Non-Melanomatous Skin Cancers Flashcards
Progression of photdamaged skin
PD skin to actinic keratosis to SCC in situ 9Bowen’s dz) to invasive SCC
Risk factors of actinic keratosis
Mostly UV exposure
Also fair skin, age, immunosuppression
p53 (most common) or ras mutation
AK premalignant lesions, if malgnant transform occurs, prognosis, risk of progression
Poentnaitla to progress to cancer but not cancer itself
Typically SCC
Most do NOT progress
Persistance of AK, cumulative UV expsourve, hx of skin cancer, immunosuppression, genetic susceptbility
AK
Appearance
Dist
Diagnosis
Erythematous, ill marginated patch/papule with a roguh, yellowish brown adheretn scale
Feels like sandpaper…easier to feel than see so palpation key
Sun exposed areas and present on sun damaged skin
Clinical…skin biopsy only if thick and indurated or unresponsive to tx
AK tx
SHould be treated but unpredictable
Prevention - decrease sun exposure
Initial - cryotherapy with liquid nitrogen (most common)
Alternatives are
topical 5-fluroura - interferes with DNA synthesis resulting in apoptosis and cell death in the sun damaged skin…warn the patients about discomfort
Imiquinmod - induces immune system to attack AKs in immunocompetent**
SCC etiology
Malignant neoplasm from keratinocytes
UV light causes mutations that accumulate resulting in grwoth advantage for those damaged cells
SCC common and risk factors
Fair skin, etc
UV, sunburns, chemical exposure (arsenic), immunosuppression, HPV, Cigs
SCC prevalence
Most in men over 60 with light skin and lots of expsoure
Second most common
SCC
Morph, distribtuion, sx
Scaling, indurated plaque or nodule that may bleed or ulcerate
Most occur on head, neck, extensor arms
Pruritic, tender, friable, non-healing bleeding grwoth /ulcer
SCC diagnosis and dermatopathology
Skin biopsy
SCC in situe - no dermal involvement and can progress
INvasive SCC - invaded the dermis
SCC tx
Refer to derm
Excise - most lesions…SOC
Curettage and electrodessication - reserved for in situ dz or shallow lesions…high rate of recurrent
Poor surgical candidates and adjuvant therapy - radiation
Mohs micrographic survery
Indications
Real time eval of tumor margins
Maximize tissue conservation
Recurrence rates low
Indistinct borders - nose, eras, eyes, lips, scalp, hands
SCC course
Where
…rate
Metastasis to regional lymph nodes
Diameter more thnan 2 cm or deeper than 4 mm
Recurrent
Immuosuppressed
Ears, scalp, non-bearing lip
Arising in scars, chronic ulcers, burns, isnus tracts, genitalia
Higher rate of metastasis than BCC so higher mortality
Keratocanthoma
What is it, epi, CM, Tx
Form of rapidly growing SCC…may involute and regress
Most over 40
Ealry lesion is solitary, round nodules, rapid grwoth
Maturing - central keratotic plug visible and lesion is crater like
Tx - refer to derm for excision
Bowen dz
CM…genital vs. non
Form of in situ SCC
Cricumscribed erythematous or pigmentated patches with keratotis surface
Genital - caused by HPV so screen
If non-gen in sunprotected areas, look for arsenic ingestion or internal malignancy
Bowne dz
Metast
Tx
Recurrence
13-33% risk
Refer to derm…excise and debulk
High risk and malginant cells extend along follicles into dermis
BCC
Etiology
Risk
Appearane
Diagnosis
Most common
Basal layer of epidermis
UV rays and PTCH (tumor suppressor) mutation
Fair skin, fale, over 60, easliy bleeding lesions
Most common and head and neck and depends on type
Skin biopsy
Nodular and pigmented BCC
Nodular - most common…face (more on nose)…papule or nodule, translucent or pearly…central depression or crater…telangiectasias with rolled away border
Shiny, blue-black papule, nodule or plaque…pigment is speckled
Superficial and slcerosing (scarring) BCC
Super - most freq on thorax…red, slightly scaling, well demaracted, eczematous like patch…centrally may be slightly eroded and crusted
Least common and most aggressive…atrophic, smooth, flesh colored…firm, indurated, ill defined borders, scar like
BCC tx
Excision
Curettage and electrodessication for in situ or shallow
BCC natural coruse
Metastassi
Locally invasive
Metastasis is rare
Location more on nose and ear
Over 2 cm
Histologic pattern (scleorsing or infiltrative)
Kaposi sarcoma
Most affected
Type of condition
Diagnosis
Tx
Vascular neoplastic condition (HHV 8 infection)…endothelial cell origin
Purple macules, papules, and nodules
Can also affect mucous membranes, GI, LN, lungs
Refer to derm
Initial - radiation, excision or cryotherapy
Alt - intralesional or systemic chemo or IFN alpha
HIV and skin cancer
BCC or SCC is most common
BCC is more common in HIV…SCC in organ transplant
HIV also more developing HPV associated and invasice SCCs
Melanoma in HIV more aggressive
