Skin Cancer - Fisher

Question 1

What are some general principles somewhat unique to skin cancer (I know this is vague)?

Answer 1

1) Environmental exposure plays a huge role
2) Potential for early detection
3) noninvasive screening

Question 2

Describe the histologic appearance of basal cell carcinoma

Answer 2

Nodules of blue epithelium in the epidermis; basophilic, pleomorphic, and hyperchromatic

Question 3

Describe the histologic appearance of squamous cell carcinoma

Answer 3

Hyperchromatic, pleomorphic nuclei exhibiting disorganized growth. Invasion through the basal layer. Cells are very PINK and keratinizing

Question 4

What mutation is very common in basal cell carcinoma?

Answer 4

PTCH

Question 5

What 2 areas confer the greatest risk for metastasis in squamous cell

Answer 5

The lips and ears; good vascular network

Question 6

Why is the risk of skin cancer increasing in young females?

Answer 6

tanning beds

Question 7

Risk factors for basal cell carcinoma?

Answer 7

1) UV exposure
2) fair complexion
3) hx of blistering sunburns
4) family hx
5) immunosuppression

Question 8

3 types of patients at extremely increased risk for squamous cell carcinoma?

Answer 8

HIV, transplant, and rheumatologic patients; both are chronically immunosuppressed

Question 9

What distinct histologic feature is seen in nodular type basal cell?

Answer 9

a palisade of tumor cells clefting (separating) from the adjacent stroma

(Look at the very right picture)

Question 10

What pathway does UV radiation mutation that is critical in skin cancers?

Answer 10

Sonic Hedgehog pathway

Question 11

Where are superificial basal cell carcinomas located histologically?

Answer 11

In the papillary dermis

Question 12

Describe the gross appearance of a nodular type BCC

Answer 12

“Pimple-like lesion that does not heal and bleeds”

Translucent, pearly paupule with erythema and telangiectasia

Question 13

Where are BCC commonly located

Answer 13

UPPER LIP most common; Head and neck; central face (sun exposure)

Question 14

What is the most common subtype of BCC? The 2nd most common?

Answer 14

Nodular most common; superficial 2nd most

Question 15

Describe the gross appearance of superficial BCC

Answer 15

a flat, very pearly/shiny oval lesion; patient often complains of “chronic area of eczema”

Question 16

What happens to the appearance of BCC as they progress?

Answer 16

They can start making pigment, become darker

Question 17

What is important about morpheaform BCC?

Answer 17

It’s the most aggressive type; lacks the features of other BCC so they can normally grow deep prior to clinical detection

Looks like a scar

Question 18

Describe the gross appearance of a morpheaform BCC

Answer 18

scar-like plaque, lightly colored with ill defined borders

Question 19

What is Basal cell nevus syndrome (Gorlin Syndrome)?

Answer 19

Mutation of the PTCH1 tumor suppressor gene; BCCs at very early ages –> AD inheritance

Get lots of disfiguring jaw cysts

Question 20

Metastasis rate of BCC?

Answer 20

Almost non-existent

Question 21

2 commonly used topical agents in treatment of BCC

Answer 21

Imiquimod and 5-flurouracil

Question 22

Mechanism of action of Imiquimod

Answer 22

Engages the immune system via TLRs to start an interferon storm and upregulate tumor surveillance

Question 23

What type of treatment will you NEVER consider with morpheaform BCC

Answer 23

Topical; it has to be excised due to risk of vertical invasion

Question 24

Targeted therapy for advanced BCC?

Answer 24

Vismodegib

Question 25

ADE(s) associated with vismodegib

Answer 25

Patients lose weight because they can’t taste food, also experience muscle cramps

Question 26

What is Mohs surgery? Why is it beneficial to the patient?

Answer 26

Dermatologist excises the tumor and examines the margins at the bedside; makes for a more targeted excision and improves cosmetics

Question 27

Describe the gross appearance of SCC

Answer 27

Extremely keratotic, crusted surface

“Funny lumps and bumps, make lots of crust”

Question 28

Common sites of metastasis seen in SCC

Answer 28

Regional lymph nodes and the lungs

Question 29

What is Bowen’s disease?

Answer 29

SCC in situ; does not invade the dermis

Patch that looks like eczema

Question 30

Gross appearance of Bowen’s disease

Answer 30

Looks like an eczematous plaque

Question 31

What is Erythoplasia of Queyrat?

Answer 31

SCC in situ on the glans penis (i’ll spare you the picture)

Question 32

What are actinic keratosis?

Answer 32

benign neoplasms of the epidermis commonly on sun exposed skin; they are precursors to non-melanoma skin cancer

Question 33

Describe the gross appearance of actinic keratoses

Answer 33

Scaly/rough, THIN, non-indurated lesions commonly on sun exposed areas

Question 34

Most common places for actinic keratoses in women? In men?

Answer 34

Lower legs in women; dorsal forearms and hands in men

Question 35

What if an actinic keratosis feels thick to palpation? What are you now thinking?

Answer 35

That it’s SCC

Question 36

Why do burns increase the chance of SCC development

Answer 36

They provide “fertile” ground for malignant development; inflammatory tissue injury with excessive repair

Question 37

2 dimensions for high risk of SCC metastasis (horizontal and veritcal spread)?

Answer 37

Larger than 2 cm (horizontal) and deeper than 4 mm (vertical)

Question 38

What is a Marjolin ulcer?

Answer 38

SCC that developed at the edge of a burn

Question 39

What is a keratocanthoma? What commonly is the course?

Answer 39

A neoplasm of keratinocytes; rapidly grows and is painful; involutes spontaneosly