Pigmented lesions and skin cancers Flashcards
normal nevi
-A benign growth on the skin that is formed by a cluster of melanocytes . A nevus is usually dark and may be raised from the skin. Also called “mole.”
-They are common benign skin tumors
-More common in light skinned people and sun exposed skin
-Grow with you!
normal mole
-Usually under 6mm
-Homogenous color
-Between 10-40 on a person’s body
-Some “congenital”
-Symetrical*
-Well defined border
-Tan, brown or flesh colored
-If suspicious, biopsy
-smooth border
-uniform color
-smaller diameter usually
-not growing or changing
-symmetric
atypia
-mild
-moderate
-severe
-markers for possible melanoma
skin exam
-Be systematic (from head to toes)
-if you’re really doing a full body exam, don’t miss these areas:
1. Conchal bowls (inside the ears)
2. Medial cathi
3. Inner gluteal cleft
4. Parianal region
5. Between fingers and toes
-is there a mole where the sun doesnt shine? have they been in a tanning bed?
melanoma
-Most deadly form of skin cancer!
-30% come from existing nevi
-Some pts will complain of change in normal mole
-Most Melanomas are found on routine skin exams
-Most are found on trunk or legs
-back of the knee
-Superficial melanomas are mostly found on sun exposed areas
-Many Types- All determined by Pathology
-Melanoma incitu- confined to epidermis -> best melanoma to have
stages of melanoma
-stage 0- epidermal region only
-stage 1- localized
-stage 2- localized but thicker
-stage 3- spread to lymph nodes
-stage 4- spread to other organs
melanoma work up
-if suspected -> punch bx is recommended -> looks at thickness of it
-clark’s levels or breslow’s thickness in the pathology report
-Depth will determine prognosis
-Sentinel Node Bx if greater than .8mm thickness -> see if it spread to lymph
-Tx is Excision with WIDE margins***
-Continual monitoring for more melanomas
-After removal, skin checks every 3 months
-Chances of having another are greater than those who have not had a melanoma!
-tell pts to tell other doctors they have had a melanoma
-EYE EXAMS!- melanoma seen behind the eye
actinic keratosis
-Precancerous lesions of the keratinocytes
-Very common >55
-Develop after intense long-time sun exposure
-Long time sun exposure may lead to mutation of the p53 gene -> unravels DNA
-Approximately 10% may turn into Squamous cell cancer if left untreated**
-Rough* scaly macules that remain even after moisturizing
-We treat with Cryotherapy
-Also Blue Light therapy
-5-fU aka “field therapy”- topical chemo
squamous cell cancer
-2nd MC skin cancer
-Malignant tumors of the epidermal keratinocytes
-Full thickness involvement of the epidermis (Partial thickness AK)
-Rough, pink, scaly papule or plaque
-If diagnosed early, metastatic involvement is low
-Treated with MOHS Surgery* (trace out the margins)***or Excision with large margins]
-(compared to melanoma you just take out a large portion to ensure its all out)
-Monitor for more!
-Invasive primary cutaneous malignancy-can be deadly
tangential bx
-scrape bx
-face
causes of squamous cell skin cancer
-Mostly caused by accumulated UV light exposure
-Other factors include:
-Radiation
-Chemicals- hydrocarbons, arsenic
-Tobacco
-Burns
-Hpv infections- warts and turn into squamous cell
-Spread within skin and lymph system
-Preceded by ACTINIC KERATOSES- starts at epidermis and goes down
basal cell carcinoma
-MC type of skin cancer in US
-MC presentation is a pearly* shiny papule with telangiectasia (blood vessels on surface)
-Slow growing and mostly localized
-Rarely metastatic
-Can cause significant tissue damage
-Most are slow Growing
-Intense sun/UV exposure
-Light skin, hair and eyes but also darker skinned people as well
-Can occur at any age but primarily after 40
-Variants- nodular, pigmented, superficial, morpheaform (AKA infiltrative)
-Morpheaform can grow deep and not noticeable on the epidermis
basal cell carcinoma risk factors
-Sun exposure
-Blistering Burns
-Radiation Therapy
-Fair Complexion
-Immunosuppression- body doesnt fight it
-Family history- ***** Not because they are Hereditary! -> lifestyle
-Proximity to equator
-Most are found on the head, neck, trunk and extremities
-Rarely occur on non hair bearing areas
-Px complaints:
-Numbness
-Pins and needles
-Itches
-painful
basal cell treatment
-Dependant on size location and Histology
-MOHS Gold Standard cure rate of 99%
-Elliptical excision with wide margins
-ED&C x3 - burn and scrape
-Radiation for unresectable tumors Gorlin Syndrome(poor margin control)
-Cryo surgery for patients that refuse treatment
basal cell carcinoma take aways
-Early Treatment is important
-Limit your sun exposure
-Sunscreens, loose clothing, sunglasses, hats
-Yearly Skin Checks
-When in doubt- Always Biopsy!
-NEVER USE TANNING BEDS!!!!!
