Skin Cancer Flashcards
What % skin cancer is BCC, SCC
BCC 80%, SCC 20%
Genetic conditions that cause BCC
Xerodermum pigmentosum and basal nevus syndrome
Causes SCC
HPV, smoking cause SCC of the lip, scars or inflammatory conditions, thermal and electrical burns
Most common cause of skin cancer
UVA and UVB rays
What is congenital melanocytic nevi
nevus or mole present at birth, is a type of mole that can develop into melanoma
Sizes of congenital melanocytic nevi
moles that can develop into melanoma
size small <1.5cm
Medium 1.5-20cm
Large >20cm large has 1% Chance of becoming melanoma
Common acquired nevi
a mole that can develop into melanoma that develops later in life
Types of common acquired nevi (3)
Junctional , compound and intradermal
________ typically small (<6mm)are well circumscribed, flat lesions with smooth surfaces that are brown or black and circular, found above the basement layer
Junctional nevi (nevi that can become melanoma)
………. contain melanocyte clusters in the dermis and epidermis. Small well-circumscribed slightly raised papules that often contain excess hair, surface is rough and colour is tan to brown throughout. These lesions may become nodular
Compound nevi (nevi that become melanoma)
_______small well circumscribed dome shaped lesions that range from flesh to brown, they may contain excess hair. Rarely transform into melanoma
intradermal nevi (nevi that can become melanoma)
skin cancer is most common in ages —–
50+
dysplastic nevi
aka atypical moles have one off more clinical features of melanoma:
- Asymmetry
- Irregular borders
- colour variation
- diameter >6mm
dysplastic nevus syndrome characteristics
what can it turn into and how commonly?
- Moles have distinct pathologic features
- pts have 50+ moles
- pts have 1, 1st degree or 2nd degree relative with melanoma
- dysplastic nevus syndrome has up to 100% chance of becoming melanoma
4 functions of the skin
- Produces vitamin D which is absorbed by the GI tract
- Protects internal organs from outside pathogens
- Regulates temperature through perspiration
- Provides receptors for heat, cold, pain and sensation
layers of the skin from most deep to superficial
basement membrane
subcutaneous
dermis
epidermis
what layer of the skin contains nerves, blood vessels and fat tissue and areolar connective tissue that lies below the dermis layer
subcutaneous
what layer of the skin onnective tissue layer contains blood and lymphatic vessels, nerves, nerve endings and hair follicles
dermis
the 2 divisions of the dermis layer %
Upper layer 20% is called the papillary layer and contains dermal papillae, ridges that are responsible for fingerprints
The lower 80% is called the ticular layer containting hair follicles, sebaceous (oil) and subdiferour (sweat) glands and their ducts, nerve endings and blood vessels
5 divisions of the epidermis layer
stratum basale, stratum granulosum, stratum corneum, stratum spinosum, stratum lucidum
What layer of the epidermis is the following: contains stem cells able to produce karatinocytes and provides a barrier between the host and the environment and cells that give rise to hair follicles, it contains melanocytes, and merkel cells ( in the areas where hair doesnt grow),merkel cells are function in he sensation of touch, Merkel cell cancers are lethal even more lethal than melanoma
Stratum basale
what layer of the skin is the following: contains rows of keratinocytes, that have a spiny appearance microscopically
stratum spinosum of the epidermis
what layer of the skin is the following: this layer contains 3-5 rows of somewhat flattened cells, the keratinocytes produce keratinohyalin which is a precursor to keratin
stratum granulosum of the epidermis
what layer of the skin is the following: only found in areas where thick skin is present (palms of hands and soles of feet) contain 3-5 rows of clear, flat cells that contain eleidin, another keratin precursor
Stratum lucidium of the epidermis
what layer of the skin is the following: forms skin surface and has thick rows of dead scaly (squamous cells) that are completely filled with keratin and lack internal organelles
stratum corneum of the epidermis
what connects the dermis and epidermis layers together?
the basement membrane
Melanoma is radio _______
resistant
most common sites of melanoma in men? women?
men: H&N and trunk
women: legs
4 types of melanoma
SSM- superficial spreading melanoma
NM-nodular melanoma
LMM- lentigo maligna melanoma
ALM-arcal lentigious melanoma
what type of melanoma is the following: most common subtype- 70% they arise on any part if the body and have a horizontal growth pattern, their periphery is notched or irregular, colours can be: brown, black, red, pink or white, after some time, the tumour tends to spreads more vertically, which results in irregular, notched surface
superficial spreading melanoma SSM
What type of melanoma is the following: 15% of all menlanomas, can occur on any anatomic site also, 2X miore common in M than F lesions can be dark, brown blue or amelanoitc- meaning no colour at all- when they are amelanotic they are more lethal as they are difficult to diagnose
nodular melanoma (NM)
What type of melanoma is the following:
aka Hutchinsons freckles 5% of all melanomas occur most often in chronically sun exposed spots most often in white elderly ladies, Radial growth phase for decades before it starts its vertical growth phase LMM is similar to SMM but lacks red hue and has minimal elevation
lentigo maligna melanoma (ALM)
What type of melanoma is the following: account for 10% of all lesions found on the palms and soles nail beds and mucous membranes. ALM is most common in blacks and asians has a tan or or brown flat stain on palms or soles. ALM can also appear as discoloration under nail bed and is mistaken for fungal infection
Arcal lentigious melanoma (ALM)
whats the growth phases of melanoma and how long does each stage take?
radial growth pattern takes 15 years in SSM, 5 years in LMM and has NO radial growth in NM and then grows vertically
T Staging melanoma
T1 melanoma <1mm in thickness
T2 melanoma 1.1-2mm in thickness
T3 melanoma 2-4mm in thickness
T4 melanoma >4mm in thickness
N staging melanoma
N1 mets in 1 Ln N1a one nodal micromets mass N1b one nodal macromets mass N2 Mets in 2-3 nodes N2a 2-3 micromets mass N2b 2-3 macromets mass N2c2-3 nodes in transit mets/ satellites without metastatic nodes N3 4+ nodes or matted metastatic nodes or in transit mets / satellites with metastatic nodes
M staging melanoma
M1a mets to skin or distant LN
M1b mets to lung
M1c mets to other visceral sites or mets to any site associated with elevated serum lactic dehydrogenase
stage grouping melanoma
Stage 0 Tis N0 M0 Stage1A T1a N0 M0 Stage 1B T1b N0 M0 T2a N0 M0 Stage 2A T2b N0 M0 T3a N0 M0 Stage 2B T3b N0 M0 T4a N0 M0 Stage 2C T4b N0 M0 Stage 3 any T >N1 M0 Stage 4 anyT anyN M1
most common BCC subtype
nodular ulcerated BCC
4 subtypes BCC
- nodular ulcerated BCC
- superficial
- Morphea
- cystic
what BCC is as follows: most commonly found in the H&N, they appear mostly shiny, translucent and accompanied by telangiecatsis- an abnormal dilation of the capillaries and atrioles that may be visible at the skin surface
nodular ulcerated BCC
What BCC is the following: mostly on the trunk and appears as a red plaque which can appear in areas of translucent papules as it spreads over the skin surface, ulceration is common
superficial BCC
What BCC is the following: often appears like a scar, is very rare and is often found in the H&N has a high propensity for invasion and recurrence after treatment
Morphea or sclerosing BCC
What BCC is the following: uncommon type that undergoes central degradation to form a cystic lesion
cystic BCC
Where does SCC arise from ?
keratinocytes of the upper epidermis
Verrocouos SCC of the skin
grows slowly as a cauliflower like lesion and can be associated with HPV, ut is usually found in the genital area, orl cavity or sole of the foot
what SCC is associated with HPV
verrocouos SCC
Where is verrocouos SCC of the skin usually found ?
genital area, oral cavity or sole of the foot
high risk features of SCC and BCC
High risk features include: Depth/ invasion >2mm Clark level >4 perineural invasion Anatomic location: primary site: ear, hair bearing lip Poorly or undifferentiated
T stage of SCC and BCC
T1- tumour is <2cm with less than 2 high risk features
T2- tumour is >2cm with 2+ high risk features
T3- tumour with invasion of the maxilla, mandible, orbit or temporal bone
T4- tumour with skeletal invasion (axial or appendicular) or perineural invasion of the skull base