Skin Cancer Flashcards
1
Q
General skin care for pts?
A
- tx your skin gently
- limit bath time
- avoid strong soaps
- shave carefully
- pat dry
- moisturize dry skin - apply an emollient immediately after bathing or showering (eucerin, vanicream, cetaphil, aquaphor) - lotions contain more water and alcohols than creams and ointments
- eat a healthy diet
2
Q
What can happen if you over exfoliate the skin?
A
- disrupt epidermis causing increased drynes
- as a resuly the skin produces more oil leading to possible acne
- also can disrupt blood vessels
- gentle exfoliation 1-2x a week or none is recommended
3
Q
How does smoking affect the skin?
A
- smoking ages the skin faster, leading to thickened leathery skin with more prominent wrinkles
- it narrows tiny blood vessels in outer most layers of skin which decreases blood flow, it depletes skin of O2 and nutrients that are impt to skin health
- smoking also damages collagen and elastin, the fibers that give your skin its strength and elasticity
- in addition - facial expressions made when smoking can contribute to wrinkles
4
Q
What increases the risk of skin cancer? UVA and UVB association?
A
- repeated low exposure to UV radiation
- brief and early (childhood sunburns) increase risk of melanoma
- a hx of 5 or more severe sunburns in childhood and adolescence more than doubles the risk of developing melanoma
- 2/3 melanoma may be attributed to excessive sunlight exposure
- UVB causes most of DNA damage, but UVA radiation is also impt in the pathogenesis of melanoma
5
Q
Primary prevention of skin cancer?
A
- avoid exposure to UV radiation
- use sunscreen greater than SPF 30
- wear protective clothing, a hat and sunglasses when possible
- schedule outdoor activities b/f 10 am and after 4 pm
- avoid all tanning activity (including tanning salons)
- use extra caution near water, snow and sand as they reflect damaging rays of the sun
- educate parents so kids are protected
- reapply sunscreen every 2 hrs, apply 15-20 min b/f sun exposure = just delays sunburn - don’t spend excessive amt of time in sun
6
Q
Secondary prevention of skin prevention?
A
- inspect moles for changes
- remove suspicious moles
- remove actinic keratoses and other precancerous lesions
7
Q
Recommendations for skin cancer screening?
A
- monthly self exams recommended for persons:
personal hx of skin cancer
1st degree family hx of skin cancer
precursor lesions
sun damaged skin - yearly clinician skin exams for pts at high risk
8
Q
What should pt examine on self skin exam?
A
- examine entire body
- palms, forearms, upper arms, and axillae, followed by back of legs and feet, toe web spaces and soles
- find a buddy!
9
Q
What are the types of skin cancers?
A
- melanoma
- BCC
- SCC
- kaposi’s sarcoma
10
Q
What are sun spots (also called aging spots)? Are they the same thing as freckles
A
- macular lesion aka solar lentigo: from sun exposure, seen in elderly
- No, freckles fade in winter and become unapparent in older pts, whereas solar lentigines remain for life and become more prominent with aging
11
Q
What is seborrheic keratosis?
A
- other type of lesion commonly referred to as an aging spot
- they are elevated however look a lot diff than solar lentigenes, may look crusty, may be all over esp back, they look like they could be picked off
12
Q
What are cherry angiomas? Benign or maligant?
A
- are extremely common, benign, bright red to violaceous, domed vascular lesions. Generally appear first around 30 and increase in numbers over the yrs
13
Q
Anytime a melanoma is suspcected, what should be done?
A
- EXCISIONAL Bx
- a punch bx from only part of lesion may not be sufficient enought for path to make proper histologic dx or may miss abnormal cells (falso negative)
- a shave bx will not assess the depth of melanoma which is critical for staging
14
Q
If you are worried that a melanoma has spread to regional lymph nodes - what should be done?
A
- refer pt immediately to surgeon
- they will excise the lesion and do FNA on palpable axillary lymph node
15
Q
How common is melanoma? How dangerous is it?
A
- Most serious form of skin cancer, malignant tumor arising from melanocytes
- 3rd MC skin cancer
- 6th MC cancer in North America
- 5 yr survival rates for people with melanoma depend on stage of the disease at time of dx
16
Q
Epidemiology of melanoma?
A
- far less common than BCC and SCC but accounts for majority of skin cancer deaths
- rapidly increasing incidence
- sex ratio 1:1
17
Q
Major RFs for melanoma?
A
- fair skin (tan poorly and burn easily)
- episodic intense sun exposure (severe blistering sunburn hx)
- 1st degree family hx
- precursor lesions include congenital nevi, especially dysplastic nevi, and giant hairy nevis
18
Q
What are the ABCs of melanoma?
A
- Assymetry
- border irregularity
- color
- diameter (greater than 6 mm)
- enlargement or evolution
19
Q
7 pt checklist?
A
- major features: change in size change in color change in shape - minor features: inflammation bleeding or crusting sensory change lesion diameter greater than 6 mm
20
Q
Where does melanoma appear on men and women the most?
A
- men: back
- women: lower legs
21
Q
Normal vs dysplastic nevus?
A
- standard nevus: congenital discoloration of circumscribed area of the skin due to pigmentation (mole)
- dysplastic nevus: some malignant characteristics
22
Q
Determining degree of melanoma?
A
- breslow thickness: tumor thickness in mm
- clark level: refers to anatomical descriptor (anatomical planes) of depth (I-V) of malignant cells
- thicker the tumor lower the survival rate (tumors less than 0.76 mm (in-situ) have over 90% cure rate after simple excision)
- tumors 0.76-4 mm have over 80% risk of distant disease and less than 50% of 5 yr survival, if mets - less than 10% will live beyond 5 yrs
23
Q
What are the prognostic features of melanoma?
A
- good prognosis: breslow under 1 mm
- intermediate prognosis: breslow 1-4 mm
- bad prognosis: breslow greater than 4 mm
24
Q
Diff subtypes of melanoma?
A
- superficial spreading melanoma
- nodular melanoma
- lentigo maligna melanoma
- acral letniginous melanoma
25
Characteristics of superficial spreading melanoma?
- can make a difference here by doing good skin exams
- MC (70%), grows superficially b/f deep penetration, great prognosis if caught early
- MC on torso for men and legs in women
- MC dx ages 30-50
26
Characteristics of nodular melanoma?
- 2nd MC form, represents about 15%
- often invasive from onset, poor prognosis
- any site, has rapid vertical growth and typically dx at later stage
- Most frequently dx in 60s
27
Lentigo maligna melanoma characteristics?
- 5% of melanomas, tendency for head and neck
- More common in pts over 60 yo on sun damaged skin
- least aggressive of melanomas, may be present for 5 yrs b/f invasion, often favorable prognosis
28
What are characteristics of acral lentiginous melanoma?
- occurs on palms, soles, subungual areas, and mucous membranes
- MC in people of darker skin
- commonly dx at advanced stage, poor prognosis
- hutchinson's sign:
longitudinal pigmented streak - extend from proximal or lateral nail fold, appearance: often irregular in shape, develops quickly, may widen or darken
pigmented globules - may be seen at distal clipped nail
- refer for bx of nail unit
29
benign causes of longitudinal melanonychia? Malignant?
```
- benign:
pigmented bands/nevi: found in 90% blacks, 20% Asians
trauma
meds: minocycline, chemo, anti-malarials
infections: fungal
Addisons, B12 def, hemochromatosis
- malignant:
usually solitary and most often involves thumb/great toe
```
30
What is a halo nevus?
- pigmented nevus surrounded by de-pigmented zone
- isolated halo nevus more common in pts under 20
- halo phenomenon is rxn against melanin:
may be due to melanoma elsewhere (immune response)
up to 20% assoc with melanoma
full skin, mucocutaneous and lymph node exam recommended
- sudden onset multiple halo nevi: concerning for presence of melanoma
- may be sign of ocular melanoma
31
What is non-cutaneous melanoma?
- rare
- ocular melanoma: mostly choroid and ciliary body
- mucosal melanoma:
head and neck
vulva and vagina
anal
urethra
esophagus
32
BCC epidemiology?
- lifetime risk of developing this: 30%, 1 of the MC malignancies in humans
- incidence increases with age (55-75)
- incidence rising across all subgroups esp common in caucasians
- very uncommon in dark skinned people
- states closer to equator = higher incidence
33
PP of BCC? Appearance?
- arises from basal layer of epidermis - caused by DNA damage of keratinocytes
- rarely met (only if delayed therapy) - but these can be locally invasive and destructive of skin and surrounding structures including bone
- etiology: excess exposure to UV radiation
- typical appearance: translucent/pearly white papule with telangiectasis over surface that slowly enlarges with subsequent development of central ulceration
34
Presentation of BCC?
- approx 70% occur on face
| - majority are nodular, may also be superficial and morpheaform
35
Tx options of BCC?
- surgical excision: traditional, mohs micrographic surgery
- radiation therapy
- electrodessication and curretage
- cryotherapy, Efudex or imiquimod only for superficial BCC
36
Recurrence rate after Mohs?
- less than 1%
37
MC skin cancer?
- BCC (80%)
- 4x more frequent than SCC
- mets less than 1%
- local destruction of tissue
38
PP of SCC?
- arises from malignant proliferation of keratinocytes of epidermis
- 2nd most common skin cancer worldwide
- often begins as Actinc keratosis
- may be assoc with HPV 16, 18, 31, 33, 35
- bowen's disease: carcinoma in situ, next level following actinic keratosis
39
Presentation of SCC?
- Bowen's disease typically presents as chronic, asx, nonhealing, slowly enlarging erythematous patch with sharp but irregular outline (scaling and crusting may be found)
- invasive SCC: typically presents as flesh colored nodule that enlarges and often undergoes ulceration and crusting (lesion may be keratotic with thickened surface)
40
Tx of actinic keratoses?
- liquid nitrogen cryotherapy
- topical therapies:
efudex, imiquimod, TCA
- curettage for hypertrophic lesions
- chemical peels
- lasers
- photodynamic therapy; IPL with and w/o levulan
41
Tx of SCC? What does this depend on?
- Depends on level of disease
- actinic keratosis - nonhypertrophic - liquid nitrogen
hypertrophic - surgical curettage (send to path)
multiple AKs - Efudex or imiquimod
- bowens disease:
surgical excision, cryotherapy, efudex for 6 wks
- advanced SCC: surgical excision or radiation
42
What is a keratoacanthoma?
- cutaneous tumor that presents as dome shaped nodule with central keratin filled crater
- develops on hair bearing, sun exposed skin, middle aged and elderly adults with fair complexions are most freq. affected
- controversy exists over whether KA represents a distinct entity or a variant of cutaneous SCC
43
What is Kaposi's sarcoma?
- vascular tumor assoc with HHV-8 aka KSHV
44
4 forms of Kaposi's sarcoma?
- classic: older men of mediterranean and Jewish origin
- endemic or African: found in all parts of equatorial Africa, particularly Sub-saharan africa, not typically assoc with immune deficiency
- organ transplanted
- AIDS related: used to be 20,000x more prevalent b/f use of highly active antiretroviral therapy
45
Characteristics of KS?
- highly variable clinical course
- not just skin problem, also in oral cavity, GI, and resp. tract
- characteristic skin findings:
MC papular
elliptical along skin tension lines
mult colors
may be surrounded by yellow halo
46
Tx of KS?
```
- local tx:
surgery
radiation
cryotherapy and laser
intralesional therapy
topical - imiquimod
- systemic:
chemo
immunomodulators
```
47
Classic presentation of BCC?
- face or head, translucent or pearly lesion with telangiectasis with subsequent central ulceration
