SKIN CANCER & HEALTH MAINTENANCE Flashcards
GENERAL SKIN CARE
Treat skin gently Limit bath time Avoid strong soaps Shave carefully Pat dry Moisturize dry skin Eat a healthy diet
emollients
eucerin vanicream cetaphil nutraderm aquaphor vaseline
hydrating the skin
- apply an emollient immediately after bathing or showering - leaving some water on skin
- best emollients are eucerin vanicream cetaphil nutraderm aquaphor vaseline
- lotions contain more water & alcohols than creams & ointments, and should therefore be avoided as they can worsen dry skin
don’t over-exfoliate!
- important not to over-exfoliate the skin, as this can disrupt the epidermis and cause increased dryness
- as a result, the skin produces more oil, leading to possible acne
- can also disrupt blood vessels
- gentle exfoliation 1-2x/week or none is recommended
smoking damages the skin
causes the skin to age faster
Narrows the blood vessels in the outermost layers of skin
Damages collagen and elastin
Can contribute to wrinkles from the repetitive facial expressions made when smoking
Repeated low exposure to UV radiation results in
SKIN CANCER
Brief and early (childhood sunburns) increase the risk of
melanoma
A history of ____ or more severe sunburns in childhood and adolescence more than _______ the risk of developing melanoma
3
doubles
2/3 of melanoma may be attributed to excessive ______________
sunlight exposure
_________radiation causes most of the DNA damage
UVB
but UVA radiation is also important in the pathogenesis of melanoma
PRIMARY PREVENTION OF SKIN CANCER
Avoid Exposure to Ultraviolet Radiation
Use sunscreen > SPF 30
Protective clothing, hats and sunglasses
Schedule outdoor activities before 10am and after 4pm and seek shade when appropriate
Avoid all tanning including tanning salons
Use extra caution near water, snow and sand as they reflect damaging rays of the sun
sunscreen
- Educating parents so children are protected
- Generously apply sunscreen to ALL exposed skin using a SPF of 30 or higher that provides broad-protection from both UVA and UVB
- Reapply every 2 hours
- Reapply after swimming or sweating, use waterproof formulations
- Needs to be applied 15 to 20 minutes before sun exposure
- For sunscreen to work effectively it must be applied liberally and often
- Using sunscreen should not be an excuse to spend long amounts of time in the sun
- Sunscreen can delay sunburn
SKIN CANCER SCREENING / EARLY DETECTION
Inspect moles for changes
Remove suspicious moles
Remove actinic keratoses and other precancerous lesions
Monthly self-examinations are recommended for persons with:
- personal history of skin cancer
- 1st degree family history of skin cancer
- precursor lesions
- sun damaged skin
Yearly clinician skin exams for patients at high risk
Some patients may need exams every six months
skin cancers
melanoma
BCC
SCC
Kaposi’s Sarcoma
freckles vs SLs
freckles fade in the winter and become unapparent in older patients, whereas solar lentigines remain for life and become more prominent with aging
Extremely common, benign, bright red to violaceous, domed vascular lesions. They generally appear first around age 30 and increase in number over the years
cherry angiomas
Anytime a melanoma is suspected, an ______ biopsy is indicated
excisional
A punch biopsy from only part of the lesion may not be sufficient enough for the pathologist to make a proper histologic diagnosis or may miss the abnormal cells (false negative)
A shave biopsy will not assess the depth of a melanoma which is critical for staging
most serious form of skin cancer, it is a malignant tumor arising from melanocytes.
melanoma
MELANOMA IS
Far less common than basal cell and squamous cell cancers but accounts for the great majority of skin cancer deaths
Rapidly increasing incidence
Sex ratio 1:1
risk factors for melanoma
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
ABCDEs of MELANOMA
Asymmetry (irregular or raised) Border irregularity (dark or inhomogeneous) Color (multiple colors/shades) Diameter (>6mm) Enlargement or evolution
“ugly duckling”
SEVEN POINT CHECKLIST
o Major Features
change in size
change in color
change in shape
o Minor Features Inflammation Bleeding or Crusting Sensory change Lesion diameter > 6mm
In a study evaluating both the ABCDE and seven point evaluation systems:
All melanomas (n = 65) were detected using the seven point checklist and all were found to have at least one of the three major criteria defined by that system
Five (7.7 percent) melanomas were not picked up by the ABCDE checklist.
Screening examination of the total skin surface can increase the likelihood of detecting melanoma _____-FOLD compared with partial examination.
Men have more lesions on the ____ and women on their _______ since these are common areas of sunburn; screening of those sites could particularly aid early detection
SIX
back
lower legs
nevus that has some malignant characteristics
dysplastic nevus
a congenital discoloration of a circumscribed area of the skin due to pigmentation (commonly referred to as a mole)
NEVUS
tumor thickness in mm
Breslow
depth of tumor
Clark level
refers to anatomical descriptor (anatomical planes) of depth (I-V) of the malignant cells, “to dermis but not subq” etc.
clark levels I-V
I = in epidermis, stops at basal lamina II = past basal lamina into papillary dermis III = through papillary dermis, stops at reticular dermis IV = into reticular dermis V = through reticular dermis into subcutaneous fat
breslow _____________ = bad prognosis
> 4 mm
Breslow _________ = good prognosis
< 1 mm
1-4mm = intermediate prognosis
most common melanoma
superficial spreading melanoma
superficial spreading melanoma
- most common (70%)
- grows superficially before spreads deep
- great prognosis if caught early
- has a preference for torso in men & legs in women
- most commonly diagnosed between ages 30-50
NODULAR MELANOMA
- 2nd most common form of melanoma (15%)
- often invasive from the onset - has a poor prognosis
- any site has rapid vertical growth and is typically diagnosed at a later stage
- most frequently diagnosed in 6th decade of life
least aggressive melanoma
lentigo maligna melanoma
LENTIGO MALIGNA MELANOMA
- 5% of melanomas
- tendency for head & neck
- more common in patients > 60 with sun damaged skin
- least aggressive melanoma
- may be present for 5 years before invasion (termed lentigo maligna before invasion)
- often has a favorable prognosis
melanoma that is most common in people with darker skin types
acral lentiginous melanoma
ACRAL LENTIGINOUS MELANOMA
- occurs on palms, soles, subungual areas and mucous membranes
- most common in people with darker skin types
- commonly diagnosed at an advanced stage
- poor prognosis
HUTCHINSON’S SIGN
ACRAL LENTIGINOUS MELANOMA
longitudinal pigmented streak on nail - extends from proximal or lateral nail fold. develops quickly and may widen or darken. Often irregular in shape
- Pigmented globules may be noted at distal clipped nail plate
- need to refer for biopsy of nail unit
things that can cause longitudinal melanonychia
- can occur from trauma, meds (mino / chemo / anti-malarials), infections (fungal), Addison’s, B12 deficiency, Hemochromatosis
longitudinal melanonychia
- which is benign - pigmented bands / nevi on nails = found in up to 90% of blacks & 20% of asians
- can occur from trauma, meds (mino / chemo / anti-malarials), infections (fungal), Addison’s, B12 deficiency, Hemochromatosis
Malignant subungual melanoma = usually solitary and most often involves the thumb or great toe
vs longitudinal melanonychia = will see on multiple fingers
***UP TO 20% OF HALO NEVI CAN BE ASSOCIATED WITH
MELANOMA
HALO NEVUS MAY BE THE PRESENTING SIGN OF
OCULAR MELANOMA
NON-CUTANEOUS MELANOMA (rare)
o ocular melanoma (mostly choroid or ciliary body)
o Mucosal melanoma ⦁ head & neck ⦁ vulva & vagina ⦁ anal ⦁ urethral ⦁ esophageal
BCC EPIDEMIOLOGY
Lifetime risk of developing a BCC is 30%….one of the most common malignancies in humans
Incidence increases with age (55-75 y/o show 100-fold higher incidence than those <20)
Incidence is rising across all subgroups
Particularly common in Caucasians
Very uncommon in dark-skinned populations
States closer to the equator have much higher incidence
BCC arises from the
Basal layer of the epidermis….. Caused by DNA damage of Keratinocytes
translucent / pearly white papule with telangiectasias over the surface that slowly enlarges, and development of a central ulceration
BCC
basal cell carcinomas
BCC arises from the - BASAL LAYER of the epidermis
is caused by DNA damage of keratinocytes
- rarely metastasizes, however, can be locally invasive & destructive of skin & surrounding structures, including the bone
Etiology = excess UV radiation exposure
Appearance = translucent / pearly white papule with telangiectasias over the surface that slowly enlarges, and development of a central ulceration
majority of BCCs occur on the
face
majority of BCCs are what type
nodular
topical 5-FU = efudex or Imiquimoid (aldara) = only for __________ BCC
superficial
treatment options for BCC
- surgical excision
- MOHS
- radiation therapy
- ED&C
- Cryotherapy
- topical 5-FU = efudex or Imiquimoid (aldara) = only for superficial BCC
arises from the malignant proliferation of the keratinocytes of the epidermis
SCC
SCC may be associated with
HPV
SCCIS =
bowen’s disease
which is the next level after AKs
⦁ typically presents as chronic, asymptomatic, nonhealing, slowly elarging erythematous patch with sharp but irregular outline (scaling & crusting may be present)
bowen’s disease (SCCIS)
flesh-colored nodule that enlarges and often undergoes ulceration and crusting
invasive SCC
AK TREATMENT
- cryotherapy
- Efudex or Aldara
- Curettage
- chemical peels (TCA)
- laser
- photodynamic therapy
nonhypertrophic vs hypertrophic vs multiple AK treatment
if nonhypertrophic = LN2
if hypertrophic = surgical curettage - send these to path
multiple AKs = Efudex or Imiquimod (aldara)
controversy exists over whether KA is a distinct disease or a variant of
SCC
Cutaneous tumor that presents as a dome-shaped nodule with a central keratin-filled crater
KERATOACANTHOMA
vascular tumor associated with HHV-8 (herpes virus)
KAPOSI’S SARCOMA
4 forms of Kaposi’s Sarcoma
⦁ Classic = affects older men of Mediterranean & 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 (KS prevalence was much higher before antiretroviral therapy)
KS presentation
- KS = highly variable clinical course
- NOT just a skin problem - also affects oral cavity, GI tract and respiratory tract
- Skin findings ⦁ papules most often ⦁ elliptical along skin tension lines ⦁ multiple colors ⦁ may be surrounded by yellow halo
KS treatment
o Local treatment ⦁ surgery ⦁ radiation therapy ⦁ cryotherapy & laser therapy ⦁ intralesional therapy ⦁ topical therapy - imiquimod
o Systemic Treatments
⦁ chemotherapy
⦁ immunomodulators
