Skin Cancers/Malignancies

Question 1

What causes skin cancer?

Answer 1

• UV radiation
• Genetics
• Chemicals
• Viruses like HPV

Question 2

RF for skin cancer?

Answer 2

• Fair skin
• FHx
• Personal Hx
• Cumulative sun exposure
• Severe sun burns

Question 3

What classification is used for skin typing?

Answer 3

Fitzpatrick Scale (Type I- VI)

Question 4

What are the different types of skin cancer?

Answer 4

• Actinic Keratosis (pre-cancer)
• Squamous Cell Carcinoma
• Basal Cell Carcinoma
• Malignant Melanoma

Question 5

T/F Actinic Keratosis can evolve into SCC.

Answer 5

True!

Question 6

How does Actinic Keratosis often present?
Where is it m/c located?

Answer 6

• Rough/scaly/dry patch that comes and goes, pink or flesh colored (can also have hypertrophic lesions that look like thick stuck-on crusts)
• M/C on sun exposed areas like scalp, hands, forearms, face, ears, lips

Question 7

How is Actinic Keratosis treated?

Answer 7

• 1st line = Cryosurgery
• Topical meds like Imiquimod, 5-FU, etc.

Question 8

What is the M/C type of skin cancer?

Answer 8

Basal Cell Carcinoma (locally destructive)

Question 9

RF for BCC?

Answer 9

• Fair skin, light eyes, red hair (skin types I-III)
• Chronic arsenic exposure, ionizing radiation, immunosuppression
• Cumulative sun exposure, sun burns, tanning beds

Question 10

What are the different types of BCC?

Answer 10

Superficial: scaly pink patches

Pigmented: brown-black

Nodular (M/C): “PEARLY” papules with rolling or translucent borders

Morpheaform (most aggressive): sclerotic or scar-like

Note: may be ulcerated

Question 11

How is BCC treated?

Answer 11

• Topical meds like Imiquimod, 5-FU
• Electrodessication & Curettage (ED&C)
• Standard Excision
• Mohs Micrographic surgery (tissue-sparing, higher cure rate)
• Radiation
• Vismodegib

Question 12

RF for Squamous Cell Carcinoma?

Answer 12

• Cumulative sun exposure / Phototherapy
• HPV
• Immunosuppression
• Oral Lichen Planus
• Industrial carcinogens like tar and arsenic
• Xeroderma Pigmentosum (Autosomal recessive disorder)
• Tobacco

Question 13

What skin manifestations are seen with SCC?

Answer 13

• Pink scaly patches or papules
• Cutaneous horns
• Non-healing ulcers
• Indurated plaques
• Hx of scabbing, crusting, or bleeding

Question 14

Where is SCC m/c located?

Answer 14

On head and neck then upper extremities then trunk then legs

Question 15

What are the different typess of SCC?

Answer 15

• SCC in Situ (Bowen’s Disease)
• Invasive SCC
• Keratoacanthoma-type (sprout-like volcanoes, nodules with central crusts)

Question 16

How is SCC treated?

Answer 16

• Topical meds like Imiquimod and 5-FU
• ED&C
• Standard Excision
• Mohs Micrographic Surgery
• Radiation

Question 17

What’s the worst type but least common skin cancer?

Answer 17

Melanoma

Question 18

RF for Malignant Melanoma?

Answer 18

“MF RIS”

M: Moles >10 atypical moles OR numerous common moles

F: FHx of Melanoma

R: Red hair & freckling

I: Inability to tan (skin types I & II)

S: Severe sunburn before age 14 OR exposure to tanning beds prior to age 35

Question 19

What are the different types of Melanoma?

Answer 19

Lentigo Maligna: m/c in elderly

Superficial Spreading (M/C): m/c in young

Nodular: usu. invasive at time of dx

Acral Lentigenous: Palms, soles, nails; m/c in African & Asian Americans

Question 20

What does Melanoma look like?
Where is it m/c located?

Answer 20

• Brown, Black, Blue, Red, Tan, White macules/papules/nodules
• M/C on trunk & upper back for Men and legs & upper back for women

Question 21

What are the ABCDE guidelines for monitoring for early signs of Melanoma/malignant skin conditions?

Answer 21

A: Asymmetry
B: Irregular Borders
C: Different colors
D: >6 mm Diameter
E: Evolving/Changing in size, shape, color, etc.

Question 22

How is Melanoma treated?

Answer 22

• Surgical excision with WIDE MARGINS = mainstay for Stages 1 & 2
• Chemo
• Radiation (appropriate for Stage 3)
• Immunotherapy
• Targeted therapy
• Oncolytic virus