Non melanoma Skin Cancer

Question 1

What are the characteristics of Actinic Keratosis (AK)? how do you treat?

Answer 1

-precursor to SCC
-due to chronic sun exposure
-rough sand paper like surface
Tx: topical cream, liquid nitrogen, photodynamic therapy, chemical peel

Question 2

What are the characteristics of cutaneous horn? how do you treat?

Answer 2

• skin colored, antler like projection, often on face and scalp
• mostly benign but can overlie BCC or SCC
• Tx: excision

Question 3

What are the characteristics of Keratoacanthoma (KA)?

Answer 3

• rapidly gorwing dome shaped crateriform papule/nodule with central crater of keratin
• well differentiated SCC
• due to sun exposure, trauma, surgical excision
• Tx: excision, mohs, radiation, drugs

Question 4

What are the characteristics of squamous cell carcinoma?

Answer 4

• Second most common type of skin cancer (accounts for 20% of cutaneous malignancies).
• Develops on sun-exposed sites along AKs. Often appear like a scaly eczematous patch.
• Most often induced by chronic UV radiation.
• HPV (-16,-18,-,31,-35) associated with SCCs that develop in the genitals or periungually.
• Chronic scarring processes (chronic ulcers, burns, hidradentitis suppurtiva, EB, radiation therapy) are risk factors for developing SCCs.
• low metastases

Question 5

What are the characteristics of Bowen’s Disease?

Answer 5

• Erythematous, slightly scalying and crusted patch that is sharply defined.
• Intraepidermal SCC (SCC in-situ) that arises from adnexal epithelium and invades the epidermis.
• Epidermal maturation is absent, so the epidermis is disorganized.
• Can be more aggressive than SCC arising from an actinic keratosis (tumor also can track down a hair follicle, making it resistant to ED&C).

Question 6

What are the characteristics of Basal Cell Carcinoma? What are the risk factors?

Answer 6

-Most common cancer in the US: majority (75%) of NMSC are BCCs
-Associated with mutations in CDKN2A, or point mutations in p53
-Also associated with inactivation of patched tumor-suppressor gene (PTCH) and the activation of smoothened (SMO) or sonic hedgehog (SHH) genes.
-Risk factors:
Intermittent sun exposure (prior sunburns)
Radiation treatment
Family history of BCCs
Immunosuppression

Question 7

What are the characteristics of Gorlin’s syndrome?

Answer 7

AKA basal cell nevus syndrome
Major criteria
Two or more basal cell carcinomas in persons younger than 20 years
Odontogenic keratocysts of the jaw
Three or more palmar or plantar pits
Bilamellar calcification of the falx cerebri
Bifid, fused, or markedly splayed ribs
First-degree relative with Gorlin syndrome

Question 8

What are the characteristics of Paget’s Disease?

Answer 8

• Unilateral, sharply marginated, erythematous crusted patch or plaque on the nipple and/or areola.`
• Mistaken for eczema of the nipple (but is unilateral, compared to eczema, which should be bilateral).
• Histologically, one sees nests of Paget cells in the epidermis.
• Associated with invasive or in-situ ductal adenocarcinoma of the affected breast.
• Send patient to Surgical Oncology

Question 9

What are the characteristics of extramammary Paget’s Disease?

Answer 9

• Affects sites with apocrine glands (vulva, scrotum, inguinal or axillary regions).
• Rarely affects other anatomic locations.
• Patient age is > 50 years old, and there is often a delay in diagnosis.
• Non-healing patch often misdiagnosed as intertrigo or fungal infection.

Question 10

What are the characteristics of Merkel’s Cell Carcinoma?

Answer 10

-Red to violaceous nodule with a shiny surface.
-Incidence is 2 per million.
-95% of cases occur in a patient > 50 years old.
-Associated with Merkel cell polyomavirus (MCV).
Aggressive tumor with dermal and nodal spread.
-Cell of origin is felt to be the Merkel cell (mechanoreceptor in the basal layer of the epidermis).
-1/3 of cases have regional node involvement, and 50% will develop hematogenous spread.
-Patient’s diagnosed with Merkel cell carcinoma need a total body skin exam, evaluation of lymph nodes and a CT scan.
-5 year survival is 64%.

Question 11

What are the characteristics of dermatofibrosarcoma Protuberans?

Answer 11

• Locally aggressive tumor with high recurrence rate; characterized by a bulky, protuberant mass.
• Associated with translocations of chromosomes 17 and 22.
• 50-60% occur on the trunk and is slowly progressive but has a low metastatic potential.
• Treatment with Mohs surgery (2% recurrence rate), wide local excision (11-50% recurrence rate) or gleevec (imatinib)