Skin Cancer Flashcards
History of ___ or more severe sunburns in childhood and adolescence more than doubles the risk of developing melanoma.
High risk individuals should perform self- skin exams how often?
5 or more.
monthly self skin exams.
What are the types of skin cancers?
melanoma
basal cell carcinoma
squamous cell carcinoma
kaposis sarcoma
What are cherry angiomas?
benign, bright red to violaceous, domed vascular lesions. Generally appear around 30YO.
What type of bx is indicated anytime melanoma is suspected?
anytime a melanoma is suspected an excisional biopsy is indicated. Punch bx may not be sufficient enough for pathologist to make proper histological dx or may miss the abnormal cells. Shave bx will not assess the depth of the melanoma which is critical for staging.
Melanoma:
- benign or malignant?
- risk factors
- ABCs
- what is the 7 point checklist?
- which is better at detecting CA, ABC or 7point?
malignant, most serious form of skin CA….accounts for the great majority of skin CA deaths.
Risk factors:
- fair skin
- episodic intense sun eposures
- 1st degree FHx
- precursor lesions include congenital nevi, especially dysplastic nevi and gaint hairy nevus
A-asymmetry B-border C- color D- diameter (greater than 6mm) E- enlargement/evolution
7point checklist:
- Major features:
- -change in size, color, shape
- Minor:
- -inflammation, bleeding/crusting, sensory change, lesion diameter greater than 6mm.
7point checklist is better at detecting skin CA.
What is a nevus and dysplastic nevus?
WHat is Breslow thickness?
What is clark level?
Nevus: mole
dysplastic nevus: mole with malignant characterisitcs
Breslow thickness: refers to tumor thickness (in mm)
Clark level: staging system used in conjunction with breslow thickness to describe the anatomical level of invasion of the CA. (I-V) (ex. I = confined to epidermis, V =invasion of subQ fat)
deep is bad, shallow is better
Melanoma:
- MC type?
- what are the subtypes?
MC type is superficial spreading melanoma; great prognosis if caught early.
Subtypes:
- superficial spreading melanoma
- nodular melanoma
- Lentigo Maligna melanoma
- Acral Lentiginous Melanoma
- Longitudinal melanonychia
- non-cutaneous (head/neck, vulva/vagina, anal, urethra, esophagus, ocular**)
Nodular melanoma:
-characteristics?
Lentigo maligna melanoma:
-characteristics?
Acral Lentiginous Melanoma:
-characteristics
Nodular:
-rapid, vertical growth, poor prognosis, dx 6th decade of life.
Lentigo:
-MC head and neck, least aggressive, favorable prognosis
Acral:
- occurs on palms, soles, subungual, and mucous membranes
- MC in those with darker skin types, poor prognosis
- brown pigmented longitudinal streak in nail = hutchinsons sign.
Longitudinal melanonychia
-causes
benign: trauma, meds, fungal infection, addisons, B12 deficiency, hemochromatosis
Malignant
Halo Nevus:
- what is this?
- cause
What; pigmented nevus surrounded by a de-pigmented zone
Cause:
- rxn against melanin
- may be associated with melanoma elsewhere eliciting immune response.
- may be presenting sign of ocular melanoma.
Basal Cell Carcinoma:
- metastatic?
- cause
- appearance of the lesion
- MC location
- tx
Rarely metastatic
Cause: excess exposure to UV radiation
Appearance of lesion:
-translucent/pearly white papule with telangiectasias over the surface that slowly enlarge with subsequent development of central ulceration.
MC location is on the face.
Tx:
- surgical excision (traditional or mohs)
- radiation therapy
- electrodessication and curettage
- cryotherapy, topical 5-FU, or imiquimod (only for superficial BCC)
Describe Mohs Micrographic Surgery.
Which skin CA is MC?
technique where thin layers of tumor tissue are removed and then examined microscopically.
procedure is repeated until entire tumor is removed (no abnormal cells seen under microscopy.
MC skin CA is basal cell carcinoma.
Squamous cell carcinoma
- SCC often begins as what?
- cause
- what is bowens dz?
- describe lesion
SCC often begins as Actinic Keratosis
Cause:
- may be associated with HPV 16, 18, 31, 35
- sun exposure
Bowens Dz: refers to carcinoma in siture, which is the next level after actinic keratosis
Lesion:
- non healing, slowly enlarged erythematous patch with sharp but irregular outline.
- asymptomatic
Invasive Squamous Cell Carcinoma:
-describe the lesion
Lesion:
-flesh colored nodule that enlarges and often undergoes ulceration and crusting
squamous cell carcinoma Tx:
- Actinic Keratoses:
- -tx
- Bowens dz:
- -tx
- advanced squamous cell carcinoma
- -tx
Tx:
- Nonhypertrophic AK: liquid nitrogen cryotherapy
- hypertrophic AK: surgical curettage
- multiple AKs: topical 5-FU or imiquimod
others:
- chemical peel, laser, photodynamic therapy (intermittent pulse light)
Bowens:
- surgical excison of the lesion
- cryotherapy
- 5-FU
Advanced SCC:
-surgical excision or radiation
