Skin Cancer

Question 1

basal cell carcinoma from… looks like…

Answer 1

germinative kcytes

resemble basal layer

Question 2

squamous cell CA form, looks like

Answer 2

epidermal kcytes

resembles spinous layer

Question 3

melaoma from/resembles?

Answer 3

melanocytes

Question 4

most common mut in sporadic tumors of

Answer 4

PTCH

Question 5

what places squamous cell CA pt at high risk of met

Answer 5

ear/scalp/nose/lip
immsupp
arise in scar/ulcer/burn/sinus/genitals
arsenic
bone mm nn
big / deep

Question 6

px of melanoma most important?

Answer 6

ulcer, dept of dermal inv

Question 7

nonmelanoma skin cancer risk in US

Answer 7

1/5 lifetime risk

Question 8

most comon invasive neoplasm in US?

Answer 8

basal cell CA

Question 9

mut in basal cell

Answer 9

PTCH 30% in sporatic ones

Question 10

what is PTCH

Answer 10

tsg, regulates basal epidermal cell prolif

Question 11

risk of basal cell

Answer 11

UV, fair, hx of sunburn, fam hx, immsupp (10x)

Question 12

upper vs lower face?

Answer 12

basal/ squamous

Question 13

most common subtype of basal cell

Answer 13

nodular

Question 14

pathology of basal cell

Answer 14

basophilic hyperchrom cells –> nodules from surface

Question 15

subtypes of bvasal cell

Answer 15

nodular, sup’l, pigmented, morpheaform (scloeritic), micronodular, cystic, infiltrative

Question 16

basal cell nevus syndrome (Gorlin)

Answer 16

auto dom, rare
mut PITCH 1 (so sonic hedgehog takes over, lots of exp)
early age BCC like 23 yo
MSK defect, jaw cysts
inc risk of medulloblstoma, fibrosarcoma

Question 17

mets in basal cell

Answer 17

rare

Question 18

tx basal cell

Answer 18

excise, electroodess+ curretage, cryosurg, radiation, topical chemo if superficial (imiquimod, 5-FU)

Question 19

Vesmodegib

Answer 19

tx adv basal cell
competitive antagonist
super expensive, only for ptch muts, bad musc cramps, GI distress

Question 20

squamous cell gross

Answer 20

CRUSTY, hyperkeratotic

Question 21

development of squamous cell

Answer 21

uv dam –> mut p53 –> epid cells –> squamous cell dysplasia –> squamous cell carc in situ –> breaks through basal layer, invasive

Question 22

second most common skin CA

Answer 22

squamous cell

Question 23

progression

Answer 23

minimal atypical (actinic keratosis)
full epid atypia above BM (SCC in situ)
invasive (SCC)

Question 24

Bowen’s disease

Answer 24

SCC in situ

Question 25

eryhtroplasia of queyrat

Answer 25

SCC in situ on genitalia

Question 26

actinic keratoses

Answer 26

thin non indurated lesions
lack of induration is clue to tell us it is so superficial
not thick
you see a bunch of them
SUN EXP AREA

Question 27

ssquamous cell mut?

Answer 27

no specific. often p53 mut

Question 28

risk of squamous cell

Answer 28

UV, HPV (16, 18, 31, 35)
luekoplakia
immunosupp
chem (arsenic)
radiation
burn scars
chronic inflamm

Question 29

risk of squamous metastasis

Answer 29

related to size, depth of invasion, anatomic site, host immune status
>2 cm
>4 mm depth
LIPS AND EARS

Question 30

how many squamous cell met

Answer 30

<5 %

Question 31

higher risk of squamous mets?

Answer 31

actinic induced on lip
marjolin’s ulcers
HPV induced
leukoplakia

Question 32

where does squamous cell met?

Answer 32

nodes

lung

Question 33

if squamous on actinic induced non-mucosal skin, risk of met?

Answer 33

lower. 0.5-1%

Question 34

keratoacanthoma

Answer 34

neoplasm of kcytes
type of fast growing squamous cell
painful
body elminates it spontaneously

Question 35

Marjolin’s ulcer

Answer 35

ulcerated invasive squamous cell on inflamm/scar/radiation/truama

Question 36

squamous tx

Answer 36

depends on progression
actinic – topical, cryo
in situ: topical, intralesional, excision
invasive: excise