skin CA Flashcards
EPidermis layers
stratum corneum - dead layer
stratum granulosum - epi
stratum spinosum -epi
stratum basalis- above basement membrane then dermis
UV rays spectrum
UVC- 100-290- blocked by ozone layer- not earth surface
UVB- 290-315- “ directly damage skin
UVA- 315-400 sun that reaches us! indirectly damages skin
non-melanosma skin ca
BCC (most common ca in whites and rarely mets) or SCC (2nd most common ca, more common elderly)
SCC risk factors
elderly, caucasians, UV exposure, fair skin, male, >50YO, inflammatory skin conditions, smoking, arsenic , HPV infection, immunosuprresion
actinic keratosis
pre-cursor lesion of SCC d/t chronic uv exposure rough scaly plaques on sun-exposed skin focal keratinocyte atypia and disorganization in epidermis and upper epi intact, <1% progress to SCC tx- cryotherapy or topical chemo
bowens disease
pre-cursor lesion of SCC
d/t chronic sun exposure or viral infection (HPV 16 or 18)
red or brown plaque wiht crusted scale
25% lead to SCC into dermis, full thickness epidermal atypia and disorganization no dermal invasion
tx chemo cryo or sx
SCC tx
surgical excision **GOLD STD
Mohs micrographic sx
radiation (except verrucous carcinoma)
Keratoacanthoma
variant of SCC- nodules with crater like center with keratin plug on sun exposed area, tx with sx, grows quickly, resomebles SCC
verrucous carcinoma
SCC variant- resembles giant wart, caused by HPV 16 and18 tx with surgery NOT radiation
marjolins ucler
SCC variant- develop from chronic ulcer or would or trauma, aggressive to mets (35%), tx with sx
Mucosal SCC
SCC variant- smokers, aggressive than traditional SCC, mets 20-70%, tx sx
BCC risk factors
high dose UVB exposure (sunburn) ionizing radiation (xray) carcinogenic chemicals ( arsenic) genetic syndromes (BC nevus syndrome)
BCC differential dx
actinic keratosis, bcc, scc, mmm, dysplastic nevi
BCC s&s
sun exposed areas, pearly nodular iwth telangiectasis, central ucler possible with occ bld, as new? bleed? scab? heal? previous skin ca? risk facotrs? painful?
SCC s&s
plaques, papules, nodules
red, scaly or ulcerated
full thickenss epidermal atypia wiht invasion into dermis
mets 2-6%
as new? hurt? growing? heal? risk facotrs? hx? painful?
SCC differential dx
actinic keratosis BCC SCC MM dysplastic nevi
BCC tx
curettage and electrodesiccation (for superficial BCC <1cm, non-hair bearing skin cure 95% * cryo- liq nitrogen, cure 90%, * topcial chemo radiation therpay surgical exicison ** GOLD standard mohs micrographic surgery vismodegib *leave hypopigmented and hypertrophic scars
BCC referral
suspicious lesions refer to derm, definitive dx use biopsy either shave, punch or excisional
if not tx- will get worse on ear/muscle/neck not mets
curettage and electrodesiccation
superficial BCC, <1 cm non-hair bearing skin trunk/arms cure 95% leave hypopigmentation and scars not morepheaform or infiltrated BCC recurrence due to skill of person
cryosurgery
liquid nitrogen, target tissue, cure 90%, lead to hypopigmentation and scars, recurrence due to skill of person
topical chemotherpay
topical 5-flurouracil BID for 3-12 weekds
superficial BCC
cure 75-93%
SE pain, redness, scaring, crusty
radiation therapy
poor surgical canidates (elderly, poor helalth, lg lesions)
daily tx for 6 weeks
80-93% cure rate
SE: rash, dry skin
surgical exicsion
GOLD standard for BCC
decrease recurrences, margins of gd skin takne
95% cure
SE: bld, infeciton, nerve damage, scarring
mohs micrographic sxq
tx for BCC aggressive or on face/scalp/neck tissue sparing margin control cure 95% time consuming cut horizontal edges
vismodegib
app. jan 2012
local or advance or mets BCC
melanoma risk factors
intermittent high UV exposure >50 melanocytic nevi FH or dyplastic nevi nevus>20cm lighter skin immuno-suppressant lg congenital nevus
melanoma differential dx
actinic keratosis BCC SCC MM dysplastic nevi
melanoma s&s
A-asymmetry
B- border irregular
C-color- variable from brown to black
DM- >6mm
E- elevation or evolution- raised, changing, evolving pigmented lesions
non-healing skin area >3 weeks, ulceration, bleed, weep, abnormal lesions of hands, nails, feet
melanoma types
melanoma in situ lentigo melanoma superficial spreading nodular melanoma acral lentiginous melanoma subungual melanoma
melanoma in situ
Irregularly pigmented macule or patch (often fulfills ABCDE)
Sun-exposed skin in elderly pts
Progresses to Lentigo Maligna-more invasive
lentigo maligna
atrophic epidermis
loss of rete ridges
increases numbers of atypical basilar melanocytes
melanocytes vary in size, shape, hyperchromic nuclei
Solar elastotic changed in the dermis
No atypical melanocytes in dermis
lentigo maligna melanoma
15% of melanomas
elderly pts
Sun damaged skin
Identical to lentigo maligna, but possesses a vertical growth (deeper, but not as wide)
superficial spreading melanoma
Most common type (70%)
Frequently found on the back in men, on legs in women
May arise from a nevi
Fulfills ABCDE’s
Nodular melanoma
2nd most common type of melanoma (15-30%) Rapidly developing nodule Can be ulcerated and bleed Mostly in the vertical growth phase Can rarely be amelanotic (nonpigmented) Sometimes neg ABCD, but possible E
acral lentiginous melanoma
Rarest type (5-10%), but most commonly seen in darkly pigmented pts (70%) Occurs on palms and soles
subungual melanoma
Variant of acral lentiginous melanoma
Can present as hyperpigmented streak on the nail plate (longitudinal melanonychia)
Hutchinson’s sign: pigmentation of the proximal nail fold
seborrheic keratosis
not mole - benign growth
dx of melanoma by..
biopsy (excisional (to get depth) 1st then shave or punch)
immunohistochemical stains can highlight melanocytes in difficult cases
Breslow depth
most important! depth in mm from top of granular layer clarks levels: 1- within epidermis 2- into pap dermis 3- filing pap dermis 4 into reticular dermis 5 into SQ fat
factors affecting prognosis in melanoma
thickness- breslow depth - see clark levels ulceration? lymph nodes mets (5 yr survival 66%) extra-nodal mets (5 yr survival 10%) br
clarks levels in melanoma prognosis
I- within epidermis II- into pap dermis III- filing papillary dermis IV- into reticular dermis V- into SQ fat
tx melanoma
1) surgical excision with app margins
2) sentinel lymph node biopsy.. only on tumors>1mm
3) elective lymph node dissection
4) adjutant or palliative chemotherapy
surgical excision with appropriate margins
4mm thickness 2-3cm margins
Primary skin ca prevention
Decrease sun exposure
Minimize exposure during peak UV hrs (10a-4p)
Wide brimmed hat,clothing etc. >15 min exposure req protection
min30 SPF, broad spectrum (including UVA coverage and zinc), reapply every 2 hours or after swimming
Start early in childhood
Educated pts to seek med attn for nonhealing sores (>4-6weeks) or changes to lesions/nevi.
Secondary skin CA prevention
Early detection
Frequent skin ca screening in high risk pts
Biopsy of suspicious lesions-when in doubt, cut it out!!! or refer to derm:)
breslow staging in melanoma prognosis
stage 1 thin 1mm
stage 3 involvement of lymph nodes
stage 4 involvement of internal organs
