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OS Derm > Pathophys-Day 2 Skin Cancer > Flashcards

Pathophys-Day 2 Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

BCC, SCC, melanoma arise from which layers?

A

BCC:germ keratinocytes/basal layer
SCC: epidermal keratinocytes/spiny
Melanoma: melanocytes

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2
Q

PTCH mutations are found in __% of ___ cancers

A

30% of BCC

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3
Q

What does PTCH do?

A

Regulate keratinocyte proliferation as a tumor suppressor

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4
Q

Immunosuppressed patients are at greatest risk for which skin cancer

A

SCC, but also more for BCC

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5
Q

What are some risk factors for BCC?

A 
UV
Fair complexion
BLISTERING sunburns
Family hx
Immunosuppression
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6
Q

What are some characteristic features of BCC gross appearance?

A

Teliangectasia

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7
Q

BCC histo appearance?

A

Blue nodules in dermis with PALISADES and RETRACTION from stroma which is required for survival (thus low metastasis)

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8
Q

Topical treatment for superficial and nodular?

A

Not for nodular

5-FU

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9
Q

nodular/’classic’ bcc appearance gross

A

pearly rolled border
central erosion
telangiectasia

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10
Q

sclerotic/morpheaform bcc appearance gross

A

crusty, ill-defined

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11
Q

Gorlin syndrome mutation, S/S?

A 
PTCH tumor suppressor
AD
M/S defects, jaw cysts
BCCs in 20's
Inc risk of other neoplasms inc medulloblastoma, fibrosarcoma
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12
Q

PTCH signaling overview

A

PTCH tumor suppressor inhibits SHH from binding to SMO (TKI inhib vesmodegib inhibits SMO)

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13
Q

Does BCC usually metastasize?

A

Almost never, <1%

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14
Q

Tx for BCC

A

Excision is first choice

Electrodessication, cryosurgery, radiation…topical for superficial (imiquimod/5FU)

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15
Q

Compare the prognosis for head/neck/cervical vs mucosal/lung SCC

A

H/N/C less aggressive than mucosal/lung

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16
Q

SCC gross path

A

Well demarcated and crusty

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17
Q

Contrast SCC mutagenesis to BCC

A

While BCC often involves an identified gene defect, PTCH, SCC arises from any number of mutants with the ‘2 hit’ hyp.

Classically SCC begins in basal area/lower epi and progress upwards

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18
Q

Compare SCC to SCCis

A

SCCis is defined as atypical keratinocytes found throughout entire thickness of epidermis

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19
Q

What is the progression of SCC?

A

Actinic keratosis -> SCCis (i.e. Bowen’s or Erythroplasia of Queyrat - penis) -> SCC

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20
Q

Actinic keratosis micro path

A

Parakeratosis: nuclei in stratum corneum

Pleomorphic

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21
Q

AK gross path

A

Thin lesions that lack induration (superficial)

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22
Q

SCC micro path

A

Pink and keratinizing like stratum spinosum, with islands of squamous cells extending into dermis

keratin pearls

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23
Q

Major risk factors for SCC?

A 
UV, HPV 16, 18
Chronic inflammation
Immunosuppression
Chronic skin irritation/ulceration
Arsenic
Radiation
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24
Q

What factors influence SCC metastasis risk?

A

Size
Depth
Site
Status

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25
Q

**Highest risk sites for metastasis of SCC?

A

Lips and ears for both mets and local spread

Also vulvar, penile, HPV-induced

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26
Q

What are Marjolin ulcers?

A

Areas of previously severely/chronic traumatized skin that are at high risk for SCC

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27
Q

Where does SCC met to?

A

Lymph nodes and lung

28
Q

SCC gross path

A

Central ulceration
Rolled borders
Crusty

29
Q

Describe keratoacanthoma

A 
Neoplasm of keratinocytes
Rapid growth over 2-6 weeks
Painful
Spontaneous involution
Well-differentiated
30
Q

SCC treatment?

A

AK: topical/cryo
SCCis: topical/intralesion/excision
Invasive: excision

31
Q

Who is at highest risk for melanoma?

A

White men over 50

32
Q

What is the gold standard for melanoma Dx?

A

biopsy

33
Q

Who is melanoma on the rise in?

A

Old men and women with hx of tanning

34
Q

Contrast SCC and melanoma pathogenesis

A

Melanoma is not step-wise like SCC; malignant melanocytes from the beginning

35
Q

Melanoma vs mole?

A

80% of melanoma de novo not from moles

36
Q

Where is melanoma in situ?

A

Just epidermis only

37
Q

Where is mel in situ common?

A

face, good for topical

38
Q

Melanoma must reach the __ to metastasize

A

dermis

39
Q

What are the three types of nevi and their characteristics?

A

Junctional: ?
Compound: dermis+epidermis
Intradermal: nests in bottom?

40
Q

Describe a common acquired melanocytic nevus

A

Small, well circumscribed, uniform pigment, symmetrical

Nests in epidermis and dermis

41
Q

Nev vs melanomas in terms of maturation?

A

Nevi: melanocytes mature with descent (get smaller); confined to basal layer
Melanoma: melanocytes do not mature with desc

42
Q

Micro path of melanoma?

A

Large melanocytes with halo artefacts around; melanocytes will be up above basal layer and look funny/disorganized

43
Q

Describe radial growth

A

Growth outward, as opposed to downward which is bad for metastasis

44
Q

Describe vertical growth

A

Journey toward metastasis, blue tumor pushes down into dermis

45
Q

Melanoma riskf actors

A 
Large # moles
Giant congenital nevi
Blistering sunburns
Fam hx
Fair skin / tanning bed
Immune dysfunction
46
Q

Melanoma ABCDE

A 
Assymetry
Borders: irregular
Color: mottled, not uniform
Diameter: >6
Elevation
47
Q

What form of melanoma is commonly found on the hands and feet?

A

Acral lentiginous

48
Q

What form of melanoma on face usually?

A

Lentigo maligna

49
Q

Nodular mel less or more aggressive?

A

Aggressive

50
Q

What is the most common type of malignant melanoma in patients with dark skin?

A

Acral lentiginous (hands and feet)

51
Q

Who commonly gets lentigo maligna?

A

Old people on face with sun exposure

52
Q

What does it indicate when a nodule arises on top of a lentigo maligna?

A

metastasis

53
Q

Nodular melanoma facts

A

Sun exposed skin
No preceding radial growth
Men > Women

54
Q

Superficial spreading melanoma gross appearance

A

Multicolored, partially regressed from immune attack

55
Q

Red, white, and blue sign?

A

superficial spreading melanoma

56
Q

Keratin cysts on the surface of a suspicious dark lesion suggest what?

A

Not mel

57
Q

Explain why melanomas can be found outside of the skin

A

Melanocytes are derived from the neural crest, as are the eyes/retina, inner ear, and medulla

58
Q

How does melanoma usually spread?

A

Lymphatics

59
Q

What is the single most important prognostic factor in Mel met?

A

lymph node involvement

60
Q

What is the most important histo prog factor in mel met?

A

Breslow thickness and ulceration

61
Q

What is the Breslow thickness for Mel IS?

A

0

62
Q

What is Breslow’s thickness?

A

Distance of involvement from stratum granulosum top to deepest tumor cell

63
Q

What is the most common single gene mutation in melanoma?

A

BRAF, 50%

64
Q

What targeted therapy for melanoma?

A

Vemurafenib, BRAF inhibitor

Survival benefit is modest

65
Q

Vemurafenib facts

A

Metastatic/unresectable mel
Benefit with Ipilimumab combo

50% mel have it, 50% respond

66
Q

Specific relationships between the cancers and sunlight?

A

SCC: cumulative clearly
BC: UV imp but maybe not cumulative
Mel: has a role, w other factors

OS Derm (20 decks)

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