Skin Neoplasms & Verrucous Lesions Flashcards
What is the MC skin cancer in the US?
Basal cell carcinoma
Who is basal cell carcinoma MC in?
Fair-skinned w/ prolonged sun exposure
Xeroderma pigmentosum
What are the s/s of basal cell carcinoma?
Flat firm area w/ small, raised, translucent/pearly/waxy papule & central ulceration & raised, rolled borders
May have overlying telangiectatic vessels
What location on the body is basal cell carcinoma MC?
Face, nose, trunk
What are characteristics of basal cell carcinoma?
Slow growing: locally invasive, but very low incidence of mets
Often friable
How do you diagnose basal cell carcinoma?
Punch or shave biopsy (basophilic palisading cells on histology)
How do you treat basal cell carcinoma?
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
What causes malignant melanoma?
UV radiation
What are the characteristics of malignant melanoma?
Aggressive (high mets potential)
MC in caucasians & light hair/eye color, xeroderma pigmentosum
What are the 4 subtypes of melanoma?
- SF spreading: MC type, may arise de novo or from pre-existing nevus
- Nodular: 2nd MC type, a/w rapid vertical growth phase
- Lentigo maligna
- Acral lentiginous: MC in dark-skinned
- Desmoplastic: most aggressive
What are the s/s of melanoma?
ABCDE: asymmetry, borders irregular, color variation, diameter usually ≥ 6mm, evolution
Melanoma: What is the most important prognostic factor for METS?
Thickness
10 year survival < 1mm 95%
How do you diagnose melanoma?
Full thickness wide excisional biopsy + LN biopsy
How do you treat melanoma?
Complete wide surgical excision w/ LN biopsy or dissection
+/- alpha-interferon, immune therapy, or radiotherapy
What are the characteristics of squamous cell carcinoma?
Often preceded by actinic keratosis, HPV infection, sun & environmental exposure, xeroderma pigmentosum, chronic wounds
Bowen’s disease = SCC in situ. Slow growing
Squamous cell carcinoma is MC in what locations?
Lips, hands, neck & head
What are the s/s of SCC?
Red, elevated thickened nodule w/ white scaly or crusted bloody margins
How do you diagnose SCC?
Biopsy
How do you treat SCC?
Wide local surgical excision = tx of choice!
Electrodessication & curettage, Mohs, radiation
Who is actinic keratosis & seborrheic keratosis MC in?
MC in fair-skinned elderly w/ prolonged sun exposure
What are s/s of actinic keratosis?
Dry, rough, scaly “sandpaper” skin lesions or erythematous, hyperkeratotic plaques
+/- projection of skin (horn)
How do you diagnose actinic keratosis?
Punch or shave biopsy
How do you treat actinic keratosis?
Observation
Cryosurgery, dermabrasion
Topical 5-fluorouracil, imiquimod
What are characteristics of actinic keratosis vs seborrheic keratosis?
Actinic: Premalignant –> SCC
Seborrheic: MC benign skin tumor
What are s/s of seborrheic keratosis?
Small papule/plaque velvety warty lesion w/ “greasy/stuck on appearance”
Flesh colored, grey, brown & black
How do you treat seborrheic keratosis?
No tx needed
Cosmetic: cryotherapy, curettage, or laser
