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Derm > Skin Cancer (Fisher) > Flashcards

Skin Cancer (Fisher) Flashcards

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Dermatology Board Prep flashcards
1
Q

What mutation is frequently found in sporatic BCC tumors?

A

PTCH

tumor suppressor gene which regulated basal epidermal cell prolif

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2
Q

BCC risk factors:

A 
UV exposure
Fair complexion
H/o sunburns (especially blistering)  
Family history of BCC
Immunosuppression
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3
Q

Characteristic histology of BCC

A
  1. peripheral palisade
  2. clefting from adjacent mucinous stroma
  3. Basophilic hyperchromatic cells
  4. nodules, often extending from surface epidermis
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4
Q

Characteristic gross appearance of BCC

A

rolled pearly edges
telangiectasias
central erosion

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5
Q

BCC subtypes

A 
– Nodular
– Superficial
– Pigmented
– Morpheaform (sclerotic) – Micronodular
– Cystic
– Infiltrative
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6
Q

Disorder which includes:
Mutation of PTCH1 and BCCs at early age (~23yo)
musculoskeletal defects and jaw cysts
increased risk of other neoplasms

A

Basal Cell Nevus Syndrome

Gorlin Syndrome

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7
Q

BCC treatment:

A 
Treatment 
– Excision
– Electrodessication and curretage
– Cryosurgery
– Radiation
– Topical treatment for superficial BCC
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8
Q

Do BCC commonly metastasize?

A

no–exceedingly rare

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9
Q

Targeted therapy for advanced BCC:

What does “advanced” include?

A

Vismodegib

Metastatic disease, Recurrent disease (post surgery), Non-surgical candidates

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10
Q

A 2-hit hypothesis explains what type of abnormality?

A

squamous cell dysplasia

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11
Q

2nd most common skin cancer

A

Sq cell

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12
Q

How does SCC progress?

A
  1. Minimal atypia (actinic keratosis)
  2. Full thickness epidermal atypia, above BM (SCC in situ)
  3. Invasive (SCC)**

**ranges from well to poorly differentiated

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13
Q

What is actinic keratoses?

A

Thin non- indurated lesions

no induration = clue to superficial nature of lesions

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14
Q

SCC histology:

A
  1. Hyperchromatic pleomorphic nuclei
  2. disorganized growth with mitoses
  3. invasion through the basal layer.
  4. keratin pearls
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15
Q

3 biggest risk factors for SCC development?

A

UV
HPV
Immunosuppression

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16
Q

Risk of metastasis of SCC related to:

A
  1. size of tumor (>2 worse)
  2. depth of invasion into dermis (>4mm worse)
  3. anatomic site (lips/ears worse)
  4. host immune status
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17
Q

Vulvar, perineal and penile HPV-induced SCC have a (higher/lower) rate of metastasis than the overall rate.

A

higher–30% compared to like…1%

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18
Q

Other “types” of SCC (2)

A
  • Keratoacanthoma
  • Marjolin’s Ulcer

(likely entirely inconsequential)

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19
Q

What is Keratoacanthoma?

A

Painful neoplasm of keratinocytes

Grows rapidly over 2-6 weeks

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20
Q

What is Marjolin’s Ulcer?

A

ulcerated invasive SCC arising on a background of chronic inflammation, scarring, radiation, trauma

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21
Q

How do you treat Actinic Keratosis?

A

cryotherapy

topical therapy

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22
Q

SCC treatment generally depends on…

A

degree of progression

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23
Q

How do you treat SCC in situ?

A

topical therapy
intralesional
excision

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24
Q

How do you treat invasive SCC?

A

excision

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25
Q

Who is at the highest risk for melanoma?

A

white men > 50

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26
Q

Melanoma is the most common type of cancer in what population?

A

25-29yo

27
Q

Melanoma is the 2nd most common type of cancer in what population?

A

15-29yo

28
Q

Horrible fact: 1 American dies every hour from melanoma.

A

Let’s go cherry bomb some tanning beds. And, if we’re already at it, let’s eliminate a few taco bell’s.

29
Q

Nevi histology?

A
  1. Small
  2. Symmetric
  3. Well-circumscribed
  4. Organized/discrete, uniform size/shape
  5. Melanocytes ‘mature’ with descent into dermis
  6. No melanocytes above the basal layer
30
Q

Melanoma histology?

A
  1. Large
  2. Asymmetric
  3. Poorly circumscribed
  4. Nests are confluent, irregular spacing and sizes/shapes
  5. Melanocytes do not ‘mature’ with descent
  6. Melanocytes located above the basal layer
31
Q

Melanoma in situ has a ____ growth phase.

Invading melanoma has a _____ growth phase.

A

radial

vertical

32
Q

Both nevi and melanoma are/can…

A
  • comprised by melanocytes

- share some mutations (eg BRAF)

33
Q

~20% of melanoma develop from

A

pre-existing nevi

34
Q

High numbers of nevi (esp >50) can increase…

A

risk of melanoma

35
Q

Etiology of melanoma (general)

A

– Genetic predisposition (eg. CDNK2, BRAF)
– Environment (eg. UV)
– Underlying immune status

36
Q

Melanoma risk factors:

A
  • Large number of common nevi (esp. >50)
  • Giant Congenital Nevi
  • Atypical Nevi
  • History of blistering sunburns
  • Family History of Melanoma
  • Light complexion, tanning bed use
  • Underlying immune dysfunction
37
Q

Melanoma screening alphabet

A
  • A Asymmetry
  • B Borders: irregular, scalloped
  • C Color: mottled, variegated, not uniform
  • D Diameter: >6mm
  • E Elevation
  • “changing mole”
  • “ugly duckling sign”
38
Q

5 melanoma subtypes

A
  • Acral lentiginous
  • Lentigo Maligna Melanoma
  • Nodular
  • Superficial spreading
  • Amelonotic
39
Q

What subtype of melanoma is defined by anatomic location on palmar, plantar and subungual skin?

A

Acral lentiginous

40
Q

What subtype of melanoma is frequently in older patients on sun-exposed skin?

A

Lentigo Maligna Melanoma

41
Q

What subtype of melanoma has a red, white and blue sign?

A

superficial spreading melanoma

42
Q

What subtype of melanoma is the most common type in pts with darker skin?

A

Acral lentiginous

43
Q

What type of melanoma appears on sun exposed skin, but has no preceding radial growth?

A

nodular melanoma

44
Q

What subtype of melanoma has preceding radial growth?

A

Lentigo Maligna Melanoma

45
Q

What subtype of melanoma has a lot of color variation, asymmetrical/irregular borders and it large and elevated?

A

superficial spreading melanoma

46
Q

Melanocytes are _______ derived cells

A

neural crest

47
Q

In addition to skin, melanoma can be found:

A

inner ear
iris
vulva

48
Q

Melanoma metastasis mostly occurs via

A

lymphatics

49
Q

1 organ site for melanoma metastasis

A

skin

50
Q

Most common cause of death in melanoma

A

CNS involvement

51
Q

Single most important prognostic factor for melanoma:

A

Lymph node involvment

52
Q

Most important histological prognostic factors for melanoma:

A

reslow thickness and ulceration

53
Q

“Breslow’s thickness” is defined as distance of melanoma involvement from the _______ (top) to the deepest tumor cell (bottom)

A

stratum granulosum

54
Q

Melanoma Treatment:

A

Catch it early and cut it out

55
Q

50% of melanomas harbor ____ mutations

A

BRAF

56
Q

Small molecule inhibitor of BRAF

A

Vemurafenib

57
Q

Approved for unresectable or metastatic (stage 4) melanoma

A

Vemurafenib

58
Q

New treatment for unresectable or metastatic (stage 4) melanoma involves:
Why?

A

combination therapy, especially with ipilimumab

Initial response to Vemurafenib very impressive but melanoma adapts

59
Q

Forms dimers between neighboring thymine pairs in DNA

A

UVB

60
Q

What type of cancer?

Sunlight certainly plays a role, along with genetics, other environmental factors, and immune system

A

melanoma

61
Q

What type of cancer?

Cumulative lifelong UV exposure clearly related to development

A

Squamous Cell CA

62
Q

What type of cancer?

UV important but not clearly related to cumulative doses.

A

Basal Cell CA

63
Q

Xeroderma Pigmentosum is caused by:

A

Defects in genes that function in nucleotide excision repair of thymine dimers

Derm (12 decks)

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