Precancer/nonmelanoma skin cancers Flashcards
Atrophic flat pearly pink to red thin, scaly plaque
superficial BCC
speckled brown, blue, black melanin in lesions
pigmented bcc
atrophic poorly defined borders, smooth pink or flesh colored papules/plaques, may have a scar appearance
morpheaform/infiltrative bcc
Multiple BCC in childhood associated with pitted palms and soles, cysts on jaw, coarse facial features and skeletal abnormalities
nevoid basal cell syndrome
arborizing vessels
leaf like structures
concentric spoke wheel like structures
large blue gray ovoid nest
multiple blue-gray non-aggregated globules
BCC dermoscopy
High risk BCC AREA
THE ‘H’ AREA;
central face, periorbital, eyebrows, eyelids, nose, lips, chin, mandible, temple, ear, pre- and post-auricular, genitalia, hands, feet
Moderate risk BCC
scalp forehead, cheeks, neck, pretibial
low risk bcc
trunk/extremities
Low risk vs high risk BCC types
low risk; nodular & superficial
High risk- morpheaform, micronodular, infiltrative, basosquamous w/ perineural invasion >6mm in high risk areas or > 1 cm in low risk areas
1st line treatment of BCC
MOHs with 4 mm margin
surgical excision with 4mm margin
C&E for superficial BCC
precursors to SCC
cellular mutation from cumulative UV exposure
pink/red rough macules w/ a sandpaper texture, white to yellow scale occurring on sun damaged skin
Actinic keratosis
Types of 5FU cream
- efudex 5% cream 2x/day for 2-4 weeks
- tolak 4 % daily for 4 wks for lesions on face, ear, or scalp
- carac 0.5 daily for up to 4 weeks for face and anterior scalp
Bowen’s disease
induced by HPV
solitary, red brown, violaceous papules/plaques that are well defined.
Squamous Cell in Situ
SCCis of glans and prepuce of penis, vulva, oral mucosa
Well defined shiny red plaque
erythroplasia of Queyrat
Sudden onset (weeks) rapidly growing plaque/nodule with crater like center of keratin
Keratocanthoma
2nd most common type of skin cancer
SCC
mutation of p53 tumor suppression gene secondary to uv exposure, aging, smoking, or immune suppression
Neural or vacular invasion may occur.
SCC
What are risk factors for SCC
fair, blue eyes w/ blonde or red hair
cumulative sun exposure, especially in childhood, arsenic exposure
smoking
outdoor occupation
areas of burns, trauma or chronic inflammation
flesh colored to erythematous papuels/nodules which may be hyperkeratotic, smooth, or ulcerated.
SCC
linear, irregular vessels
elongated hair pin vessels, dotted vessels or a combo
White halo surrounds the vessels
brown or gray dots in a linear arrangement
dermoscopy of SCC
SCC; greater than or equal to 2 cm on trunk or extremities
high risk SCC tumor
SCC; greater than 1 cm on cheeks forehead scalp neck and pretibial
high risk
SCC; less than 1cm on cheeks forehead scalp neck and pretibial
low risk
SCC; less than 2 cm on trunk and extremities
low risk
SCC; well to moderately differentiated
low risk
SCC; poorly differentiated
high risk
Low risk SCC management-
standard excision iwth 4-6mm margin or C&E for small, low risk SCC
High risk SCC management-
MMS or surgical excision with confirmed negative margins
Always check for what when performing a biopsy of a high risk SCC
lymph nodes
Rare, aggressive cutaneous malignancy
>70 years old
fair skin
fast growing
merkel cell ca
asymptomatic, firm, nontender, solitary, rapidly growing nodule form 0.5-5cm, may be red, pink, violaceous reddish-brown or skin colored , mostly occur in head and neck region, if lymphadenopathy present-advanced disease present.
merkel cell ca
what should be ordered once merkel cell ca is confirmed with biopsy?
PET/CT before surgery
SNLB
one or multiple smooth red/pink papules/plaques/nodules
slow growing
CBCL
often large >5cm nonspecific eczematous dermatitis favoring lower trunk and extremities, pruritic, usually lasts for years
patch stage of mycosis fungoides
well defined, dusky violaceous red collor, sometimes annular
What phase of mycosis fungoides?
plaque stage
red and dusky nodules that may progress to deep ulcers, commonly occur around head, neck, groin, breasts and axillary, more aggressive form
Mycosis fungoides tumor stage
erythrodermic skin, exfoliative, patient will complain of hot, painful, pruritic skin, hyperkeratosis of palmos and soles, alopecia, onychodystrophy w/ diffuse lymphadenopathy
sezary syndrome
rare slow growing primary cutaneous malignancy, higher incidence in african americans, and females, mean onset 4th decade of life.
one or more multiple ill defined slow growind red brown firm plaque or nodules, typically painless
Often present in the shoulder or chest area
Dermatofibrosarcoma protuberans
onset or develop at birth through age 2 years
congenital nevus
How to predict adult size of CMN?
measure largest diameter in mm of lesion on child, then multiply:
Face- 2.8
trunk and extremities- 8
legs- 12
Patient has LG CMN >40cm
multiple satellite nevi
more than 2 CMN
Crossing over spinal column
Neurocutaneous Melanosis
Refer to pediatric neurologist
Light brown patch with hyperpigmented speckles of macules
nevus spilus
onset usually adolescence, shoulders scapula and upper trunk, hair
becker’s nevus
most occur between 10-20 years old
less than 10mm, symmetrical pink to red, smooth, dome shaped papule
well defined lesion on the head and lower extremities, few on trunk
spitz nevus
age of onset after 10
location on the back
>1 cm
asymmetry
irregular/poorly defined borders
ulcerated/irregular surgace
clinical features of an atypical spitz nevus
what is the management for a spitz nevus?
complete excision in both children and adults
Severely dysplastic Nevi management:
completely excised with a 5 mm margin
What is the most common type of melanoma
superificial spreading
What are the ABCDEs of melanoma
asymmetry
border irregularity
color variegation
diameter > 6mm
evolution
2nd most common type of melanoma
brown or black, rapidly growing lesion
nodular melanoma
sun exposed skin like the face, neck and arms, irregular, flat, variegated pigmentation
Lentigo maligna
Most commonly found in darker skin types
hutchinsons sign is key factor in dx suspicion
Acral Melanoma
red or pink papule that enlarges and may have some grey at the periphery, RED, RAISED and RECENT CHANGE
amelanotic melanoma
guidelines for in situ
0.5-1 cm
guidelines for melanoma less than or equal to 1 mm
1cm margin
guidelines for melanoma 1-2 mm
1-2cm
guidelines for melanoma > than 2 mm to 4 mm
2 cm
guidelines ofr melanoma greater than 4 mm
2 cm
what are the two types of staging for the depth of a melanoma
breslow and clark