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MSK/Derm > SM 260: Nonmelanoma Skin Cancer/Photobiology > Flashcards

SM 260: Nonmelanoma Skin Cancer/Photobiology Flashcards

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Dermatology Board Prep flashcards
1
Q

Which is more likely to cause sunburns, UVA or UVB?

A

UVA is 1000x less likely to cause sunburn than UVB

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2
Q

What does UVA cause?

A

Tanning and Photoaging because it penetrates deep into the skin

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3
Q

What does UVB cause?

A

Burning and delayed tanning because it is primarily absorbed by the Epidermis Also activates Vitamin D

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4
Q

What does UVC cause?

A

Most carcinogenic, but also shielded by Ozone and almost never reaches the skin

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5
Q

Which form of UV can cause skin cancer?

A

All forms of UV can cause skin cancer

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6
Q

What is the most important extrinsic factor in aging skin?

A

Cumulative UV exposure, especially to UVA

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7
Q

What factors besides UVA age the skin?

A

Smoking, alcohol, poor nutrition

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8
Q

What are signs of photoaging?

A

Spotty hyperpigmentation and hypopigmentation, skin thickening, and loss of elasticity

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9
Q

How can DNA be damaged by UV light?

A

Directly = thymine dimer formation via UVB

Indirectly = ROS formation via UVA

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10
Q

What mutations can UV damage induce in DNA?

A

Inactivation of tumor suppressors like p53 Activation of oncogenes like Ras and BRAF Evasion of Apoptosis via p53 Limitless replicative potential via Telomerase

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11
Q

What benefit does UV light have?

A

Activation of Vitamin D via UVB

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12
Q

What are the two types of Nonmelanoma Skin Cancer?

A

Keratinocyte Carcinomas include Basal Cell Carcinoma and Squamous Cell Carcinoma

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13
Q

What are the risk factors for Keratinocyte Carcinomas?

A

Environmental exposures, skin type, genetic predisposition, predisposing skin conditions, and immunosuppression

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14
Q

What genetic predisposition can lead to a Keratinocyte Carcinoma?

A

Xeroderma pigmentosum, Basal Cell Nevus Syndrome

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15
Q

What predisposing skin conditions can lead to a Keratinocyte Carcinoma?

A

Chronic ulcers and longstanding inflammation

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16
Q

What are the Fitzpatrick Skin Phototypes used for?

A

Used to classify the ability of skin to burn or tan when challenged with UV radiation

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17
Q

Which Fitzpatrick Skin Phototypes should use photoprotection?

A

Everyone, even the darkest of skin

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18
Q

What is a Shave Biopsy?

A

The most superficial skin biopsy, minimal bleeding, less likely to scar and no sutures required

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19
Q

What is a Punch Biopsy?

A

A diagnostic technique for pigmented lesions like Nevi and deeper lesions, uses sharp round punches to provide full thickness clean edged specimens for histology with a suture and stitches to close

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20
Q

How should Basal Cell Carcinoma be managed?

A

Surgical excision

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21
Q

What is Nodular BCC?

A

The most common subtype of BCC, that looks like a pearly papule/nodule and telangiectasias with rolled borders on the head and neck

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22
Q

What is a Superficial BCC?

A

Pink or translucent patch or thin plaque with rolled borders which may be scaly

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23
Q

What is an Ulcerated BCC?

A

A translucent ulcerated and crusted lesion with a rolled border

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24
Q

What is a Pigmented BCC?

A

A pearly papule with telangiectasias and dark pigment within

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25
Q

What is a Morpheaform BCC?

A

Translucent color with a rolled border and telangiectasia, plaque appears white and bound down or scar-like in areas

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26
Q

How is Basal Cell Carcinoma diagnosed?

A

Biopsy

27
Q

Does Basal Cell Carcinoma tend to metastasize?

A

No

28
Q

How should Squamous Cell Carcinoma be managed?

A

Surgical Excision and regular skin examinations

29
Q

Which population is most at risk for SCC?

A

People with white/fair skin are most at risk for Squamous Cell Carcinoma

30
Q

Where does SCC tend to develop?

A

Sun exposed areas: head, neck, forearms

31
Q

Which has a higher mortality and why: SCC or BCC?

A

Squamous Cell Carcinoma, because it has a higher rate of metastasis

32
Q

Which cells are the source of SCC, and how do they become cancerous?

A

Keratinocytes, due to sun exposure if in a sun-exposed area or carcinogen/chronic inflammation in a non-sun-exposed area

33
Q

What can cause both SCC and BCC?

A

Immunosuppression in Caucasian transplant patients, but especially SCC

34
Q

How does SCC present?

A

Various morphologies: papule, plaque, or nodule, may be pinkish-red or skin colored, scale, and Exophytic (grows outward), friable (bleed easily), and indurated/firm

35
Q

If it bleeds easily, is it SCC or BCC?

A

Friable = bleed easy = SCC

36
Q

What is SCC in situ?

A

Bowen’s Disease; circumscribed pink-red patch or plaque with scaly or rough surface where the cancer is confined to the epidermis

37
Q

What promotes SCC metastasis?

A

Smoking, immunsuppression, larger and deeper tumors are more likely to metastasize

38
Q

Why do we treat BCC?

A

Symptomatic, locally aggressive, may destroy vital structures over time due to rapid growth

39
Q

Why do we treat SCC?

A

Metastatic potential, symptomatic, may destroy vital structures over time due to rapid growth

40
Q

What is the goal of skin cancer treatment?

A

Complete elimination of tumor with best cosmetic result

41
Q

What are surgical skin cancer treatments?

A

Curette and Desiccation, excision, cryosurgery

42
Q

What are non-surgical skin cancer treatments?

A

Imiquimod cream, Fluorouracil cream, and photodynamic therapy for Superficial BCC

43
Q

What is the standard skin cancer excision?

A

Elliptical excision with layered suture closure

44
Q

What is a standard skin cancer excision good for?

A

Most BCC and SCC

45
Q

What is a standard skin cancer excision not good for?

A

Cure rates inferior to Mohs surgery for recurrent or infiltrative BCC, and BCC/SCC at high risk anatomic sites like the face

46
Q

What is Mohs Micrographic Surgery?

A

A surgical technique used for SCC and BCC with superior histographic analysis of tumors that preserves more tissue and has lower recurrence rates

47
Q

When should a Mohs Micrographic Surgery be pursued?

A

High risk anatomic locatoins: face, nose, ears, eyes, hands Aggressive tumors that infiltrate or sclerose or reccur

48
Q

What are primary skin cancer prevention strategies?

A

Sun avoidance and shade, as well as SPF 30+ sunscreen to protect against UVB if reapplied every 2 hours

49
Q

What are secondary skin cancer prevention strategies?

A

Chemoprophylaxis with chemotherapy and immune modulates as well as reduction of immunosuppression

50
Q

What are Actinic Keratosis?

A

Premalignant tumors that may transform into SCC, which originate from the Keratinocyte

51
Q

How do AK’s present?

A

Symptomatic/tender, found in sun-exposed areas, erythematous papule or thin plaque with a gritty scale that feel like sandpaper

52
Q

What are the risk factors for AK?

A

Cumulative UV exposure, increasing age, fair skin, and immunosuppression

53
Q

What is the treatment for AK?

A

Cryosurgery if localized, topical 5-fluoruracil/imiquimod if diffuse

54
Q

What is Xeroderma Pigmentosum?

A

An AR disorder of NER genes that prevent the removal and repair of photoproducts from damaged DNA, which greatly increase risk of skin cancer

55
Q

How can skin cancer risk be managed in Xeroderma Pigmentosum?

A

Avoid the sun

56
Q

What is Nevoid Basal Cell Carcinoma Syndrome?

A

A rare AD disease due to a defect in the tumor suppressor gene Patch, leading to constant activation of Sonic Hedgehog which predispose BCC via tumor cell proliferation disinhibition

57
Q

What is Oculocutaneous Albinism?

A

A group of disorders with a partial or total lack of melanin leading to increased frequency of SCC and Melanoma, demanding sun avoidance

58
Q

How can UV light alter the immune system and inflammation?

A

UV light suppresses the immune system to improve Psoriasis but exacerbates inflammation to worsen Lupus

59
Q

What genes are mutated by UV light to cause Squamous Cell Carcinoma?

A

Ras, p53

60
Q

What genes are mutated by UV light to cause Squamous Cell Carcinoma?

A

Patch

61
Q

What genes are mutated by UV light to cause Melanoma?

A

CDKN2A aka P16

62
Q

What genetic disorders increase the risk of skin cancer?

A

Xenoderma Pigmentosum, Basal Cell Nevus Syndrome, and Oculocutaneous Albinism

63
Q

What type of skin cancer does continued, lifelong UV radiation predispose?

A

SCC

64
Q

What type of skin cancer does intermittent, intense UV radiation predispose?

A

BCC

MSK/Derm (46 decks)

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