Skin Lesions

Question 1

What are the most common skin cancers?

Answer 1

1. Basal cell carcinoma (75%)
2. Squamous cell carcinoma (20%)
3. Melanoma (4%)

Question 2

What is the most common fatal skin cancer?

Answer 2

Melanoma

Question 3

What is malignant melanoma?

Answer 3

A redundancy!

Question 4

What is squamous cell carcinoma?

Answer 4

Carcinoma arising from epidermal cells

Question 5

What are the most common sites for squamous cell carcinoma?

Answer 5

Head, neck, and hands

Question 6

What are the risk factors for squamous cell carcinoma?

Answer 6

Sun exposure, pale skin, chronic inflammatory process, immunosuppression, xeroderma pigmentosum, arsenic

Question 7

What is a precursor skin lesion for squamous cell carcinoma?

Answer 7

Actinic keratosis

Question 8

What are the signs and symptoms of squamous cell carcinoma?

Answer 8

Raise, slightly pigmented skin lesion; ulceration or exudate; chronic scab; itching

Question 9

How is the diagnosis of squamous cell carcinoma made?

Answer 9

Small lesion: excisional biopsy

Large lesion: incisional biopsy

Question 10

What is the treatment for squamous cell carcinoma?

Answer 10

Small lesion (< 1 cm): Excise with 0.5-cm margin
Large lesion (> 1 cm): Resect with 1-2-cm margins of normal tissue (may require skin graft or flap)

Question 11

What is the dreaded sign of squamous cell carcinoma metastasis?

Answer 11

Palpable lymph nodes (remove involved lymph nodes)

Question 12

What is Marjolin’s ulcer?

Answer 12

Squamous cell carcinoma that arises in an area of chronic inflammation (e.g. chronic fistula, burn wound, osteomyelitis)

Question 13

What is the prognosis for squamous cell carcinoma?

Answer 13

Excellent if totally excised (95% cure rate)

Question 14

What is the treatment for solitary metastasis of squamous cell carcinoma?

Answer 14

Surgical resection

Question 15

What is basal cell carcinoma?

Answer 15

Carcinoma arising in the germinating basal cell layer of epithelial cells

Question 16

What are the risk factors for basal cell carcinoma?

Answer 16

Sun exposure, pale skin, radiation, chronic dermatitis, xeroderma pigmentosum

Question 17

What are the most common sites for basal cell carcinoma?

Answer 17

Head, neck, and hands

Question 18

What are the signs and symptoms of basal cell carcinoma?

Answer 18

Slow-growing skin mass (chronic, scaly); scab; ulceration +/- pigmentation, pearl-like

Question 19

How is the diagnosis of basal cell carcinoma made?

Answer 19

Excisional or incisional biopsy

Question 20

What is the treatment for basal cell carcinoma?

Answer 20

Resection with 5-mm margins (2-mm in cosmetically sensitive areas)

Question 21

What is the risk of metastasis of basal cell carcinoma?

Answer 21

Very low (recur locally)

Question 22

What is an epidermal inclusion cyst?

Answer 22

Benign subcutaneous cyst filled with epidermal cells (should be removed surgically) filled with waxy material.
No clinical difference from a sebaceous cyst.

Question 23

What is actinic keratosis?

Answer 23

Premalignant skin lesion from sun exposure.

Seen as a scaly skin lesion.

Question 24

What is seborrheic keratosis?

Answer 24

Benign pigmented lesion in the elderly.

Observe or treat by excision (especially if there is any question of melanoma), curettage, or topical agents

Question 25

What is Bowen’s disease of the skin?

Answer 25

Squamous carcinoma in situ (should be removed or destroyed, thereby removing problem)

Question 26

What is Mohs surgery?

Answer 26

Repeats thin excision until margins are clear by microscopic review.
Used to minimize collateral skin excision.