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Skin and soft tissue > Premalignant lesions of the skin > Flashcards

Premalignant lesions of the skin Flashcards

1
Q

What is acantholysis

A

loss of intercellular connections between keratinocytes

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2
Q

What is acanthosis

A

increase in s. gervinatum due to larger population of epidermal cells

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3
Q

WHat is hyperkeratosis

A

Increase in the stratum corneum

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4
Q

What are premalignant lesions of BCC?

A
  • Nevus sebaceous of jadassohn
  • Nevus sebaceous LINEAR
  • Porokeratosis
  • Arsenic keratosis
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5
Q

What are precancerous conditions with increased risk of BCC development?

A

BCC BXGG - ARM

B - Bazec

XP

Gorlins

Gardners

Albinism

Radiodermatitis

Muir-Torres

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6
Q

What are premalingant lesions of SCC

A

Premalignant

  • Porokeratosis
  • Leukoplakia
  • AK
  • Arsenic keratosis
  • Cutaneous horn

SCC Insitu

  • Bowen’s
  • Paget’s
  • Erythroplasia de Quarat
  • Erythroplasia
  • Epithelioma (intraepithelial)
  • Epidermoid Ca (subungal)
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7
Q

What are precancerous conditions with risk of developing SCC?

A

SCC X MAR

XP

Muir Torre

Albinism

Radiodermatitis

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8
Q

What are premalignant lesions for MM?

A

Cellular Blue Nevus

GCMN

Dysplastic nevus

Lentigo Maligna

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9
Q

What are precancerous conditions with risk of developing MM

A

XP

FAMM

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10
Q

What is arsenic keratosis

A
  • Punctate keratosis caused by arsenic exposure 5-30yrs later
  • Exposure is
    • Occupational
      • pesticide, mining, carpentry
    • Therapeutic
      • fowlers solution
  • SCC>BCC
  • Treatment - chelate arsenic, excise SCC/BCC
    *
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11
Q

What is nevus of JADASSOHN?

A
  • Congenital nevus on face/scalp/forehead containing overgrowth of entire dermis. Salmon oily plaque with smooth papillomatous area->verucous with age
  • Incidence of conversion to BCC>SCC <1%
  • Treatment - excise if neoplastic changes
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12
Q

What is porokeratosis

A
  • Atrophic annular plaque with ridgelike pigmented border called cornoid lamella (hyperkeratotic)- sharp margins and outward growth
  • OCcurs in linear*, disseminated, punctate, Mibeli (classic)*
  • DDX: lichen planus/sclerosis, AK, Verucca Vulgaris
  • risk of transformation 10% SCC>BCC. Greatest for *
  • Treatment
    • medical : 5-FU, imiquimod
    • Surgical excision
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13
Q

What is Actinic Keratosis

A
  • Hyperkeratotic lesion on erythematous plaque with background solar damage
  • RFs
    • sunexposure
    • age, men, fair skin
    • hx of AK
  • Includes cutaneous horn, actinic chelitis
  • Path: hyperkeratosis, acanthosis, parakeratosis
  • Transformation
    • 10% over 10yr =>SCC
    • 0.5% metastasis with actinic chelitis
  • Treatment
    • Medical: 5-Fu, Imiquimod, PDT
    • Surgical: cryotherapy (mainstay), dermabrasion, excision
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14
Q

What is a cutaneous horn

A

Hyperkeratotic projection overlying

  • AK
  • SK
  • SCC
  • Verruca vulgaris
  • molluscum contagiosum

Tx: excision w 2-3mm margin for diagnosis of underlying histopatho

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15
Q

What is leukoplakia

A

Squamous proliferation of white plaque on oral mucosal surface. Due to epithelal hyperplasia and surface hyperkeratosis.

  • Leukoplakia simplex - white homogenous plaque, asymptomatic
  • ErythroLeukoplakia - white and red plaque - associated w pain, itch (higher risk of trasnformation)

Associated w Etoh, smoking, illfitting dentures

Transformation risk - 1-20%

Tx

  • Excision WLE - no guide on margins
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16
Q

What is bowens disease

A

SCC in situ - scaly plaque qith erythematous base, hyperkeratotic plaque

RFs

  • actinic damage, radiation
  • genetic predisposition, HPV16
  • immunosupression
  • chronic wound
  • arsenic, petroleum byproduct

Trasnformation: 5% AND 1/3 will metastasize

Treatment

  • MEdical - imiquimod (not 5-FU cuz need to penetrate to adnexal structure), Rtx, PDT
  • Surgical - 5mm excision or mohs
17
Q

What is Bowen Papulosis

A

GENITAL Bowens - BP is the trasnformation from genital warts to SCC. Associated with HPV16, 18, 31, 33

  • pigmented papules/nodules in genitals with flat/verrucous surface
  • Transformation 3%

Tx

  • MEdical - 5-FU, imiquimod
  • Surgical - excision, ED
18
Q

What is Pagets disease

A

Intraepidermal extension of adenocarcinoma from secretory gland. Eryhtemtous scaly plaque wiht irregular borders

  • Mammary - indicates Ductal CA. Nipple discahrge on breast with scaly itchy plaque. <50% ass. with breast mass
  • Extra-Mammary - found in genital regions. Thick scaly plaque with itchiness. USually from 1’ cells of genital egion but may be 2’ to visceral cancer or adnexal AdenoCa

Tx

  • Mamary pagets: AS IDC: excsiion with mastectomy/lumpectomy, +/- rdx, chemo, SLNB
  • EMPD: WLE, work up for underlying malingnancy
19
Q

What is erythroplasia of Queyrat

A

SCC in situ from mucocutaneous epitheliium of

  • penile glans, vulva
  • oral mucosa

Associated with HPV16,18, poor hygiene, smoking, immunosuppresoin

Transformation 10-30%

Tx

  • MEdical - 5-FU imiquimod, PDT, laser NdYAG
  • Surgical - excision
20
Q

What is erythroplakia

A

Chronic red oral mucosal patch - 95% of oral cancers begin as erythroplakia

  • RFs:
    • tobacco 2-4x risk of oral ca
    • tobacco +alvohol 15x risk of oral ca
  • Transfomration 50% - considered as SCC requiring excision
21
Q

What is the pathology for SCC in situ

A
  • acanthosis
  • thick rete ridges
  • hyperkeratosis
  • parakeratosis
22
Q

What is epiermoid carcinoma (subungal)?

A

Bowens disease of nail bed => verucous lesion, onycholysis

Predisposing Rfs

  • HPV16
  • chronis paronychia
  • smoking
  • radiation, sun

Transformation - 20%

Tx - surgical excision w rim of normal tissue

if into bone, its invasive SCC and requires en bloc bone excision w possible DIP amp

23
Q

What is epithelioma (intraepidermal)

A

Scaly lesion with intraepidermal collection of atypical keratinocytes

Tx - excision

24
Q

What is XP

A

AR Genetic defect cuasing poor DNA mismatch repair, resulting in high skin cancer susceptibility with UV irradiation

  • most common in japanese

Clinical features

  • Skin - freckles, dry skin. Dx of AK then BCC/SCC/melanoma with time
  • Eyes: photosensitivity keratitis - may lead ot blindness
  • Neuro: SNdefects, progressive xonal degen - may lead to deafness
  • Oral - may have leuko/erythro/SCC on tongue and oral cavity

Diagnosis

  • prenatal CVS, FHx, clinical findings, DNA repair test

Prognosis

  • 1000x increase riskof BCC SCC melanoma <20

Tx

  • protection
  • 5-FU, cryotherapy for precursors AK, high dose retinoids
  • Surgical - EDC, excision
25
Q

What is radiodermatitis

A

Chronic radiation keratosis in area of previous radiation

SCC lag time up to 20yrs, high risk of metastasis if SCC develops

Stages

erythema, epilation

dry/moist desquaamtion

dermal fibrosis and telangiectasia

26
Q

What is gorlins syndrome

A

AD familial cancer syndrome wtih predisposition to BCC developedment ealry in life

Mutated of PTCH1 TSG

Clinical features

  • BCC nodular>superficial
  • high forehead, falx cerebri calcification, dysgeneration of corpus callosum
  • bifid ribs, vetebral skeletal abnoralities
  • palmar plantar pits

Tx

  • avoid ionizin radiation (CT)
  • Medical: 5-FU, imiquimod, Vismodegib (for BCC mets/slow progression)
  • Surgical:reserved b/c so many lesions -excision mohs EDC
27
Q

What is albinism

A

AR with absent or reduced melanin synthesis resulting in hypopigmented hair, skin ,eye

Normal # melanocytes, defective prod of melanin

SCC inevitable>BCC>melnoma

28
Q

What is muir torre

A

AD condition with 1 sebaceous Ca and one visceral malingnancy

Most typical cutaneous tumor:

sebaceousCa/adenoma, KA

Most typical visceral tumor:

Colorectal then urogenital

29
Q

What is 5-FU

A

Effudex - inhibits pyrimidine synthesis

Indication: AK, superficial BCC

App: topical bid x6wk

ContraI: pregnancy

S/E- blistering, erosion

30
Q

What is Imiuimod

A

aldara - Immunomodulator of Tcalls

Uses: AK sup BCC

App; daily q6wk

31
Q

How r retinoids used for premalignant skin lesions

A

decrease cohesivenss of hyperproliferative ketinocytes

Use: acne

off label - AK BCC

32
Q
A

Skin and soft tissue (13 decks)

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