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
what can pruritus point to in systemic dz
malignancy
what do gottrens papules point to in systemic dz
dermatomyositis
internal malignancy
what does clubbing point to in systemic dz
internal malignancy
cyanotic Heart Dz
IBD
Lung dz
Other skin lesions relating to systemic dz (probs not on exam)
kaposi sarcoma–> HIV/AIDS (#1)
malar rash–> SLE