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Fall 2014 - CM Dermatology > Premalignant/Malignant Lesions > Flashcards

Premalignant/Malignant Lesions Flashcards

1
Q

ACTINIC KERATOSIS

A
  • common, persistent keratotic lesions
  • pre malignant (SCC)
  • usually asymptomatic, but may be tender if rubbed or while shaving
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2
Q

ACTINIC KERATOSIS

Predisposing factors

A
  • 50 yo+ (but can also occur younger!)

- chronically sun exposed areas (face, ears, balding scalp, dorsal hands, forearms)

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3
Q

ACTINIC KERATOSIS

Clinical appearance

A
  • multiple, discrete
  • flat or elevated
  • red, pigmented or skin colored
  • may have adherent scale (palpation feels like rough sandpaper)
  • most < 6mm
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4
Q

ACTINIC KERATOSIS

Tx

A
  • sun protection: sunscreen, hat, clothing
  • topical therapy: cryotherapy, 5-fluorouracil, imiquimod, laser resurfacing, chemical peels
  • warn of downtime for all treatments
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5
Q

BASAL CELL CARCINOMA

A
  • most common form of skin CA
  • related to sun exposure (cumulative)
  • most common on scalp, face, ears, neck
  • rare on dorsal hands
  • slow growing
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6
Q

BASAL CELL CARCINOMA

Risk factors

A
  • intermittent intense sun exposure (prior sunburns)
  • radiation therapy
  • family hx of BCC
  • immunosuppression
  • fair, esp w/ red hair
  • Fitzpatrick type I or II (easy sunburning)
  • blistering sunburns as a child
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7
Q

BASAL CELL CARCINOMA

Variations

A
  • nodular
  • superficial
  • pigmented
  • micronodular
  • morpheaform
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8
Q

BASAL CELL CARCINOMA

Nodular BCC Characteristics

A
  • pink, pearly, telangiectatic papule
  • rolled border
  • central depression that may have ulceration and crusting
  • 50-80% BCC
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9
Q

BASAL CELL CARCINOMA

Superficial BCC Characteristics

A
  • MC on trunk
  • scaly
  • dry patch that doesn’t heal
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10
Q

BASAL CELL CARCINOMA

General Characteristics

A
  • persist, enlarging gradually
  • can invade and destroy surrounding tissues
  • rarely metastasize but can directly spread
  • asymptomatic - bleed w/o pain
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11
Q

BASAL CELL CARCINOMA

Tx

A
  • biopsy
  • goal: permanent cure w/ best cosmetic result
  • determined by variant, size, location
  • electrodessication, curetage
  • elliptical excision
  • Moh’s surgery
  • topical chemotherapy
  • F/U every 6 months then yearly
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12
Q

SQUAMOUS CELL CARCINOMA

A
  • second most common form of skin CA
  • frequently develop on site of AK
  • face, scalp, neck, dorsal hands
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13
Q

SQUAMOUS CELL CARCINOMA

Risk factors

A
  • fair complexion
  • chronic, long term sun exposure (eg farmers)
  • biologics and other immunosuppressives, HPV, chronic ulcer, HS, hx of radiation, PUVA, DLE, erosive lichen planus
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14
Q

SQUAMOUS CELL CARCINOMA

Characteristics

A
  • begins w/ sun damage changes (AK, actinic cheilitis)
  • red base w/ hyperkeratotic white adherent scale
  • becomes raised, larger
  • over time, becomes nodular and ulcerated
  • faster growing, can be invasive and metastasize
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15
Q

SQUAMOUS CELL CARCINOMA

Course/Outlook

A
  • have a low threshold for biopsy: degree of differentiation used to grade
  • metastasis: 0.5-5% (greater risk on scars, lip, ear)
  • poorer prognosis with immunocompromised patients
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16
Q

SQUAMOUS CELL CARCINOMA

Tx

A
  • excision with margins
  • Moh’s surgery for head/neck, large lesions
  • lymph node palpation, biopsy if enlarged
  • adjunct therapy
  • self exam education
  • regular F/U 6 months then annual
17
Q

KERATOACANTHOMA

A
  • controversial diagnosis: previously categorized as reactive or pseudomalignancy
  • now considered malignant and managed like SCC
18
Q

KERATOACANTHOMA

Features

A
  • solitary nodule
  • central keratotic plug
  • firm, often tender
  • rapid growth to max size 3-6 weeks, stable for wks to months then resorbs leaving a pitted scar
  • can progress to invasive or metastatic carcinoma
  • often indistinguishable from SCC
  • dermatopathology necessary for Dx
19
Q

KERATOACANTHOMA

Risk factors

A
  • rare before 40, peak age 50-69
  • fair skin
  • most common on face, neck, dorsal arms/hands, legs
20
Q

KERATOACANTHOMA

Ddx

A
  • SCC
  • molluscum contagiosum
  • wart
21
Q

KERATOACANTHOMA

Tx

A
  • assume SCC
  • excision biopsy best (need depth to evaluate dermis)
  • surgical excision of partial biopsy
  • Moh’s surgery for large or recurrent or cosmetically sensitive lesions
22
Q

MELANOMA

A
  • rapidly increasing skin CA of melanocytes
  • one person dies of MM hourly; 76100 new cases in 2014
  • potentially curable with early detection
  • affects young and old (rare in children)
  • enviro and genetic components: 86% due to sun, risk double if 5+ sunburns or 1+ blistering sunburn
23
Q

MELANOMA

Risk factors

A
  • fair skin
  • 50-100 nevi
  • hx of atypical nevi
  • PMH of melanoma
  • FH of melanoma, atypical nevi
  • h/p 1 blistering or 5+ sunburns
  • large congenital nevi
  • immunosuppression
  • tanning bed (one session increases risk by 20%)
24
Q

MELANOMA

Subtypes

A
  • superficial spreading
  • nodular
  • acral lentiginous
  • lentigo maligna
  • melanoma in situ
  • amelanotic melanoma
  • subungual
25
Q

MELANOMA

Warning signs/What to watch for

A
  • huge variations
  • ABCDE
  • may have itching or tenderness
  • may have bleeding or ulceration
  • slow or abrupt change
  • examine all pigmented lesions regularly
26
Q

MELANOMA

What to do w/ atypical lesion

A
  • if MM suspected, complete excision with 1-3 mm margin
  • if lesion too large, perform punch biopsy
  • lentigo maligna tend to be large and on cosmetically sensitive area so do broad shave biopsy
  • send to dermatopathologist
27
Q

MELANOMA

  1. Breslow thickness
  2. Clark level
A
  1. vertical mm from top of granular layer to deepest point of tumor involvement; thinner/localized is better
  2. anatomic plane of invasion; deeper = greater risk metastasis
28
Q

MELANOMA

Tx

A
  • surgery referral, wide local excision
  • derm referral
  • consider lymph node biopsy
  • adjuvant therapy
  • frequent F/U
  • also need to be followed by ophthalm and dentist b/c can develop MM in iris or mouth
29
Q

MELANOMA

What to do for a pt Dxed w/ MM lesion

A
  • full skin exam: conjunctive, oral mucosa, genital, perianal; photography or mole mapping
  • palpate lymph nodes
  • check scars of previous MM for recurrence
  • consider labs: low yield, but may help with prognosis (work with derm and oncology)
  • patient education
  • 6 month F/U
30
Q

MELANOMA

Prevention/Pt education

A
  • avoid peak sunlight hours
  • broad spectrum sunscreen daily
  • sun protective clothing
  • lip balm SPF 15+
  • minimize exposure in kids <18 months
  • avoid tanning beds
31
Q

Cryotherapy

  1. Define
  2. List preferred lesions
A
  1. separates dermis from basal membrane

2. AK, acrochordons, condyloma, molluscum, seborrheic keratosis, solar keratosis, verrucae

32
Q

Moh’s Surgery

  1. Define
  2. List preferred lesions
A
  1. staged (gradual downward) excision of pathologic lesion

2. BCC, SCC, high risk locations, large or aggressive tumors

Fall 2014 - CM Dermatology (11 decks)

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