Skin malignancies Flashcards
Diagnostic features of Basal Cell Carcinoma
mc form
- pearly papule, erythem patch, or nonhealing ulcer in sun exposed areas (face, trunk, lower legs)
- waxy, “pearly” appearance w/ telangiectastic vessels easily visible
- appears redish, somewhat shiny, scaly plaques on back and chest and lower legs
-history of bleeding occasionally
- can be umbilicated
- can be lobular/nodulated
Diagnostic features of Squamous Cell Carcinoma
- nonhealing ulcer or warty nodule
- small red conical hard nodules (occasionally ulcerate)
- keratinization, erythemetic borders (can be red, crusty)
- commonly on HANDDD, pinna of ear
- can have keratinous growth
Diagnostic features of Malignant Melanoma
- Description: non symmetrical, can have irregular borders, varied colors (mostly black), can have areas of fibrosis and ischemia at edges
- white= ischemic
- blue and whitish hues = bad (malignant present)
look at ABCDE criteria
GENERAL risk factors
history of sunburns/heavy sun exposure
- blue/ green eyes
- blonde/red hair
- fair complexion
- equatorial living
- subq-equotorial living (new zealand)
risk factors for SCC
may arise from ACTINIC KERATOSES (15% chance)
other: Bowen dz, erythroplasia of queyrate, UV radiation, ionizing irradiation, HSC transplant, infection w/ HIV/AIDS, CLL, IS drugs, photosensitizing drugs
- if have areas of chronic inflammation, chronic ulceration and scarring–> predispose to SCC
risk factors for Malignant Melanoma
- hx of sunburns and/or heavy sun exposure
- green/blue eyes
- blonde/red hair
- fair complexion
- > 100 typical nevi, any atypical nevi
- prior fam hx or fam hx of melanoma**
- p16 mutation**
-familial dysplastic nevus syndrome or severe dysplastic or atypical nevi = >5x risk for developing
epidemiology of cutaneous BCC
most often fair skinned person w/ hx of sun exposure (intense, intermitten)
persons of color: DIFF PX; often pigmented; can have rolled border; can also be in diff locations such groin, scrotum, perianal region and feet
epidemiology of cutaneous SCC
- common in fair skinned individuals
- organ transplant recipients + other IS pts
- prolonged sun exposure on exposed parts in fair skinned and in those that burn easily/tan poorly
- exposure to UV light
*persons of color- can see in non-sun exposed areas
epidemiology of malignant melanoma
- mean age of dx = 63 y/o; 15% under 45 y/o
- incidence rapidly rises in whites after 20 y/o
- fair skinned individuals at highest risk
- caucasions: back for men, LE and trunk for women, highly variable course
- highly variable course
- in african americans + asians–> palms, soles, nail beds
- *INVERSE RELATIONSHIP bw incidence of melanoma and skin color**
- -> highest incidence in caucasians, intermediate among hispanics, lowest among asians and african americanss
melanoma screening
ABCDE
Asymmetry
Border- irregular, notched, scalloped, ragged, or poorly defined
Color - various shades from one area to another (black = necrotic; blue = deeper depth of invasion; white = ischemic, fibrosis, deeper invasion)
Diameter- > 5mm
Evolution: changes in lesion over time
premalignant lesions
pyoderma gangrenosum–> malignancy
actinic keratosis–> SCC
erythroplasia of queryat–> precancerous lesion of penis; (20-30% assoc w/ malignancy); SCC predisposition
which are nonmelanoma skin cancers
basal + squamous cell skin cancers
risk factors for BCC
- sun exposed skin in otherwise normal fair-skinned individuals
- UV LIGHT = most often cause
in persons of color–> less common but still check!
which of the ABCDE melanoma screening criteria carries greatest sensitivity + specificity at predicting metastatic potential of lesion?
COLOR
what are the standard treatments/therapies for these cancers
mostly surgical EXCISION
adjuvant therapy differs
