Skin malignancy Flashcards
3 main types of skin malignancy
1) basal cell
2) squamous cell
3) melanoma
what are the risk factors for skin malignancy
• 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)
what is most common form of cutaneous cancer?
basal cell carcinoma
what does basal cell carcinoma look like
• 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.
what is the cause of BCC
• 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…
BCC in persons of color
- pigmented papules and nodules
- head, neck, groin, scrotum, perianal, feet
- may look like seborhheic keratoses, nevocellular nevi, or malignant melanomas
what is the tx of BCC
- Surgical excision
- Electrodesiccation and curettage
- Mohs micrographic surgery
- Topical agents.
what does SCC look like?
• Nonhealing ulcer or warty nodule
• The lesions appear as small red, conical, hard
nodules that occasionally ulcerate
what is SCC due to?
long term sun exposure
who is SCC common in?
• Common in fair-skinned individuals and in organ
transplant recipients and other
immunosuppressed patients
what might SCC arise from?
actinic keratosis
what are risk factors in developing SCC
- 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,
SCC in persons of color
- most occur in non sun exposed areas
- due to UV light
what areas are predisposed to development of SCC
Areas of chronic inflammation, chronic ulceration, and scarring are predisposed to
the development of SCC.
• This is the case for all skin colors
tx of SCC
• 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.
what are the risk factors of melanoma
• 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.
what is the mean age of dx of melanoma
• Mean age of diagnosis is 63 years, with 15%
being younger than 45 years.
when does the incidence of melanoma rise?
in white after 20 yrs old
who is at highest risk of melanoma
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.
what is the most common location of melanoma for men and women?
- Most common location
- Back for men
- Lower extremities followed by trunk for women
- Can occur anywhere on the skin surface.
melanoma prognosis
• 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
melanoma in persons of color
inverse relationship between incidence and skin color
- most often on palms, soles and nail beds
- acral tumor more common and subungal
what are the ABCDE of melanoma
• 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
what carries the greatest sensitivity and specificity at predicting metastatic potential of lesion
color
melanoma tx
• 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
what is pruritus seen in
malignancy
what is gottrens papules seen in
- dermatomyositis
- internal malignancy
what is clubbing seen in
internal malignancy
cyanotic heart disease
IBD
lung disease
what is pyoderma gangrenosum seen in
malignancy
what is kaposi sarcoma seen in
malignancy assoc with HIV/AIDS
what is actinic keratosis seen in
pre dispostion to SCC
what is erythroplasia of queryat seen in
precancerous lesion of penis
-predisposition to SCC (penis or vulva)
what is malar rash seen in?
SLE
what is tx of erythroplasia of queyrat
- aldara of 5-FU
- Mohs if around or into urethra
