysiology of CTCL
-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
clinical presentation of sezary syndrome
-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
w/u for CTCL
-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
treatment for limited stage MF CTCL
(patch/plaque stage)
-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)
