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msk-derm > Non-melanoma skin cancer > Flashcards

Non-melanoma skin cancer Flashcards

1
Q

Which type of UV light penetrates deepest?

A

UVA (then UVB and UVC)

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2
Q

What is caused by UVA?

A

It causes tanning and photoaging (A = aging)

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3
Q

What type of UV light makes up the majority that reaches the Earth’s surface?

A

UVA

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4
Q

What type of UV is emitted by tanning beds?

A

UVA

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5
Q

What is caused by UVB?

A

Sunburns (B = burns), delayed tanning, sunspots, some wrinkles, vitamin D synthesis

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6
Q

What type of UV ismost involved in vitamin D synthesis?

A

UVB

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7
Q

What does UVC light do?

A

It is the most cancer causing, but also is blocked by ozone

(C = cancer)

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8
Q

What are the two carcinogenic mechanisms of UV radiation?

A

DNA damage and immunosuppression

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9
Q

What type of UV causes the most direct DNA damage?

A

UVB

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10
Q

What is the most common effect of direct UV-mediated DNA damage?

A

Photoproducts such as TT pyrimidine dimers

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11
Q

What is the main cause of indirect DNA damage from UV?

A

UVA causing reactive oxygen species that cause damage for DNA molecules, cell membranes, and proteins

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12
Q

What gene mutations increase susceptibility to squamous cell carcinomas?

A

Ras, p53

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13
Q

What gene mutations increase susceptibility for basal cell carcinomas?

A

PTCH

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14
Q

What gene mutations increase susceptibility to melanoma?

A

CDKN2A

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15
Q

What are three genetic disorders that predispose people to skin cancer?

A

Xeroderma pigmentosum, basal cell nevus syndrome, oculocutaneous albinism

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16
Q

What type of UV exposure predisposes to squamous cell carcinoma?

A

Lifelong, chronic UV radiation

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17
Q

What type of UV exposure predisposes people to basal cell carcinoma?

A

Intermittent, intense periods of burns

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18
Q

What type of skin cancer has the greatest increase in incidence in transplant patients?

A

Squamous cell carcinoma (though all skin cancers are increased)

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19
Q

When should a shave biopsy be used?

A

Used for raised lesions that will provide a specimen with epidermis and superficial dermis

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20
Q

When should a punch biopsy be used?

A

When you need a full thickness view of the skin that includes subcutaneous fat, dermis, and epidermis

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21
Q

What is the presentation of nodular basal cell carcinoma?

A

Raised pearly or translucent papule with prominent dilated capillaries, possibly ulceration with larger lesions

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22
Q

What is the presentation of superficial basal cell carcinoma?

A

Friable thin plaque or scaly red macules, primarily horizontal growth

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23
Q

What is the presentation of morpheaform and infiltrative basal cell carcinomas?

A

Scar-like flat, atrophic plaques with ill-defined borders

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24
Q

What is the main cause of morbiditiy of basal cell carcinomas?

A

Soft tissue destruction, metastatic or nodal disease is rare

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25
Q

What are actinic keratoses?

A

Lesions that arise on sun-damaged skin that are thought to be premalignant and may progress to squamous cell carcinoma

26
Q

What is the most common presentation of actinic keratoses?

A

Erythematous thin papules with rough sand-paper texture

27
Q

What is the most superficial form of squamous cell carcinoma?

A

Bowen’s disease (or SCC in situ)

28
Q

What is the presentation of bowen’s disease?

A

Visible scaly red patches or slightly raised crusted or scaly plaques

29
Q

What is erythroplasia of queyrat?

A

Bowen’s diesease of the penile mucosa that is associated with lack of circumcision and HPV 16/18

30
Q

What is the presentation of squamous cell carcinoma?

A

Scaly or crusted papule or nodule that may be ulcerated

31
Q

What is a marjolin ulcer?

A

A form of squamous cell carcinoma that develops from areas of chronically sun damaged skin such as ulcers and scars

32
Q

What is xeroderma pigmentosum?

A

A condition that results from a mutation in one of the nucleotide excision repair genes that predisposes patients to development of keratinocyte carcinoma due to inability to repair UV-induced DNA photoproducts

33
Q

What is nevoid basal cell carcinoma syndrome?

A

A condition caused by mutations in PTCH protein, a tumor suppressor, that results in constitutive activation of the sonic hedgehog signaling pathway and predisposes them to basal cell carcinoma

34
Q

What is oculocutaneous albinism?

A

Mutations that result in partial or complete abscence of melanin, thus removing protection from photoaging and photocarcinogenesis that melanin provides, resulting in increased squamous cell carcinoma and melanomas

35
Q

What are the treatment options for keratinocyte carcinoma?

A

Surgical excision (usually preferred), curettage with electrodesiccation, Mohs micrographic surgery (used for higher risk areas), radiation therapy (only if patients can’t tolerate surgery), cryosurgery, topical treatment

36
Q

What are primary prevention methods for keratinocyte carcinoma?

A

Sun protection, avoidance behaviors

37
Q

What are secondary prevention methods for keratinocyte carcinoma?

A

Methods to diagnose and treat existent disease before progression to significant morbidity

38
Q

How would you describe this facial growth?

A

Solitary, 5 mm pearly pink papule with telangiectasias and central umbilication on the right preauricular cheek

39
Q

What is the leading diagnosis for this lesion?

A

Basal cell carcinoma

40
Q

What should the first step be in evaluating this patient?

a) reassurance
b) topical antibiotics
c) cryotherapy
d) shave biopsy
e) surgical removal

A

d) shave biopsy

41
Q

What are the histological features of basal cell carcinoma?

A

Rounded nests of basaloid cells, peripheral palisading, fibromyxoid stroma, cleft formation

42
Q

What does this biopsy suggest?

A

Basal cell carcinoma

43
Q

What is the treatment of choice for basal cell carcinoma?

a) punch biopsy
b) liquid nitrogen cryotherapy
c) reassurance with close follow-up
d) surgical removal
e) topical antibiotics

A

d) surgical removal

44
Q

What subtype of basal cell carcinoma is this?

A

Nodular basal cell carcinoma

45
Q

What subtype of basal cell carcinoma is this?

A

Superficial basal cell carcinoma

46
Q

What subtype of basal cell carcinoma is this?

A

Ulcerated basal cell carcinoma

47
Q

What subtype of basal cell carcinoma is this?

A

Pigmented basal cell carcinoma

48
Q

What subtype of basal cell carcinoma is this?

A

Morpheaform basal cell carcinoma

49
Q

How would you describe this lesion?

A

Well-circumscribed, 2 cm, deep pink nodule with central ulceration and crust, firm with palpation

50
Q

What is the most likely diagnosis for this lesion?

A

Squamous cell carcinoma

51
Q

What are the biopsy findings of a squamous cell carcinoma?

A

Normal epidermis, dermal extension of well-differentiated keratinocytes (bright pink eosinophilic keratin pearls)

52
Q

What is this?

A

Squamous cell carcinoma

53
Q

What is the most likely diagnosis?

A

Squamous cell carcinoma

54
Q

What is the most likely diagnosis?

A

Squamous cell carcinoma

55
Q

What is the most likely diagnosis?

A

Squamous cell carcinoma in situ (bowen’s disease)

56
Q

What is the most likely diagnosis?

A

Actinic keratosis

57
Q

What is the appropriate treatment for actinic keratosis?

A

Cryosurgery

58
Q

What is the most likely diagnosis?

A

Xeroderma pigmentosum

59
Q

What is the most likely diagnosis?

A

Nevoid basal cell carcinoma syndrome

60
Q

What is the most likely diagnosis?

A

Oculocutaneous albinism

msk-derm (41 decks)

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