Premalignant And Malignant Skin Lesions

Question 1

What is the most common types of cancers in the US?

Answer 1

Non- melanoma skin cancers

Risk gets high with IV light exposure (specifically UVB), immunosuppressive and organ transplant patients

**basal cell carcinoma is the MOST COMMON TUMOR PERIOD

Question 2

USPSTF screening recommendations

Answer 2

Children/adolescents and young adults aged 10-24 yrs who have fair skin

Question 3

Basal cell carcinoma

Answer 3

Presents as a pearly colored papule with overlying telangiectasias and central depression or ulcer

Caused by INTERMITTENT UV light exposure
- because of this, children and young adults can get this cancer

Typically appears as a non healing sore on the face,ears,scalp, neck or upper trunk

<1% metastasize, but 30% lifetime risk to experience a recurrence

Can become sclerosing where it rises and looks like eczema sometimes

Question 4

Actinic keratosis and Bowen disease (SCC in situ)

Answer 4

Both of these lesions are scaly macula on sun damaged skin and are precursors to actually SCC

Both types of lesions have a 0.1% chance of developing into SCC per year

Question 5

Squamous cell carcinoma

Answer 5

Cutaneous lesions that are the second most common form of skin cancer
- caused by CUMULATIVE sun exposure (because of this, it is really only seen in elderly)

Lesions are typically pink colored papules or nodules often with crusting or ulceration
- also are often keratotic
Most common locations = face/scalp/lips/ears/neck/arms /hand

Overall metastasis rather = 2-3%
- gets higher with immunocompromised, increased size and depth and invasion properties.

Commonly arise from Actinic keratosis, radiation, dermatitis, leukoplakia/erythroplakia, scars or chronic ulcers.

BCC rates only go up 5x in organ transplant, but SCC goes up 250x

Question 6

Ugly duckling concept

Answer 6

Benign moles that tend to have a similar appearance is more likely to be undergoing malignant change

anything that looks abnormal or not like the others should be looked at

ABCDEs

• asymmetry
• border irregularities
• color is not homogeneous
• diameter >6mm
• evolution exhibited

Question 7

Typical nevi vs atypical nevi

Answer 7

Typical: (never turns into melanoma)

• between 6 months- 20 yrs
• can be anywhere
• usually < 6mm
• color is evenly distributed
• morphology = round oval symmetrical and well-demarcated borders

Atypical: more likely to be melanoma, however only 1/3 of melanomas develop from these (most rise de novo)

• usually > 6mm
• color is much more varied
• morphology = asymmetrical and poorly demarcated borders

Question 8

Melanoma

Answer 8

Most lethal cutaneous cancer

• 77% of cancer deaths = this
• arise from melanocytes

Caused by CUMULATIVE RISK FACTORS

4 different subtypes

1) superficial spreading (70%)
- raised borders, different lesion colors

2) nodular (15%)
- brown/block nodules

3) acral lentiginous (10%)
- only found on hands and feet
- flat/irregular brown-black

4) lentigo maligna (5%)
- only found on face
- very irregular border and is tan-brown

Measured by the breslow score
- the depth of the lesion = chance it metastasis

Question 9

Treatment of melanoma

Answer 9

Topical 5-FU or imiquimod

• small non-invasive BCC
• Bowen disease, actinic keratosis.

Cryotherapy

• small non-invasive BCC
• actinic keratosis

Curettage/electrodessication

• BCC and SCC specifically
• Bowen disease

MOHS micrographic surgery
- BCC and SCC specifically

Surgical excision
- SCC and melanoma