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Dermatology > Skin Cancer > Flashcards

Skin Cancer Flashcards

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Dermatology Board Prep 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
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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
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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
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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
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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
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6
Q

Secondary prevention of skin prevention?

A
  • inspect moles for changes
  • remove suspicious moles
  • remove actinic keratoses and other precancerous lesions
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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
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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!
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9
Q

What are the types of skin cancers?

A
  • melanoma
  • BCC
  • SCC
  • kaposi’s sarcoma
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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
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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
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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
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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
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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

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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
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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
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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
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18
Q

What are the ABCs of melanoma?

A
  • Assymetry
  • border irregularity
  • color
  • diameter (greater than 6 mm)
  • enlargement or evolution
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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
Q

Characteristics of superficial spreading melanoma?

A
  • 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
Q

Characteristics of nodular melanoma?

A
  • 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
Q

Lentigo maligna melanoma characteristics?

A
  • 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
Q

What are characteristics of acral lentiginous melanoma?

A
  • 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
Q

benign causes of longitudinal melanonychia? Malignant?

A 
- 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
Q

What is a halo nevus?

A
  • 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
Q

What is non-cutaneous melanoma?

A
  • rare
  • ocular melanoma: mostly choroid and ciliary body
  • mucosal melanoma:
    head and neck
    vulva and vagina
    anal
    urethra
    esophagus
32
Q

BCC epidemiology?

A
  • 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
Q

PP of BCC? Appearance?

A
  • 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
Q

Presentation of BCC?

A
  • approx 70% occur on face

- majority are nodular, may also be superficial and morpheaform

35
Q

Tx options of BCC?

A
  • surgical excision: traditional, mohs micrographic surgery
  • radiation therapy
  • electrodessication and curretage
  • cryotherapy, Efudex or imiquimod only for superficial BCC
36
Q

Recurrence rate after Mohs?

A
  • less than 1%
37
Q

MC skin cancer?

A
  • BCC (80%)
  • 4x more frequent than SCC
  • mets less than 1%
  • local destruction of tissue
38
Q

PP of SCC?

A
  • 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
Q

Presentation of SCC?

A
  • 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
Q

Tx of actinic keratoses?

A
  • liquid nitrogen cryotherapy
  • topical therapies:
    efudex, imiquimod, TCA
  • curettage for hypertrophic lesions
  • chemical peels
  • lasers
  • photodynamic therapy; IPL with and w/o levulan
41
Q

Tx of SCC? What does this depend on?

A
  • 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
Q

What is a keratoacanthoma?

A
  • 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
Q

What is Kaposi’s sarcoma?

A
  • vascular tumor assoc with HHV-8 aka KSHV
44
Q

4 forms of Kaposi’s sarcoma?

A
  • 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
Q

Characteristics of KS?

A
  • 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
Q

Tx of KS?

A 
- local tx:
surgery 
radiation
cryotherapy and laser
intralesional therapy
topical - imiquimod
- systemic:
chemo
immunomodulators
47
Q

Classic presentation of BCC?

A
  • face or head, translucent or pearly lesion with telangiectasis with subsequent central ulceration

Dermatology (12 decks)

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