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Dermatology > Skin Cancer and Health Maintenance > Flashcards

Skin Cancer and Health Maintenance Flashcards

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Dermatology Board Prep flashcards
1
Q

General Skin Care for You and Your Patients

7

A
  1. Treat your skin gently
  2. Limit bath time. Frequent bathing using lots of soap and hot water actually dries out the skin more! Short lukewarm baths/showers are best.
  3. Avoid strong soaps. Strong soaps and detergents can strip oil from skin. Instead, choose mild cleansers and use sparingly.
  4. Shave carefully. To protect and lubricate skin, apply shaving cream, lotion or gel before shaving. For the closest shave, use a clean, sharp razor. Shave in the direction the hair grows, not against it.
  5. Pat dry. After washing or bathing, gently pat or blot skin dry with a towel so that some moisture remains on your skin.
  6. Moisturize dry skin. If skin is dry, use a moisturizer that fits your skin type. For daily use, consider a moisturizer that contains SPF.
  7. Eat a healthy diet. Eat plenty of fruits, vegetables, whole grains and lean proteins. The association between diet and acne isn’t clear, but some research suggests that a diet rich in vitamin C & low in unhealthy fats and processed or refined carbs might promote younger looking skin.
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2
Q
  1. Hydrating the skin: Best methods?
  2. Best products? 6
  3. What products should be avoided?
A
  1. Apply an emollient immediately after bathing or showering—leaving some water on skin
  2. Best emollients are:
    - Eucerin,
    - Vanicream,
    - Cetaphil,
    - Nutraderm,
    - Aquaphor and
    - Vaseline
  3. Lotions contain more water and alcohols than creams and ointments, and should be avoided as they can worsen dry skin
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3
Q

General Skin Care for You’re and Your Patients

1. What can over exfoliating lead to? 2

A
    • As a result the skin produces more oil leading to possible acne
    • Also can disrupt blood vessels
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4
Q

What does smoking lead to for skin damage?

4

A
  1. Smoking ages the skin faster, leading to thickened “leathery” skin w/ more prominent wrinkles
  2. Smoking narrows the tiny blood vessels in the outermost layers of skin, which decreases blood flow. This depletes the skin of oxygen and nutrients that are important to skin health.
  3. Smoking also damages collagen and elastin, the fibers that give your skin its strength and elasticity.
  4. In addition, the repetitive facial expressions made when smoking (such as pursing your lips when inhaling and squinting your eyes to keep out smoke) can contribute to wrinkles.
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5
Q
  1. Repeated low exposure to UV radiation results in what?

2. Brief and early (childhood sunburns) increase the risk of what?

A
  1. skin cancers

2. melanoma

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6
Q
  1. A history of __ or more severe sunburns in childhood and adolescence more than doubles*** the risk of developing melanoma
  2. 2/3 of melanoma may be attributed to excessive what?
  3. _______ radiation causes most of the DNA damage, but ______radiation is also important in the pathogenesis of melanoma
A
  1. 5
  2. sunlight exposure
  3. UVB, UVA
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7
Q

Avoid Exposure to Ultraviolet Radiation

5

A
  1. Use sunscreen > SPF 30
  2. Where protective clothing, a hat and sunglasses when possible
  3. Schedule outdoor activities before 10am and after 4pm and seek shade when appropriate
  4. Avoid all tanning activity including tanning salons
  5. Use extra caution near water, snow and sand as they reflect damaging rays of the sun
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8
Q
  1. Generously apply sunscreen to ALL exposed skin using a SPF of ___ that provides broad-protection from both UVA and UVB
  2. When should you apply and reapply? 3
A
  1. 30
    • Reapply every 2 hours
    • Reapply after swimming or sweating, use waterproof formulations
    • Needs to be applied 15 to 20 minutes before sun exposure
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9
Q

Screening and Early Detection
of skin cancer?
3

A
  1. Inspect moles for changes
  2. Remove suspicious moles
  3. Remove actinic keratoses and other precancerous lesions
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10
Q

Monthly skin self-examinations are recommended for persons with what? 4

Yearly clinician skin exams for patients at high risk: every _______?

A
  • personal history of skin cancer
  • 1st degree family history of skin cancer
  • precursor lesions
  • sun damaged skin

Some patients may need exams every six months

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11
Q

What are the types of skin cancers? 4

A
  1. Melanoma
  2. Basal Cell Carcinoma
  3. Squamous Cell Carcinoma
  4. Kaposi’s Sarcoma
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12
Q

Freckles fade in the winter and become unapparent in older patients. How are solar lentigines different? 2

A

whereas solar lentigines

  • remain for life and
  • become more prominent with aging
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13
Q
  1. The other type of lesion commonly referred to as an “aging spot” is a what?
  2. __________ are elevated however and look much different than solar lentigenes
A
  1. seborrheic keratosis.

2. Seborrheic keratoses

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14
Q
  1. Cherry angiomas (or angiomata) are what?

2. They generally appear first around age ____ and increase in number over the years

A
  1. are extremely common, benign, bright red to violaceous, domed vascular lesions.
  2. 30
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15
Q
  1. Anytime a melanoma is suspected what is indicted?
  2. A punch biopsy from only part of the lesion may not be sufficient enough for what?
  3. A shave biopsy will not assess what?
A
  1. an excisional biopsy is indicated
  2. for the pathologist to make a proper histologic diagnosis or may miss the abnormal cells (false negative)
  3. the depth of a melanoma which is critical for staging
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16
Q
  1. You are worried that this is a melanoma that has spread to the regional lymph nodes. The arm fatigue could potentially be explained due to impingement on the brachial plexus by the enlarged lymph node palpated on exam. What should you do?
  2. The surgeon performs an excisional biopsy on the lesion and a what on the palpable axillary lymph node?
A
  1. You refer this patient immediately to a surgeon

2. fine needle aspiration (FNA)

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17
Q

What is the most serious form of skin cancer, it is a malignant tumor arising from melanocytes?

A

Melanoma

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18
Q

Melanoma:
1. Far less common than what but accounts for the great majority of skin cancer deaths? 2

  1. How is incidence changing?
  2. Gender?
  3. Major risk factors? 4
A
  1. basal cell and squamous cell cancers
  2. Rapidly increasing incidence
  3. Sex ratio 1:1
  4. Major risk factors
    - Fair skin (who tan poorly and burn easily)
    - Episodic intense sun exposure (i.e. a severe blistering sunburn history)
    - First degree family history
    - Precursor lesions include congenital nevi, especially **dysplastic nevi and giant hairy nevus
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19
Q

ABCs of Melanoma

5

A
  1. Asymmetry (irregular or raised)
  2. Border irregularity (dark or inhomogeneous)
  3. Color (multiple colors/shades)
  4. Diameter (>6mm)
  5. Enlargement or evolution
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20
Q

Melanoma
How about a Seven-Point Checklist?
1. Major features? 3
2. Minor features? 4

A
  1. Major features:
    - Change in size
    - Change in color
    - Change in shape
  2. Minor features:
    - Inflammation
    - Bleeding or crusting
    - Sensory change
    - Lesion diameter greater than 6mm
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21
Q

Screening examination of the total skin surface can increase the likelihood of detecting melanoma SIX-FOLD compared with partial examination. Men have more lesions on the 1._____ and women on their 2.________ since these are common areas of sunburn; screening of those sites could particularly aid early detection

A
  1. back

2. lower legs

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22
Q
  1. A standard nevus can be defined as?

2. A dysplastic nevus is one which has what?

A
  1. a congenital discoloration of a circumscribed area of the skin due to pigmentation (commonly referred to as a mole)
  2. has some malignant characteristics
23
Q
  1. What does breslow thickness refer to?

2. What about clark level?

A
  1. Breslow thickness: refers to tumor thickness (in millimeters)
  2. Clark level: refers to anatomical descriptor (anatomical planes) of depth (I-V) of the malignant cells, “to dermis but not subq” etc.
24
Q

How does thickness of the tumir relate to prognosis?

A

The thicker the tumor, the lower the survival rate:

  1. Tumors less than 0.76mm (in-situ) have > 90% cure rate after simple excision
  2. Tumors 0.76 – 4.0mm have > 80% risk of distant disease and less than 50% chance of 5 year survival, if metastatic less than 10% will live beyond 5 yrs.
25
Q

On the Breslow Scale describe the following:

  1. Good Prognosis?
  2. Intermediate prognosis?
  3. Bad prognosis?
A
  1. Good prognosis
    Breslow less than 1mm
  2. Intermediate prognosis
    Breslow 1-4mm
  3. Bad prognosis
    Breslow >4mm
26
Q

Multiple subtypes of Melanoma: What are they?

A
  1. Superficial spreading melanoma
  2. Nodular melanoma
  3. Lentigo Maligna Melanoma
  4. Acral Lentiginous Melanoma
  5. Subungual Melanoma
27
Q
  1. What is the most common type of Melanoma?
  2. Describe how it grows?
  3. Prognosis?
  4. Locations most common on men and women?
  5. Most common age?
A
  1. Superficial spreading melanoma
    - Most common (70%),
  2. grows superficially before deep penetration,
  3. ***great prognosis if caught early
  4. Any site, but preference for torso in men and legs in women
  5. Most commonly diagnosed between ages 30 and 50.
28
Q
  1. Second most common type of melanoma?
  2. Prognosis?
  3. Locations?
  4. Most frequently when?
A
  1. 2nd most common form of melanoma, represents about 15%
  2. Often invasive from the onset, poor prognosis
  3. Any site, has rapid vertical growth and typically diagnosed at later stage
  4. Most frequently diagnosed in 6th decade of life
29
Q

Lentigo Maligna Melanoma
1. Frequency represents 5% of melanomas, tendency for where?2

  1. More common in the patients of what age and where?
  2. Describe its prognosis?
A
  1. head and neck
  2. > 60 y/o on sun damaged skin
  3. Least aggressive of the melanomas, may be present for five years before invasion (termed lentigo maligna before invasion), often favorable prognosis
30
Q

Acral Lentiginous Melanoma

  1. Occurs where? 4
  2. Most common in people with what skin types?
  3. Prognosis?
A
  1. Occurs on
    - palms,
    - soles,
    - subungual areas, and
    - mucous membranes
  2. Most common in people with darker skin types
  3. Commonly diagnosed at advanced stage, poor prognosis
31
Q

Acral Lentiginous Melanoma-
1. What is a Hutchinson’s Sign?

  1. Shape?
  2. Onset?
  3. May change how? 2
  4. What may be noted at the dital clipped nail plate?
  5. Management?
A
  1. Longitudinal pigmented streak
    Extends from proximal or
    lateral nail fold

Appearance

  1. Often irregular in shape
  2. Develops quickly
  3. May widen or darken
  4. Pigmented globules
  5. Refer for biopsy of nail unit
32
Q

Longitudinal Melanonychia

  1. What is it?
  2. What is it caused by? 8
A
  1. Pigmented bands/Nevi
    Found in up to 90% of blacks, 20% of Asians
  2. -Trauma
    Medications:
    -minocycline,
    -chemo,
    -anti-malarials
    -Infections: fungal
    Other:
    -Addison’s,
    -B12 deficiency,
    -hemochromatosis
33
Q

What will a Malignant (Subungual Melanoma) look like?

A

Usually solitary and most often involves thumb/great toe

34
Q

Halo Nevus
1. Pigmented nevus surrounded what?

  1. Isolated halo nevus more common in pts under age ____
  2. “Halo phenomenon” reaction against what?
  3. May be due to melanoma elsewhere eliciting what?
  4. Up to ___% of halo nevi can be associated with melanoma
  5. What kind of exams are recommended? 3
  6. What would be Concerning for presence of melanoma with halo nevi?
  7. May be presenting sign of what?
A
  1. de-pigmented zone
  2. 20
  3. Melanin
  4. immune response
  5. 20
    • Full skin,
    • mucocutaneous and
    • lymph node
  7. Sudden onset multiple halo nevi
  8. ocular melanoma
35
Q

Non-cutaneous Melanoma(rare)
1. Ocular melanoma mostly affects what area of the eye? 2

  1. Mucosal melanoma: What areas? 5
A
  1. mostly choroid and ciliary body
    • Head and neck
    • Vulva and vagina
    • Anal
    • Urethra
    • Esophagus
36
Q

Basal Cell Carcinoma

  1. Incidence increases with age (_____ y/o show 100-fold higher incidence than those less than ____)
    - -Incidence is rising across all subgroups
  2. Particularly common in who?
  3. Very uncommon in who?
  4. States closer to the________ have much higher incidence
A
  1. 55-75, 20
  2. Caucasians
  3. dark-skinned populations
  4. equator
37
Q

Basal Cell Carcinoma:
1. Where do you think it arises from?

  1. Rarely metastasize (usually only applies to a patient who has delayed therapy for many years.
    However, how can these be dangerous?
  2. Etiology is mostly exclusively what?
  3. Typical appearance? 3
A
  1. Basal layer of the epidermis….. Caused by DNA damage of Keratinocytes
  2. these can be locally invasive and destructive of skin and surrounding structures including bone.
  3. excess exposure to ultraviolet radiation
    • translucent/pearly white papule
    • with telangiectasias over the surface that slowly enlarges,
    • with subsequent development of a central ulceration
38
Q

BCC:

  1. 70% occur where?
  2. What are the types and what is the most common? 3
A
  1. Approximately 70 percent of BCCs occur on the face (consistent with etiologic role of solar radiation)
  2. Although the majority are “nodular,” there are also “superficial” and “morpheaform”
39
Q

BCC Multiple treatment options

6

A
  1. Surgical excision
    (Traditional or Mohs micrographic surgery)
  2. Radiation therapy
  3. Electrodessication and curettage
  4. Cryotherapy only for superficial BCC.
  5. topical 5-fluorouracil (5-FU)(Efudex) only for superficial BCC.
  6. imiquimod (Aldara) only for superficial BCC.
40
Q

What is Moh’s Microsurgery?

A

Technique where thin layers of tumor tissue are removed and then examined microscopically
-The procedure is repeated until the entire tumor is removed (no abnormal cells seen under microscopy)

After Mohs’ recurrence rates are less than 1%!

41
Q

What is the most frequent type of skin cancer?

A

BCC is the most frequent skin cancer (80%)

BCC is 4x more frequent than SCC

Metastases are rare (

42
Q

Squamous Cell Carcinoma (SCC)

Arises from where?

A

Arises from malignant proliferation of the keratinocytes of the epidermis (stratum corneum)
-2nd most common skin cancer worldwide

43
Q

Squamous Cell Carcinoma (SCC)
1. Often begins as what?

  1. May be associated with what? 5
  2. Bowen’s disease refers to what, which is the next level following Actinic Keratosis (which may progress if left untreated)?
  3. Typically presents as a what? 4
  4. Invasive Squamous Cell Carcinoma: typically presents how? 4
A
  1. SCC often begins as an Actinic Keratosis (again… sun-exposed areas!)
  2. May be associated with
    - HPV types 16,18,31,33, and 35
  3. carcinoma in situ
    • chronic,
    • asymptomatic,
    • nonhealing,
    • slowly enlarging erythematous patch with sharp but irregular outline (scaling and crusting may be found)
    • as flesh-colored nodule that
    • enlarges and
    • often undergoes ulceration and crusting
    • (***lesion may be keratotic with a thickened surface)
44
Q

Treatment of Actinic Keratoses

6

A
  1. Liquid nitrogen cryotherapy
  2. Topical therapies
  3. Curettage for hypertrophic lesions
  4. Chemical peels
  5. Laser
  6. Photodynamic therapy
45
Q

Treatment of Actinic Keratoses
1. Topical therapies that you may use? 3

  1. What kind of therapy would you use with photodynamic therapy?
A
    • 5-FU (Efudex)
    • Imiquimod (Aldara)
    • TCA
  2. IPL with and w/o Levulan (aminolevulinic acid)
46
Q

Squamous Cell Carcinoma
Treatment depends on what?

Actinic Keratosis (AKs)
1. Nonhypertrophic AKs?
  1. Hypertrophic AKs?
  2. Multiple AKs? 3
A

Level of disease

  1. Liquid nitrogen cryotherapy (you’ll be doing this all the time!)
  2. Surgical curettage (send these to path)
    • Topical 5-fluorouracil (5-FU)(Efudex) or
    • imiquimod (Aldara) are effective
47
Q

SCC: Bowen’s disease Rx? 3

Advanced SCC? 2

A
  1. Surgical excision of the lesion
  2. Cryotherapy
  3. 5-FU (Efudex) for 6 weeks under occlusion
  4. Surgical excision or
  5. radiation
48
Q
  1. What is a Keratoacanthoma?
  2. Develops on what kind of skin?
  3. Who are most frequently affected? 2
  4. Controversy exists over whether KA represents what?
A
  1. Cutaneous tumor that presents as a dome-shaped nodule with a central keratin-filled crater.
  2. hair-bearing, sun-exposed skin.
    • Middle-aged and
    • elderly adults with fair complexions
  4. a distinct disease entity or a variant of cutaneous squamous cell carcinoma.
49
Q
  1. Kaposi’s Sarcoma (KS) is what?

2. Four forms of Kaposi’s sarcoma?

A
  1. Vascular tumor associated with infection with human herpesvirus 8 (HHV-8), also known as the KS-associated herpesvirus (KSHV)
    • Classic: Older men of Mediterranean and Jewish origin
  • Endemic or African: Found in all parts of equatorial Africa, particularly in sub-Saharan Africa. This is not typically associated with immune deficiency.
  • Organ-transplant associated
  • AIDS related (before common use of highly active antiretroviral therapy, prevalence of KS 20,000 times higher in AIDs population)
50
Q

Kaposi’s Sarcoma

  1. Clinical course?
  2. Not just a skin problem. Also affects what? 3
  3. Characteristic skin findings? 4
A
  1. Highly variable clinical course
  2. NOT just a skin problem, also affects
    - oral cavity,
    - gastrointestinal tract, and the
    - respiratory tract
  3. Characteristic skin findings
    - Most commonly papular
    - Elliptical along skin tension lines
    - Multiple colors
    - May be surrounded by yellow halo
51
Q

Kaposi’s Sarcoma
Local Treatment? 5

Systemic Treatment? 2

A

Local treatments

  1. Surgery
  2. Radiation therapy
  3. Cryotherapy and laser therapy
  4. Intralesional therapy
  5. Topical therapy- imiquimod,

Systemic treatments

  1. Chemotherapy
  2. Immunomodulators
52
Q
  1. Melanoma:
    The ABCDEs are great, but remember that change what are the most important features to think about (meaning HISTORY)? 3
  2. The most important place to do a skin exam on a dark individual are ?
A
  1. in size, color, and/or shape

2. those places that aren’t very dark

53
Q
  1. Remember the classic presentation for BCC? 4

2. Although BCCs aren’t really killers, they can be what and therefore cause problems?

A
    • face or head,
    • translucent or pearly lesion with
    • telangiectasias
    • with subsequent central ulceration
  2. locally destructive

Dermatology (12 decks)

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