Skin Cancer

Question 1

Skin disorder that is precancerous with potential for progression to SCC; atypical keratinocyte only in basal layer of epidermis; pink gritty macules and patches that are seen in chronic sun exposure sites; KERATINOCYTE origin; more common in fair skin

Answer 1

Actinic Keratosis

Question 2

Tx for AK

Answer 2

cryotherapy, topical 5-FU, imiquimod

Question 3

type of skin cancer; atypical keratinocytes seen throughout the full thickness of epidermis; has a risk of progression to invasive SCC if left untreated; can arise from AK or de novo; pink patch or thin plaque with scale; KERATINOCYTE origin

Answer 3

Squamous Cell Carcinoma (SCC) in situ

Question 4

Tx for SCC in situ

Answer 4

5-FU, incision (curettage), Mohs surgery

Question 5

Invasive (risk of lymph node metastasis) skin cancer that arises from keratinocyte (AK/SCC in situ) or de novo; presents as pink papule or plaque with associated scale; risk factors include chronic sun exposure, HPV, immunosuppression; higher risk if lesions on lip, ear, genitalia or >2cm in diameter

Answer 5

Invasive SCC

Question 6

Tx for invasive SCC

Answer 6

excision or Mohs surgery (to decrease recurrence)

Question 7

Skin cancer surgery that is superior histologic analysis of tumor margins with maximal conservation of tissue; recurrence rates are lower compared to other surgical modalities; indicated for cosmetic areas (face, scalp and hands) and aggressive forms

Answer 7

Mohs Micrographic Surgery (MMS)

Question 8

A variant of SCC; rapid growth with central hyperkeratotic core; can regress and involute w/o tx

Answer 8

Keratoacanthoma

Question 9

Type of skin cancer; slow growing pink pearly papule/nodule with telangiectasis; fair skin and found on sun exposed areas (UV exposure is greatest risk); metastases RARE; Keratinocyte origin but no pre-cancer precursor like SCC; can be superficial or pigmented

Answer 9

Basal Cell Carcinoma

Question 10

Pink macule or patch or thin papule (Superficial/Pigmented)

Answer 10

Superficial BCC

Question 11

Seen in darker skin types (Superficial/Pigmented)

Answer 11

Pigmented BCC

Question 12

Treatment for BCC

Answer 12

Surgical: Mohs surgery, curettage, excision

Non-surgical: Imiquimod

Question 13

Pigmented skin cancer; Melanocyte origin; can arise de novo or from a pre-existing nevus; demonstrates any of the ABCDEs (asymmetry, borders, color, diameter and evolving); risk factors include lighter skin, hx of sunburns/tanning bed use, family hx, higher # of moles, red hair

Answer 13

Melanoma

Question 14

melanoma in the epidermis or epidermal-dermal junction only with no invasion of dermis

Answer 14

Melanoma in situ

Question 15

KEY prognostic factor for Melanomas; measurement from s. granulum to deepest point of melanoma invasion in dermis

Answer 15

Breslow depth

Question 16

Type of biopsy needed for melanoma diagnosis

Answer 16

Excision biopsy (remove the entire lesion to accurately measure Breslow depth)

Question 17

lentigo maligna, subungual melanoma, acral lentiginous melanoma, amelanotic melanoma, and nodular melanoma are

Answer 17

Melanoma variants

Question 18

Tx for Breslow depth <0.8 mm

Answer 18

wide local excision or Mohs surgery

Question 19

Tx for Breslow depth >0.8 mm

Answer 19

wide local excision and ALSO sentinel lymph node biopsy to assess for metastatic disease

Question 20

If melanoma biopsy confirms metastatic disease, what needs to be confirmed for treatment?

Answer 20

genetic mutations to dictate the most effective immunotherapy

Question 21

What genetic mutations are the most common in melanoma?

Answer 21

BRAF & CDKN2A