Skin Care and Benign and Malignant Dermatologic Conditions Flashcards
UV radiation has been
implicated as a strong risk factor for the development of both nonmelanoma skin cancers (NMSCs) and melanoma skin cancer
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Skin cancer has the highest
incidence worldwide of all cancers.
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hair follicles, sebaceous glands,
and the apocrine and eccrine sweat glands present in the epiderms
F derms
UVB is the
most carcinogenic through direct photochemical damage to cellular DNA and to the DNA repair mechanism of the cell
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Appropriate application ensures the protective effect of the
sunscreen.
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Retinoids as protective and reversal of photoaging
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zinc oxide and titanium dioxide are Chemical sunscreens
F physical
sunscreens
Retinoids treat areas of actinic damage
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realignment of collagen can occur with moderate peeling
F Deep peels penetrate
into the reticular dermis where they cause realignment of collagen
Fractional lasers are spatially confined rather than
confluent.
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The most
important risk factor for NMSC is the skin phenotype
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intermittent intense episodes of UV exposure appear to
increase the risk OF SCC
F BCC
A history of childhood sunburns gives an increased risk of BCC
F gives an increased risk for actinic keratosis (AK) and
squamous cell carcinoma (SCC)
Patients with human immunodeficiency syndrome are known to have a 1.8- and 5.4-fold increase in the risk for
developing melanoma
F increase in the risk for
developing BCC and SCC
The standard for diagnosis of NMSC remains a thorough
physical examination
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In terms of biopsy technique, there are several techniques but no one standard method
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Basal cell cancer represents the most common form of skin cancer
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SCC arise from the
pluripotent stem cells within the epidermis and hair follicles
F BCC
There is no role for lymph
node sampling in BCC because it stays local
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Factors that effect the prognosis of BCC
location with high-risk regions
being on the face, forehead, scalp, neck, and pretibial regions, where
lesions in these areas that are >10 mm are considered high risk
Factors that increase the risk for the recurrence of BCC
poorly defined
borders, recurrent cancer, perineural invasion, immunosuppression,
and prior XRT at the site
subtypes of BCC dividing them based on their histopathologic
pattern, which is more important than the differentiation
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The two
subtypes are circumscribed BCC and the diffuse subtypes of BCC
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nodular represents the most common
form of BCC and accounts for about 50% of all BCC
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Type of circumscribed BCC
Nodular, adenoid cystic,
keratotic, fibroepithelioma of Pinkus.
Diffuse basal cell cancers include …..
superficial, micronodular, infiltrating, and morpheaform (sclerosing)
Micronodular is the most
aggressive type and typically has the appearance of a firm depressed
plaque in a scar
F Morpheaform is the most
aggressive type
there is invasion beyond the visible edges
of the lesion that will often extend into the deep dermis in morpheaform
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Surgical margins in primary
excision depend on what?
location, tumor size, and
histologic subtype
Mohs excision is recommended
for most recurrent basal cell and squamous cell cancers
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Destructive therapy only indicated for superficial lesions
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Destructive therapyinclude electrodissection, cryotherapy, and radiotherapy
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Medical therapy includes
5-FU and imiquimod but is inferior to surgical and destructive
techniques
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AK represents an intradermal early-stage SCC and is most commonly seen in areas of prolonged UV exposure in fair-skinned and elderly patients
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AK They are characterized as precancerous
because
they have atypical keratinocytes confined to the epidermis. Their
risk of transformation to invasive carcinoma is up to 0.06% per
year
Bowen disease. It typically
presents as a scaly elevated plaque often in sun-exposed areas but in
olderr patients,
F Younger patients
Bowen disease always present in sun-exposed area
F may be in sun-protected sites
Bowen disease can be difficult to distinguish from psoriasis papules and plaques that
may resemble these processes
F AK and scc in situ (bowen disease)
can be difficult to distinguish from psoriasis
Keratoacanthomas They often present as a solitary lesion but may be in multiple locations as part of a syndrome
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Diagnosis of SCC is with
tissue biopsy and also clinical examination of draining lymph node
basins
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SCC is staged using the TNM with recent changes in 2017
to reflect the clinicohistopathologic features that increase the risk for
recurrence
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Sites where the tumor behaves more aggressively include
include
the ear, lips, and mucosa! sites
In SCC palpation
of regional lymph nodes should be performed to assess for the presence of palpable nodes as well as the size
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Any palpable nodes should
be biopsied with fine needle aspiration IN SCC
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Treatment of SCC depends on the stage of SCC, with some lowrisk cancers being amenable to destructive therapy similar to BCC.
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Direct surgical excision (primary or with Mohs) can be used for both
low- and high-risk lesions
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Tumor thickness: 2’.2 mm or Clark IV/ V considered high risk features of scc
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Melanoma is the most deadly of all the skin cancers and accounts for
75% of all the deaths related to skin cancer
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Melanoma only accounting
for less than 5% of skin cancer diagnosis
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Melanocytes that undergo a malignant transformation are most commonly in the skin but may also be present in
the eye or mucus membranes.
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Melanocyte numbers are equal
among all skin colors
T the production of melanin varies
Melanomas grow in a vertical growth pattern alawys
F Melanomas can grow in both a radial and vertical growth pattern
The
the radial pattern is usually in the dermis and some melanomas can stay
in this radial growth pattern for a long time
F The
the radial pattern is usually in the epidermis
In the vertical growth indicates a worse prognosis.
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Type of melnoma
. Superficial spreading is the most common
Nodular melanoma is the second most common
Lentigo melanoma is a rare form
. Acral-lentiginous melanoma
. Amelanotic melanomas
.Desmoplastic melanoma
Superficial spreading occurs only in sun-exposed area
F This can
occur anywhere but often occurs in regions of sun exposure
Nodular melanoma presentation of a singular lesion with a domed-shaped dark appearance that can resemble
a blood blister.
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Nodular melanoma typically has a prolonged radial growth pattern before transforming into a more vertical
F Superficial spreading
Nodular melanoma tends to develop in a vertical growth pattern
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Nodular melanoma often occurs on the trunk, and head and neck regions
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It often more advanced at the time
of diagnosis.
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Lentigo melanoma has high malignancy potential
F low malignancy potential
More common in women
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. Acral-lentiginous melanoma is the rarest
in Caucasians but accounts for greater than 30% of all melanomas
that occur in dark-skinned individuals
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Most coomon site of . Acral-lentiginous melanoma
palms, on soles of feet , and beneath the nail beds
Hutchinson sign
Acral-lentiginous melanoma In
the subungual presentation, they commonly cause a longitudinal line
in the nail plate
. Amelanotic melanomas
are responsible for 2% to 8% of invasive cases
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Desmoplastic melanomas have a tendency to metastatized
F rare melanoma form that typically has an aggressive local growth pattern but less propensity to metastasize
Definitive diagnosis of melanoma is with incisional biopsy
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The Clark classification is based on vertical depth of the
invasion in millimeters
F The Clark classification is based on the anatomic level of local invasion.
Breslow classification is based on the vertical depth of the invasion in millimeters
Breslow classification because it was a better prognosticator of disease severity and
risk recurrence
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The depth of invasion of the tumor measured
down from the granular layer of the epidermis
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Berslow thickness give best prognostic values for tumor prognosis as well as
lymph node metastasis
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excision of melanoma includes primary removal of the tumor with skin and subcutaneous tissue with facia
F Excision should include skin and subcutaneous
fat down to but not including the fascia
tumor depth only play
a role in staging.
F tumor depth, ulceration, and mitotic rate also play a role in staging.
Mitotic rate has also been identified as an independent predictor of survival and so is also a part of the AJCC staging.
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The thickness correlates with prognosis
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Indication of Sentinel lymph node sampling in melanoma
- stage I/II melanoma with tumor thickness 1.0 to 4.0 mm Breslow depth.
- Depth of 0.76 to 1.0 mm with other high-risk factors including ulceration, lymphovascular invasion, significant vertical
growth phase, and increased mitotic rate - patients with tumor >4.0 mm depth and clinically negative nodes also benefit from SLN biopsy
Complete surgical lymphadenectomy is recommended for any
patient with clinically involved nodes diagnosed via examination,
FNA, or SLN biopsy
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Node status is the most important prognostic
factor in staging melanoma.
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Merkel cell carcinoma is a rare form of skin cancer
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affecting older (>50) fair-skinned individuals in sun-exposed areas
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It
is aggressive like melanoma, and like melanoma staging depends on
node involvement with SLN biopsy
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It commonly spreads to lymph nodes with
25% to 30% of initial presenting patients have positive nodes
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Primary surgical excision with
wide margins or Mohs is standard treatment. Local recurrence is 40%
to 45%. Radiation can be used as adjuvant therapy
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Chemical sunscreens absorb UV (usually UVB) radiation with the most common sunscreen ingredient being para-aminobenzoic acid (PABA), benzophenones, and cinnamates
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Reteniod leads to epidermal thickening and increased collagen
in the dermis because of decreased breakdown and increased collagen synthesis in the dermis
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Medium peels affect the epidermis
and penetrate into the papillary dermis
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Invasive SCC often develops in sun-exposed areas such as the
scalp, face, neck, dorsal hands, skin and extensor forearms, with
the risk factor being more related to the cumulative effect.
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signs of paresthesia, anesthesia, and pain are indicative of perineural invasion
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Superficial spreading has a prolonged radial growth pattern before transforming into a more vertical
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Nodular melanoma is it is often more advanced at the time
of diagnosis
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Desmoplastic melanomas
are another rare melanoma form that typically has an aggressive local
growth pattern but less propensity to metastasize.
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the tumor measured
down from the granular layer of the epidermis. This has been shown
to be one of the best prognostic values for tumor prognosis as well as
lymph node metastasis
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