Skin Neoplasms & Verrucous Lesions

Question 1

What is the MC skin cancer in the US?

Answer 1

Basal cell carcinoma

Question 2

Who is basal cell carcinoma MC in?

Answer 2

Fair-skinned w/ prolonged sun exposure

Xeroderma pigmentosum

Question 3

What are the s/s of basal cell carcinoma?

Answer 3

Flat firm area w/ small, raised, translucent/pearly/waxy papule & central ulceration & raised, rolled borders

May have overlying telangiectatic vessels

Question 4

What location on the body is basal cell carcinoma MC?

Answer 4

Face, nose, trunk

Question 5

What are characteristics of basal cell carcinoma?

Answer 5

Slow growing: locally invasive, but very low incidence of mets

Often friable

Question 6

How do you diagnose basal cell carcinoma?

Answer 6

Punch or shave biopsy (basophilic palisading cells on histology)

Question 7

How do you treat basal cell carcinoma?

Answer 7

Electrodesiccation/curettage used MC in nonfacial tumors w/ low risk of recurrence

+/- Mohs surgery for facial involvement, or difficult/recurrent cases

Surgical excision: low or high risk recurrence

Imiquimod & 5FU for small SF non-facial lesions

Question 8

What causes malignant melanoma?

Answer 8

UV radiation

Question 9

What are the characteristics of malignant melanoma?

Answer 9

Aggressive (high mets potential)

MC in caucasians & light hair/eye color, xeroderma pigmentosum

Question 10

What are the 4 subtypes of melanoma?

Answer 10

1. SF spreading: MC type, may arise de novo or from pre-existing nevus
2. Nodular: 2nd MC type, a/w rapid vertical growth phase
3. Lentigo maligna
4. Acral lentiginous: MC in dark-skinned
5. Desmoplastic: most aggressive

Question 11

What are the s/s of melanoma?

Answer 11

ABCDE: asymmetry, borders irregular, color variation, diameter usually ≥ 6mm, evolution

Question 12

Melanoma: What is the most important prognostic factor for METS?

Answer 12

Thickness

10 year survival < 1mm 95%

Question 13

How do you diagnose melanoma?

Answer 13

Full thickness wide excisional biopsy + LN biopsy

Question 14

How do you treat melanoma?

Answer 14

Complete wide surgical excision w/ LN biopsy or dissection

+/- alpha-interferon, immune therapy, or radiotherapy

Question 15

What are the characteristics of squamous cell carcinoma?

Answer 15

Often preceded by actinic keratosis, HPV infection, sun & environmental exposure, xeroderma pigmentosum, chronic wounds

Bowen’s disease = SCC in situ. Slow growing

Question 16

Squamous cell carcinoma is MC in what locations?

Answer 16

Lips, hands, neck & head

Question 17

What are the s/s of SCC?

Answer 17

Red, elevated thickened nodule w/ white scaly or crusted bloody margins

Question 18

How do you diagnose SCC?

Answer 18

Biopsy

Question 19

How do you treat SCC?

Answer 19

Wide local surgical excision = tx of choice!

Electrodessication & curettage, Mohs, radiation

Question 20

Who is actinic keratosis & seborrheic keratosis MC in?

Answer 20

MC in fair-skinned elderly w/ prolonged sun exposure

Question 21

What are s/s of actinic keratosis?

Answer 21

Dry, rough, scaly “sandpaper” skin lesions or erythematous, hyperkeratotic plaques

+/- projection of skin (horn)

Question 22

How do you diagnose actinic keratosis?

Answer 22

Punch or shave biopsy

Question 23

How do you treat actinic keratosis?

Answer 23

Observation

Cryosurgery, dermabrasion

Topical 5-fluorouracil, imiquimod

Question 24

What are characteristics of actinic keratosis vs seborrheic keratosis?

Answer 24

Actinic: Premalignant –> SCC

Seborrheic: MC benign skin tumor

Question 25

What are s/s of seborrheic keratosis?

Answer 25

Small papule/plaque velvety warty lesion w/ “greasy/stuck on appearance”

Flesh colored, grey, brown & black

Question 26

How do you treat seborrheic keratosis?

Answer 26

No tx needed

Cosmetic: cryotherapy, curettage, or laser