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PCM IV Test 2 > Skin malignancy > Flashcards

Skin malignancy Flashcards

1
Q

3 main types of skin malignancy

A

1) basal cell
2) squamous cell
3) melanoma

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2
Q

what are the risk factors for skin malignancy

A

• History of sunburns and/or heavy sun exposure
• Often will attribute prolonged sun exposure over a
lifetime
• Short term sun exposure at risk, particularly if
multiple sunburns are experienced
• Blue or green eyes
• Blonde or red hair
• Fair complexion
• Equatorial living
• Sub-equatorial living (New Zealand)

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3
Q

what is most common form of cutaneous cancer?

A

basal cell carcinoma

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4
Q

what does basal cell carcinoma look like

A

• Pearly papule, erythematous patch (especially if > 6 mm), or
nonhealing ulcer, in sun-exposed areas (face, trunk, lower legs)
• There is a waxy, “pearly” appearance, with telangiectatic vessels
easily visible
• Pearly or translucent quality of the lesions is most diagnostic, a
feature best appreciated if the skin is stretched
• On the back and chest and lower legs, basal cell carcinomas appear
as reddish, somewhat shiny, scaly plaques
• History of bleeding is occasionally noted, more so than the other
forms of cutaneous malignancy.

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5
Q

what is the cause of BCC

A

• Fair-skinned person with a history of sun exposure (often intense,
intermittent)
• Occur on sun-exposed skin in otherwise normal fair-skinned
individuals; ultraviolet light is the cause most often…

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6
Q

BCC in persons of color

A
  • pigmented papules and nodules
  • head, neck, groin, scrotum, perianal, feet
  • may look like seborhheic keratoses, nevocellular nevi, or malignant melanomas
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7
Q

what is the tx of BCC

A
  • Surgical excision
  • Electrodesiccation and curettage
  • Mohs micrographic surgery
  • Topical agents.
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8
Q

what does SCC look like?

A

• Nonhealing ulcer or warty nodule
• The lesions appear as small red, conical, hard
nodules that occasionally ulcerate

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9
Q

what is SCC due to?

A

long term sun exposure

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10
Q

who is SCC common in?

A

• Common in fair-skinned individuals and in organ
transplant recipients and other
immunosuppressed patients

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11
Q

what might SCC arise from?

A

actinic keratosis

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12
Q

what are risk factors in developing SCC

A
  • Actinic keratoses
  • Bowen disease
  • Erythroplasia of Queyrat
  • Ultraviolet (UV) radiation (UVA and UVB)
  • Ionizing irradiation
  • Hematopoietic stem cell transplantation
  • Infection with HIV/AIDS
  • Chronic lymphocytic leukemia (CLL)
  • Immunosuppressive drugs (eg, azathioprine, cyclosporine)
  • Photosensitizing drugs (eg, doxycycline,
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13
Q

SCC in persons of color

A
  • most occur in non sun exposed areas

- due to UV light

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14
Q

what areas are predisposed to development of SCC

A

Areas of chronic inflammation, chronic ulceration, and scarring are predisposed to
the development of SCC.
• This is the case for all skin colors

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15
Q

tx of SCC

A

• The primary mode of therapy for localized SCC
is complete surgical excision
• Preferred is microscopically controlled surgery
(Mohs surgery).
• Nonsurgical interventions include topical
therapy
• For locally advanced, unresectable or
metastatic SCC, radiation therapy and
systemic treatment with chemotherapy or
targeted therapy.

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16
Q

what are the risk factors of melanoma

A 
• History of sunburns and/or heavy sun
exposure
• Blue or green eyes
• Blonde or red hair
• Fair complexion
• >100 typical nevi, any atypical nevi
• Prior personal or family history of melanoma
• p16 mutation.
17
Q

what is the mean age of dx of melanoma

A

• Mean age of diagnosis is 63 years, with 15%

being younger than 45 years.

18
Q

when does the incidence of melanoma rise?

A

in white after 20 yrs old

19
Q

who is at highest risk of melanoma

A

fair skinned indiv exposed to sun
• Individuals with certain types of pigmented lesions
(dysplastic or atypical nevi), with several large
nondysplastic nevi, with many small nevi, or with
moderate freckling have a twofold to threefold
increased risk of developing melanoma.
• Individuals with familial dysplastic nevus syndrome or
with several dysplastic or atypical nevi are at high
(>fivefold) risk of developing melanoma.

20
Q

what is the most common location of melanoma for men and women?

A
  • Most common location
  • Back for men
  • Lower extremities followed by trunk for women
  • Can occur anywhere on the skin surface.
21
Q

melanoma prognosis

A

• Surgically curable if diagnosed and treated in early phase, but potentially
lethal with increased risk when diagnosed and treated late.
• In the last decades, completely new and effective treatment options for
metastatic melanoma approved with immunotherapies

22
Q

melanoma in persons of color

A

inverse relationship between incidence and skin color

  • most often on palms, soles and nail beds
  • acral tumor more common and subungal
23
Q

what are the ABCDE of melanoma

A

• Asymmetry: one half is not identical to the other half
• Border: irregular, notched, scalloped, ragged, or poorly defined
borders as opposed to smooth and straight edges
• Color: having varying shades from one area to another
• Black- necrotic
• Blue- deeper depth of invasion
• White- ischemic, fibrosis, associated with deeper invasion
• Diameter: greater than 5 mm (some now using 6 mm)
• Evolution: changes in the lesion over time

24
Q

what carries the greatest sensitivity and specificity at predicting metastatic potential of lesion

A

color

25
Q

melanoma tx

A

• The standard of therapy for primary cutaneous
melanoma is wide local excision (WLE) by a
trained clinician in melanoma therapy.
• Surgical Intervention
• Determinants are necessary regarding
lymph node involvement and characteristics
of the patient’s lesion.
• Adjuvant treatment
• Added to surgical intervention in high-risk
patients with potential for relapse
• Interferon-alpha
• Intralesional interleukin-2

26
Q

what is pruritus seen in

A

malignancy

27
Q

what is gottrens papules seen in

A
  • dermatomyositis

- internal malignancy

28
Q

what is clubbing seen in

A

internal malignancy
cyanotic heart disease
IBD
lung disease

29
Q

what is pyoderma gangrenosum seen in

A

malignancy

30
Q

what is kaposi sarcoma seen in

A

malignancy assoc with HIV/AIDS

31
Q

what is actinic keratosis seen in

A

pre dispostion to SCC

32
Q

what is erythroplasia of queryat seen in

A

precancerous lesion of penis

-predisposition to SCC (penis or vulva)

33
Q

what is malar rash seen in?

A

SLE

34
Q

what is tx of erythroplasia of queyrat

A
  • aldara of 5-FU

- Mohs if around or into urethra

PCM IV Test 2 (11 decks)

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