Oncology Flashcards
What is carcinoma in situ?
Stage 0 cancer; not moving anywhere yet
What are some characteristics of malignant lesions?
- Change in color
- Lymphadenopathy
- Raised borders
- Painful, firm nodules
- Bleeding and crusting
What are adnexal tumors?
- Arise from cells of appendages, like hair follicles and sweat glands;
- Also from fibrous or neural tissue
Most skin cancers are caused by what?
- Ionizing radiation
- UVB rays
Besides UVB rays, what other carcinogens contribute to skin cancer?
- Paraffin oil UVA chemotherapy
- Creosote Fuel oil
- Coal Pitch
- Psoralens
Under what conditions can SCCs metastasize?
- Large lesions
- Lesions on transplant patients
- Lesions associated with burn scars (Marjolin’s ulcers)
What are Marjolin’s ulcers?
Progressively growing, aggressive SSC lesions appearing on previously traumatized skin or scars.
What is nevoid BCC syndrome?
- BCC in childhood
- May not be in sun-exposed areas
- Associated with medulloblastomas and reproductive tumors.
Cell of origin for BCC?
Pluripotential cell from pylosebaceous tissue
What do BCCs look like?
- Waxy, translucent nodules
- Telangiectasias
- Umbilicated centers
Treatment of BCSS?
- Less than 1 cm: may be removed by curettage, electro-dessication, cryotherapy, or excision
- More than 1 cm: excision with minimum of 1 mm margins laterally and deep
What causes SCCs?
- Sun exposure
- Exposure to environmental carcinogens
- Malignancy of untreated wounds
What are actinic keratosis?
- Turn into Squamous cell carcinoma
- Involve epidermis and dermis
How do SCCs metastasize?
Regionally and systemically
What do SCCs look like?
- Irregularly-shaped plaque or nodule
- Pink rolled edge with or without central ulceration
Treatment of SCCs?
Excision: 5mm margins laterally and deep
-Can use Moh’s procedure on face
Treatment of actinic keratoses?
- Topical cytotoxic cream
- Cryosurgery
- Electrodessication
Treatment for adnexal tumors?
- Excision
- Possibly sentinel node sampling
- Sebaceous carcinomas, cylindromas, and Merkel cell carcinoma
- Prognosis varies with cell type
What do melanomas arise from?
Benign nevi usually
At what stage does melanoma become regional?
III
At what stage is melanoma localized?
I-II
At what stage is melanoma metastasis advanced and distant?
IV
What are the four types of melanomas?
- Lentigo maligna
- Superficial spreading
- Nodular
- Acral lentiginous
At what size do nevi become suspicious?
6 mm
What should we do with atypical nevi?
Excise to clear margins
What should we do if we suspect a lesion is a melanoma?
Full-thickness punch biopsy or excision:
-Wide margins
How should we treat melanomas?
- Stage I, II, III: surgery
- Stage IV: systemic therapy
How is cancer staged?
- Tumor: depth, regression, ulceration
- Node status
- Metastasis
What size margins should we excise for melanoma lesions that are less than 1 mm thick?
1 cm
What size margins should we excise for melanoma lesions that are 1-4 mm thick?
2 cm
What size margins should we use for melanoma lesions that are more than 4 mm thick?
> 2 cm
When should we take sentinel lymph node biopsies?
- Tumors .76-1 thick or
- with ulceration or
- with positive deep margins or
- with mitoses or with Clark’s IV
From what sites do we biopsy lymph nodes?
- Axillary: levels 1, 2, and 3
- Inguinal
- Iliac
- Cervical
From what tissues do soft tissue sarcomas develop?
Mesenchymal tissue
Where are malignant soft tissue sarcomas found?
-Anywhere: bone, cartilage, connective tissue
-Usually extremities
-
Who usually gets rhabdomyosarcomas?
Children
Who usually gets histiocytomas?
Elderly
Where does the underlying fundamental defect lie in soft tissue sarcomas?
Genetic origin
Most common site of metastasis for sarcomas of the extremities?
Lungs
Most common site of metastasis for sarcomas of the abdomen?
Liver
What size sarcomas have a good prognosis?
Less then 5 cm
-Over 5 cm worse prognosis
What imaging is most useful in diagnosing a sarcoma?
MRI
-CT and X-ray to assess chest and lungs
Treatment of sarcomas?
Surgery: 1-2 cm margins
- Limbs: surgery plus radiation
- Chemotherapy
- Radiation
