SM_260a: Nonmelanoma Skin Cancer / Photobiology Flashcards
UVA is responsible for ____
UVA is responsible for aging
(photoaging, smoking also plays a role, also tanning)
UVB is responsible for ____
UVB is responsible for burning
UVC is most ____
UVC is most carcinogenic
Photoaging is influenced by ____ exposure and ____
Photoaging is influenced by UVA exposure and smoking
(clinical signs of photoaging: spotty hyperpigmentation and hypopigmentation, rhytids (wrinkles), telangiectasias, skin thickening, and loss of elasticity)
Photocarcinogenesis involves ____ and ____
Photocarcinogenesis involves UV-mediated DNA damage and mutation formation
- Direct damage: thymine dimer formation
- Indirect damage: ROS formation
- Mutation formation: inactviation of tumor suppressors, activation of oncogenees, evasion of apoptosis, and limitless replicative potential
UVB is important first step of ____ metabolism
UVB is important first step of Vitamin D metabolism
Nonmelanoma skin cancer means ____ carcinomas, which include ____ and ____
Nonmelanoma skin cancer means keratinocyte carcinomas, which include basal cell carcinoma and squamous cell carcinoma
(risk factors: environmental exposures, skin type, genetic predisposition, predisposing skin conditions, and immunosuppression)
Shave biopsy is the most ____ biopsy, has ____ bleeding, requires ____, and is less likely to ____
Shave is the most superficial biopsy, has minimal bleeding, requires no sutures, and is less likely to scar (dyschromia, hypopigmentation)
Punch biopsy is a commonly used diangostic biopsy technique for ___ and ___, provides ___ for histology, and involves using ___ to close
Punch biopsy is a commonly used diagnostic biopsy technique for pigmented lesions (nevi) or deeper lesions (dermal / fat), provides full thickness clean edged specimens for histology, and involves using suture to close
Describe basal cell carcinoma
Basal cell carcinoma
- Most common skin cancer
- Locally destructive
- Metastasis is very rare
- Increased risk for developing other keratinocyte carcinomas
- Recommend skin checks at regular intervals (every 6 months)
- Usually occur on the head and neck
- Diagnosis by biopsy
- Treatment depends on clinical and histological features but is often surgical
This is ____
This is basal cell carcinoma
Diagnosis is ____
Diagnosis is basal cell carcinoma
Basal cell carcinoma is treated with ____
Basal cell carcinoma is treated with surgical removal
Describe management of basal cell carcinoma
Basal cell carcinoma management
- Surgical excision with 4-5 mm margins
- Mohs micrographic surgery in certain cases
- Photoprotection
- Regular total body skin examination
- Monthly self-skin exams
Nodular basal cell carcinoma is a ____ and is most frequently found on the ____ and ____
Nodular basal cell carcinoma is a pearly papule or nodule with rolled border and telangiectasias and is most frequently found on the head and neck
(most common subtype)
Superficial basal cell carcinoma is ____ and ____
Superficial basal cell carcinoma is pink / translucent in color with telangiectasia and a slightly rolled border and a patch / thin plaque that may be scaly
(differential diagnosis includes squamous cell carcinoma in situ / Bowman’s disease or actinic keratosis)
Ulcerated basal cell carcinoma is ____
Ulcerated basal cell carcinoma is translucent color with telangiectasia, rolled border, and ulceration and crusting (scab)
Pigmented basal cell carcinoma is ____ and commonly found in ____
Pigmented basal cell carcinoma is pearly papules with telangiectasias and globules of dark pigment within and commonly found in persons of color
(differential diagnosis may include malignant melanoma, over 50% of basal cell carcinomas in persons of color are pigmented)
Morpheaform basal cell carcinoma is ____ with a plaque that ____
Morpheaform basal cell carcinoma is translucent with telangiectasia and rolled border with a plaque that appears white or bound down in scar-like areas
Diagnosis is ____
Diagnosis is squamous cell carcinoma
Next step in management is ____
Next step in management is shave biopsy
Diagnosis is ____
Diagnosis is squamous cell carcinoma
Squamous cell carcinoma involves ____, regular ____, monthly ____, and ____
Squamous cell carcinoma management involves surgical excision with 5 mm margins, regular total body skin examinations, monthly self-examinations, and photoprotection
Squamous cell carcinoma is most common in people with ____ skin, is found on ____ areas, and has increased mortality compared to basal cell carcinoma due to ____
Squamous cell carcinoma is most common in people with white/fair skin, is found on sun-exposed areas, and has increased mortality compared to basal cell carcinoma due to higher rate of metastasis
Squamous cell carcinoma cell of origin is ____ and is common under conditions of ____
Squamous cell carcinoma cell of origin is keratinocytes and is common under conditions of immunosuppression (s/p transplant)
Describe clinical manifestations of squamous cell carcinoma
Squamous cell carcinoma clinical manifestations
- Variable morphologies: papule / plaque / nodule, pink / red / skin-colored, scale, exophytic (grows outward), indurated, may present as cutaneous horn
- Friable: may bleed with minimal trauma
- Asymptomatic, painful, or pruritic
Squamous cell carcinoma in situ is called ___ and involves keratinocyte atypia that is ___ and does not ___
Squamous cell carcinoma in situ is called Bowen’s disease and involves keratinocyte atypia that is confined to the epidermis and does not invade past the dermal-epidermal junction
(circumscribed pink / red patch or thin plaque with scaly or rough surface)
Squamous cell carcinoma has higher rates of metastasis if on the ____ or in ____ patients
Squamous cell carcinoma has higher rates of metastasis if on the lips (smoking) or in immunosuppressed patients (s/p transplant)
Skin cancer treatment is ____
Skin cancer treatment is complete elimination of the tumor with best cosmetic result
Standard excision of basal cell carcinoma or squamous cell carcinoma is ____
Standard excision of basal cell carcinoma or squamous cell carcinoma is elliptical excision with layered suture closure and 4-5 mm margins
Mohs micrographic surgery offers ____ and ____ compared to standard surgical excision
Mohs micrographic surgery offers superior histologic analysis of tumor margins and maximal conservation of tissue compared to standard surgical excision
Broad spectrum protects against ____, while SPF is related only to ____
Broad spectrum protects against UVA and UVB, while SPF relates only to UVB
This is ____
This is actinic keratosis
Actinic keratosis originates from ____ , may transform into ____, and has a characteristic ____
Actinic keratosis originates from keratinocytes, may transform into squamous cell carcinoma, and has a characteristic rough gritty scale
- May be tender, located in sun-exposed areas, background of sun damaged skin, erythematous papule or thin plaque with characteristic rough gritty scale, and often diagnosd by feel (like sandpaper)
Actinic keratosis results from ____
Actinic keratosis results from cumulative and prolonged UV exposure
____ is used as treatment for localized actinic keratosis
Cryosurgery is used as treatment for localized actinic keratosis
(side effect of post-inflammatory hyperpigmentation)
Many actinic keratoses are treated with ____ or ____
Many actinic keratoses are treated with topical 5-fluorouracil / imiquimod creams or photodynamic therapy
Compare basal cell carcinoma, squamous cell carcinoma, malignant melanoma
Basal cell carcinoma, squamous cell carcinoma, malignant melanoma
____, ____, ____, and ____ are genetic syndromes predisposing to skin cancer
Xeroderma pigmentosum, basal cell nevus syndrome (Gorlin’s syndrome), familial melanoma, and oculocutaneous albinism are genetic syndromes predisposing to skin cancer
Xeroderma pigmentosum is caused by ____, and patients have a ____ risk of skin cancer including melanoma
Xeroderma pigmentosum is caused by mutations in nucleotide excision repair, and patients have a 1000x risk of skin cancer including melanoma
Basal cell nevous syndrome involves a gene defect in ____
Basal cell nevous syndrome involves a gene defect in tumor suppressor gene PTCH (Patched)
Oculocutaneous albinism is ____ and leads to increased frequency of ____ and ____
Oculocutaneous albinism is a group of genetic disorders with partial or complete absence of melanin and increased frequency of squamous cell carcinoma and melanoma
(normal number of melanocytes)
