Pre-malignant and malignant epidermal tumors

Question 1

actinic keratosis (AK)

• what can this progress to?
• major risk factor
• rash appearance
• how to you Dx this in a PE?
• where is it typically found?
• parakeratosis?
• basal cell abnormalities
• dermal abnormalities

Answer 1

• squamous cell carcinoma
• sun exposure
• palpation: gritty, broken glass feel
• discrete surface lesion that eventually develops red papules or plaques with scales
• face, scalp, ears, neck, etc.
• retained nuclei in stratum corneum
• hyperplasia and cytologic atypia of basal cells
• solar elastosis in superfical dermis

Question 2

treatment of AK

• for isolated lesions
• topical treatment
• what should you be concerned with if a patient returns after cryotherapy?
• what do you prescribe if there are multiple lesions on the face, neck and scalp?

Answer 2

• liquid nitrogen
• 5-FU
• excision, electrodissection, other crazy stuff
• if the lesion ulcerates or thickens, this could indicate progression to SCC
• 5-FU BID for 2-4wks add Imiquimod if it’s not working

Question 3

Squamous cell carcinoma

• what are the odds of a patient getting another NMSC after their initial Dx?
• ratio of BCC to SCC
• which UV light is worse?
• This disease has no invasion through basement membrane, atypical nuclei, and affects all levels of the dermis. It is…
• What if this disease affects the glans penis?

Answer 3

• 50%
• 80:20
• UVB>UVA
• Bowen disease (SCC in situ), which can affect non-sun exposed skin
• erythroplasia of queyrat

Question 4

SCC

• what color is it? why?
• what kind of surface adaptations does it acquire?
• why does it ulcerate?

Answer 4

• it’s pink to flesh colored because the epithelium is dyplastic. The more dysplasia, the more translucent and pink it will appear.
• scaling, crusting, ulceration, cutaneous horn (evil looking thing)
• eventually the epithelium outgrows the rate of keratin production, forming an ulcer

Question 5

SCC

• how to Dx? How deep do you need to go?
• how bout the lymph nodes?
• survival rate is 73%; whats the treatment?

Answer 5

• biopsy at least to mid dermis to determine invasiveness
• sentinel LN FNA IF LAD is present
• surgical removal with chemo

Question 6

Keratoacanthoma (KA)

• benign or malignant?
• **what color are they? what does it look like from the surface?
• how should they be treated?
• which cell is dysplastic?
• which inflammatory cells will you find and where?

Answer 6

• benign epithelia tumor may progress to SCC, grow rapidly and spontaneously regress after a few months
• **red to flesh colored dome shaped papule with keratinous plug
• tx like SCC
• squamoid cells, look big and glassy
• commonly have neutrophil microabcesses and eosinophils and lymphocytes in surrounding infiltrate

Question 7

basal cell carcinoma (most common malignancy)

• which cell is malignant
• how do patients present?
• hallmark histology (two words)

Answer 7

• pluripotent cells of the BM
• non-healing lesion that bleeds
• nests of basaloid cells which palisade (line up neatly) at the border of the nest, storm separates from the tumor nodules

Question 8

Nodular BCC

-appearance

Answer 8

• face is most common site
• pearly appearance, waxy papule with central depression
• bleeding with minor trauma

Question 9

superficial BCC

• common site
• color and appearance

Answer 9

• trunk

- light red, atrophic center with translucent micropapules on the edges

Question 10

Whats the best way to cure BCC

Answer 10

Moh’s surgery