Skin Cancers & Health Maintenance Flashcards by Alicia Daum

General Skin Care

Limit bath time
Avoid strong soaps
Shave carefully
Pat dry
Moisturize dry skin
Eat a healthy diet

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Hydrating the Skin

Emollient immediately after bathing or showering

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Best Emollients

Eucerin
Vanicream
Cetaphil
Nutraderm
Aquaphor
Vaseline

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Smoking & the Skin

Thickened “leathery” skin
Prominent wrinkles
Damages collagen & elastin
Smoking narrows tiny blood vessels

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Prevention of Skin Cancer

Sunscreen > SPF 30
Wear protective clothing
Schedule activities before 10 AM or after 4 PM
Avoid all tanning activity
Extra caution near water, snow, & sand

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Educate on Sunscreen Use

Reapply every 2 hours
Reapply after swimming or sweating
Apply 15-20 minutes before sun exposure

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Screening & Early Detection of Skin Cancer

Inspect moles for changes
Remove suspicious moles
Remove AK & other precancerous lesions

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When should someone perform monthly self-exams for screening for sun cancer?

Personal history of skin cancer
1st degree family history of skin cancer
Precursor lesions
Sun damaged skin

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Types of Skin Cancers

Melanoma
BCC
SCC
Kaposi’s Sarcoma

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Epidemiology of Melanoma

Great majority of skin cancer deaths

Men = Women

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Major Risk Factors of Melanoma

Fair skin
Episodic intense sun exposure (severe blistering sunburn history)
1st degree family history
Precursor lesions

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ABCs of Melanoma

A: asymmetric
B: border irregularity
C: color
D: diameter
E: enlargement or evolutions

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7 Point Checklist

Major: change in size, color, shape
Minor: inflammation, bleeding or crusting, sensory change, lesion diameter >6 mm

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Define Nevus

Congenital discoloration of a circumscribed area of the skin due to pigmentation

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Define Dysplastic Nevus

Nevus which has some malignant characteristics

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Define Breslow Thickness

Refers to tumor thickness

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Define Clark Level

Refers to anatomical descriptor of depth of the malignant cells

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Subtypes of Melanoma

Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma

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Superficial Spreading Melanoma

Great prognosis
Men: torso
Women: legs
30-50 years old

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Nodular Melanoma

Invasive from onset
Poor prognosis
Any site
Diagnosed in 6th decade of life

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Lentigo Maligna Melanoma

Tendency for H&N
More common >60 years old
Least aggressive of melanomas

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Acral Lentiginous Melanoma

Occurs on palms, soles, sublingual areas, & mucous membranes
More common in darker skin types
Diagnosed at advanced stage
Poor prognosis

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Clinical Presentation of Acral Lentiginous Melanoma

Longitudinal pigmented streak
Appearance: irregular in shape, develops quickly, widen & darker
Pigmented globules
Refer for biopsy

Benign Longitudinal Melanonychia

Pigmented bands
Trauma
Medications
Infections
Other issues

Medications That can Cause Benign Longitudinal Melanonychia

Minocycline Chemo Anti-malarials

Infections that can Cause Benign Longitudinal Melanonychia

Fungal

Other Issues that can Cause Benign Longitudinal Melanonychia

Addison's B12 deficiency Hemochromatosis

Malignant Longitudinal Melanonychia

Solitary | Most frequent: thumb/great toe

Define Halo Nevus

Pigmented nevus surrounded by de-pigmented zone

What is the concerning for the presence of melanoma?

Sudden onset of multiple halo nevi

Non-cutaneous Melanoma

Ocular melanoma | Mucosal melanoma

Most Common Location of Ocular Melanoma

Choroid | Ciliary body

Most Common Location of Mucosal Melanoma

``` H&N Vulva & vagina Anal Urethra Esophagus ```

Epidemiology of BCC

One of most common malignancies Incidence increases with age & rising Common in caucasians Uncommon in dark-skinned populations

Where does BCC arise from?

Basal layer of epidermis | DNA damage of keratinocytes

Appearance of BCC

Translucent/pearly white papule Telangiectasias Development of central ulceration

Presentation of BCC

70% on the face Majority "nodular" Also "superficial" & "morpheaform"

Treatment of BCC

``` Surgical excision Radiation therapy Electrodessication & curettage Cryotherapy (superficial BCC) Topical 5-FU (Efudex): superficial BCC Imiquimod (Aldara): superficial BCC ```

Prognosis of BCC

Most frequent skin cancer Mets rare Good prognosis

Where does SCC arise from?

Malignant proliferation of the keratinocytes of the epidermis

Define Bowen's DIsease

SCC in situ | Level following AK

Presentation of Invasive SCC

Flesh-colored nodule that enlarges & often undergoes ulceration & crusting

Treatment of Actinic Keratoses

``` Liquid nitrogen cryotherapy Topical: 5-FU, imiquimod (Aldara), TCA Curettage for hypertrophic lesions Chemical peels Laser Photodynamic therapy ```

Treatment of Non-hypertrophic AK's

Liquid nitrogen cryotherapy

Treatment of Hypertrophic AK's

Surgical curettage

Treatment of Multiple AK's

Topical 5-FU (Efudex) | Imiquimod (Aldara)

Treatment of Bowen's Disease

Surgical excision of the lesion Cryotherapy 5-FU (Efudex) for 6 weeks under occlusion

Treatment of Advanced Squamous Cell Carcinoma

Surgical excision or radiation

Define Keratoacanthoma

Cutaneous tumor that presents as a dome-shaped nodule with a central keratin-filled crater

Kaposi's Sarcoma (KS) Associated with What Infections

``` Herpesvirus 8 (HHV-8) KS-associated herpesvirus (KSHV) ```

4 Forms of Kaposi's Sarcoma

Classic Endemic or African Organ-transplant associated AIDS related

Who is most susceptible for classic Kaposi's sarcoma?

Older men of Mediterranean & Jewish origin

Who is most susceptible for endemic or African Kaposi's sarcoma?

People of equatorial Africa, particularly sub-Saharan Africa

Characteristic Skin Findings of Kaposi's Sarcoma

Papular Elliptical along skin tension lines Multiple colors Surrounded by yellow halo

What does Kaposi's sarcoma affect?

Oral cavity GI tract Respiratory tract

Local Treatment of Kaposi's Sarcoma

``` Surgery Radiation therapy Cryotherapy & laser therapy Intralesional therapy Topical therapy: imiquimod ```

Systemic Treatment of Kaposi's Sarcoma

Chemotherapy | Immunomodulators