Skin Neoplasms Flashcards
Which types of UV are most associated with skin changes and aging?
UVA & UVB
UVA
not absorbed by ozone layer
-leads to photo aging, not cancer
UVB
- mostly absorbed by ozone layer
- some reaches Earth’s surface
- carcinogenic
UVC
very carcinogenic but completely absorbed by ozone layer
Which layer of skin is affected by UVB?
epidermis
What is the primary agent responsible for sunburns
UVB
What does UV exposure cause to skin?
- thickening & thinning of skin
- thick skin found in coarse wrinkles especially on back of neck
- don’t disappear when skin is stretched
solar elastosis
thickened coarse wrinkling and yellow discoloration of skin
Define nevi
- moles
- benign overgrowth of melanocytes on skin surface
- can be congenital or acquired
Congenital nevi include what?
- mongolian spot
- cafe-au-lait spots
- nevus spilus
- congenital melanocyte nevi
What are acquired nevi?
pigmented moles
What are the three types of acquired nevi?
- junctional
- compound
- intradermal
Junctional nevi
- flat brown/black, slightly elevated
- common on sun exposed surfaces
Compound nevi
brown/black
- slight elevated
- may have coarse hairs
Intradermal nevi
- dome shaped or pedunculate (hangs by a stalk)
- may become fleshy colored
- may develop coarse hairs
Spitz nevi
- acquired melanocytic nevi
- brown to pink, dome shaped
blue nevus
- acquired melanocytic nevi
- benign dome shaped blue to black nodule
What is the most common non melanoma skin cancer?
Basal Cell Carcinomas
Clinical presentation of BCC
- pearly bordered, translucent nodules
- intralesional telangiectasis (little blood vessels)
Define BCC
- neoplasm of nonkeratinizing cells of the basal layer of the epidermis
- spreads wide and deep without treatment
Two types of BCC
nodular ulcerative and superficial basal cell
Nodular Ulcerative BCC
- nondulocystic, small flesh colored or pink translucent
- enlarges over time
- can see telangiectatic vessels
- central depression forms
- ulcer surrounded by waxy rim
- darkly pigmented in dark skinned
Incidence of BCC
- most common skin cancer in white skin
- higher in men than women
BCC treatments
- biopsy all suspicious lesions
- curettage, surgical excision, irradiation
Which layer does Squamous Cell Carcinoma happen in
epidermal layer
What does squamous cell carcinoma usually arise from?
actinic keratoses
What are two types of Squamous Cell Carcinoma?
- Intraepidermal squamous cell
- invasive squamous cell
Incidence of SCC
- second most frequent occurring malignant tumor
- men twice as likely
- dark skinned rarely affected
SCC presentation
- red, scaling, keratotic, slightly elevated lesion with irregular border
- usually with a chronic shallow ulcer
- lesions grow outward, large ulcerations have persistent crusts and raised red borders
Where does Keratoacanthoma originate?
pilosebaceous galnds
What is Keratoacanthoma?
an involuting type of SCC
SCC treatment
- excision
- shave excision, curettage, cryosurgery
Actinic keratosis AKA
solar keratosis
Presentation of Actinic Keratosis
- single or multiple discrete, dry, rough adherent scaly lesions occur on sun-exposed areas of adults
- precancers
What is melanoma
- malignant tumor of the melanocytes
- rapidly progressing and METASTATIC
Four type of melanoma
- superficial spreading melanoma
- nodular melanoma
- lentigo maligna melanoma
- acral lentiginous melanoma
ABCDE for melanoma
- Asymmetry: one half unlike the other
- Border: irregular, scalloped or poorly defined
- Color: varied from one area to another
- Diameter: larger than 6mm/size of pencil eraser
- Elevation change or evolution
Melanoma Incidence
- risen over past decade
- sun exposure (but many areas are not sun exposed.soooo…)
Melanoma Presentation
- usually rapidly changing flat mole
- slightly raised, flat, bulbous
- black, brown, red, white, blue, mottled
- can arise from previous moles or by themselves
- surrounding redness
- periodic ulceration and bleeding
Blue grey veil sign is indicative of what?
melanoma
Types of Melanoma
- superficial spreading melanoma
- lentigo maligna melanoma
- acral-lentiginous melanoma
- nodula melanoma
What percentage of cases do you see superficial spreading melanoma?
70% of cases
Lentingo meligna melanoma
- usually older patients 65-70yo
- usually 10cm diameter (don’t normally spread but can be HUGE)
- color variations
- higher irregular and notched borders
- surface usually flat with raised papular foci that occasionally are blue
Nodular Melanoma
- no radial growth phase
- lesions 5mm-1cm
- ABCDE rules do NOT apply
Acral Lengtiginous melanoma
- diagnosed older
- occurs on palms/soles or beneath nails
- non homogenous color
- malignant pigmented melanochyia striata in nails are early presentation
Thickness matters in lesions
Thickness matters in lesions
Breslow’s Classification
- tumor thickness is single most prognostic factor
- >3.6mm = 31%
Clark system
tumor rated depending on depth of tumor invasion
Why is nodular melanoma most dangerous?
Because there is no lateral growth (no radial growth)–. just vertical growth
Methods of Exam for Melanoma
- H&P, family hx
- Epiluminescent microscopy
Treatment of melanoma
-excision based on tumor thickness
