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Derm Rotation M2 > Tutorial 3- Skin Cancer > Flashcards

Tutorial 3- Skin Cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the most common cutaneous malignancy, and most common malignancy overall in caucasian persons?

A

Basal Cell Carcinoma (BCC)

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2
Q

T or F: The white population of North America has an overall 30% lifetime risk of developing SCC, with incidence increasing at more than 10% per year.

A

False:

Basal Cell Carcinoma (BCC)

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3
Q

Where do 80% of BCC lesions occur?

A

80% of lesions occur on the head and neck

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4
Q

Which one is not a risk factor for BCC?

  • Large cumulative UV exposure
  • Skin type I (always burns, never tans)
  • Freckling in childhood
  • Red or blonde hair, blue or green eyes
  • Frequent or severe childhood sunburn
  • Recreational sun exposure in childhood, with a 5x increase in risk for an average summer holiday exposure of more than eight weeks throughout childhood
A

All are risk factors for BCC

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5
Q

Which one is not a risk factor for BCC?

  • Positive family history of BCC (odds ratio 2.2)
  • Exposure to ionizing radiation
  • Immunosuppression: incidence of BCC in transplant recipients is 10x higher than in the general population
  • Arsenic exposure
  • History of acne
  • Genetic predisposition, including albinism, xeroderma pigmentosa, Bazex’s syndrome, and nevoid basal cell carcinoma syndrome (Gorlin’s syndrome)
A

History of acne is a protective effect. As are brown eyes.

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6
Q

Any non-healing lesion that has a history of bleeding or crusting with minimal trauma in a patient with a history of significant sun exposure (particularly in a patient with a history of cutaneous malignancy) is highly suspicious for ________

A

basal cell or squamous cell carcinoma

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7
Q

What are the 5 subtypes of BCC

A
  1. Noduloulcerative (“rodent ulcer”) BCC
  2. Superficial BCC
  3. Morpheaform BCC
  4. Pigmented BCC
  5. Cystic BCC
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8
Q

Name that BCC subtype:

a centrally ulcerated “gnawed at” appearance. This subtype is characterized by a solitary shiny red nodule, papule, or plaque with a prominent network of blood vessels on the surface (telangiectasia). Early lesions are small, pearly or translucent, with surface telangiectasia (fine blood vessels).

A

Noduloulcerative BCC

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9
Q

Name that BCC subtype:

presents as slow-growing, flat, well-demarcated patches. Lesions are flat, and can mimic eczema, psoriasis, and tinea. Always consider this subtype of BCC in the differential diagnosis of any macule or patch of “eczema” or “tinea” that does not resolve with standard therapy.

A

Superficial BCC

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10
Q

Why is early diagnosis diagnosis in superficial BCC important?

A

Lesion size is a significant determinant of treatment effectiveness, with greater recurrence rates occurring with larger lesions.

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11
Q

Name that BCC subtype:

Lesions clinically resemble a scar, therefore are very difficult to diagnose and can often present late, with a large degree of subclinical extension.Lesions tend to be more aggressive and locally invasive, with ill-defined borders

A

Morphaform BCC

Accounts for only 5% of BCC

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12
Q

Name that BCC subtype:

These lesions most commonly occur on the face and are dark brown to blue-black in color, often with accentuation of pigment at the periphery of the lesion. As lesions grow larger, they become more asymmetric. These lesions can clinically mimic malignant melanoma, and both entities should always be considered in any atypical-appearing pigmented lesion.

A

Pigmented BCC

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13
Q

Name that BCC subtype:

commonly appears on the face and periorbital skin and may be flesh-colored to blue-grey in color. Lesions may may mimic inclusion cysts, mucoceles, and other benign growths of adnexal structures.

A

Cystic BCC

This is the most rare subtype of BCC

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14
Q

What 2 disruptions in genetics appear to be important in the progression of BCC?

A

The sonic hedgehog-smoothened signaling pathway as well as the p53 gene product

Nearly 50% of BCCs have a mutated p53 gene.
20% of BCCs have activating mutations in smoothened, a downstream molecule in the Hedgehog-Patched signaling pathway.

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15
Q

What gene is most often altered in BCCs?

A

the PTCH gene is mutated in about 2/3 of BCCs.

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16
Q

What does the PTCH gene do?

A

The PTCH gene encodes the receptor for sonic hedgehog. Mutation of this pathway leads to decreased Bcl-2 levels, causing cells to be resistant to apoptosis.

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17
Q

Which one of these is not found histologically for BCC?

  • Large nests, cords, or islands of homogenous basophilic cells throughout the dermis
  • peripheral palisading.
  • retraction artifact or retraction clefting, with separation of the stroma surrounding tumor islands.
  • Cells do mature or become more differentiated towards the center of the islands
A

Cells DO NOT become more differentiated towards the center of the island- they do in squamous cell carcinoma though

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18
Q

Is metastasis common in BCC?

A

No- between 0.0028% to 0.55%.

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19
Q

Are pts that had BCC at a higher risk for getting it again? What else are they at risk for?

A

Yes! the three year cumulative risk for development of additional BCCs is between 33% and 77%!! AKA three out of every four patients with a diagnosis of basal cell carcinoma will develop a second skin cancer within the next three years

Patients with BCC are also at increased risk for the development of squamous cell carcinoma (6% risk at 3 years) and malignant melanoma (risk ratio 2.2)

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20
Q

What is the second most common cause of cutaneous malignancy?

A

Squamous Cell Carcinoma (SCC)

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21
Q

What is the most common skin cancer in dark-skinned individuals?

A

SCC

It is also the most common cause of skin cancer related deaths in this population

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22
Q

What is the overall risk of metastasis for SCC?

A

Less than 5%

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23
Q

Where is risk of metastasis increased for SCC?

A

Muscocutaneous borders like the lip (30%). Also the ear

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24
Q

What type of SCC has a crateriform appearance with a central keratin plug?

A

Keratoacanthoma

KA is characterized by rapid growth, up to several centimeters in size, over a period of weeks to months. The lesions can also demonstrate rapid regression. The lesion has a classic crateriform appearance with a central keratin plug. There is an abrupt transition between the lesion and the adjacent epidermis. KAs are most commonly seen on sun-exposed skin.

25
Q

What are thought to be clinical precursors to SCC?

A

Actinic Keratoses

26
Q

What is the risk for an individual AK to progress into an invasive SCC?

What is the lifetime risk of SCC in an individual with AKs?

A

1%

6-10%

27
Q

What is Bowens Disease?

A

Bowen’s disease is a synonym for SCC in situ, typically referring to lesions on sun-exposed skin. The scaly patches resemble eczema, superficial BCC, or psoriasis.

28
Q

What is erythroplasia of Queyrat?

A

Erythroplasia of Queyrat is SCC in situ on the male genitalia, classically the glans penis of uncircumcised males.

29
Q

T or F:

More than 70-80% of SCC recurrences and metastases develop within 2 years of treatment of the primary tumor.

A

True

30
Q

What should you check every 6 months for 3 years after the primary diagnosis of SCC and annually thereafter?

A

Patients should be seen for a full skin check and LN examination.

31
Q

Name that NMSC treatment:

Technique based upon scraping the tumor cells with a curette, then treating the base of the lesion with electrocautery.

A

Surgical: Curettage and cautery

32
Q

Name that NMSC treatment:

The mainstay of therapy for low-risk BCC and SCC.

A

Surgical: Simple excision

33
Q

How big should the margins be to provide cure in a simple excision of BCC and SCC?

A

4-5 mm

This provides cure in up to 95% of BCC and SCC. A fusiform or elliptical excision minimizes tissue redundancies at the poles of the excision

34
Q

name that NMSC treatment:

Sequential removal of successive layers of tissue, with microscopic analysis of 100% of the tumor margins through mapping of horizontally-oriented frozen sections of all surgical margins. The surgeon serves as both surgeon and pathologist.

A

Mohs Surgery

35
Q

What is the 5 year tumor-free rate for Mohs surgery?

A

The five-year tumor-free rate for Mohs surgery is 95-99%, as compared to rates of 80-93% for other interventions.

36
Q

name that NMSC treatment:

Use of liquid nitrogen

A

Cryotherapy

Liquid nitrogen is commonly used in dermatology to treat several benign lesions, including verruca vulgaris (warts) and actinic keratoses.

37
Q

name that NMSC treatment:

a pyrimidine analogue which inhibits RNA synthesis. It is a systemic immunosuppresant.

A

Fluorouracil or F-5U

5-FU is used topically for the FDA-approved treatment of AKs and superficial BCCs. It is also used in the evidence-based treatment of SCC in situ.
5-FU is an excellent alternative to cryotherapy for the treatment of AKs, or as an alternative to surgical treatment for BCC or SCC in situ, with a clearance rate of approximately 75-85% for AKs.

38
Q

Name that NMSC treatment:

an immune modulator, up-regulating TH1 cytokines interferon a (IFN-a) and tumor necrosis factor a (TNF-a), which targets the host immune system to the area of application

A

Imiquimod

FDA approved for the treatment of verrucae, AKs and superficial BCCs. It is also used in the evidence-based treatment of SCC in situ.
Similar to 5-FU, imiquimod is an excellent alternative to cryotherapy for the treatment of AKs, or as an alternative to surgical treatment for BCC or SCC in situ

39
Q

Name that NMSC treatment:

an excellent treatment option for patients who would not tolerate surgery, including elderly, debilitated patients with extensive tumor burden.

A

Radiotherapy

40
Q

Name that NMSC treatment:

This treatment takes advantage of the pathologic process which occurs in porphyria cutanea tarda (PCT) for the FDA-approved treatment of actinic keratoses (AKs), as well as for treatment of BCC, SCC, and SCC in situ. a precursor agent, most commonly 5(d)-aminolevulinic acid (ALA), is placed on the skin. Damaged skin preferentially takes up the precursor ALA, which functions as a “magic bullet”. ALA is then converted into protoporphyrin IX (pPIX), which releases free oxygen radicals upon light exposure..

A

Photodynamic therapy (PDT)

41
Q

Which skin cancer is increasing at a rate greater than any other form of cancer in the United States?

A

Melanoma

42
Q

What is the most common malignancy in women ages 25-29?

A

Melanoma

43
Q

What are the ABCD’s of melanoma

A

A: asymmetry B: border irregularity C: color D: diameter

44
Q

Patients with dysplastic nevus syndrome have a ___ fold increased risk for the development of melanoma.

A

184

45
Q

name that lesion: diameter >5mm and may be flat with a raised center (“fried egg” appearance).

A

Dysplastic Nevi

46
Q

What defines Dysplastic Nevus Syndrome? (3)

A

Occurrence of malignant melanoma in one of more first- or second-degree relatives.
The presence of a large number of melanocytic nevi, often more than 50, some of which are atypical and often variable in size.
Melanocytic nevi which demonstrated certain histologic features.

47
Q

The lifetime risk of malignant transformation in patients with large congenital nevi (>20cm) is __%

A

6%

48
Q

What is the difference between lentigo maligna and lentigo maligna melanoma

A

LMM tends to grow slowly and often are confined to the epidermis (lentigo maligna) for years before dermal invasion occurs (lentigo maligna melanoma). The terminology is confusing, with lentigo maligna referring to melanoma in situ, while lentigo maligna melanoma is in fact invasive melanoma.

49
Q

What is the most common type of melanoma?

A

Superficial Spreading Melanoma

50
Q

Name the subtype of melanoma:

Lesions may arise from preexisting nevi and demonstrate asymmetry, pigment variegation, and irregular borders. Though lesions have no preference for sun-damaged skin, they most commonly present on the trunk in men and lower extremities in women. The median age at diagnosis is only 44 years old.

A

Superficial spreading melanoma

51
Q

Name the subtype of melanoma:

Most common type of melanoma among African-Americans, Japanese, and Native Americans, due to the fact that other types of melanoma are less common in these patient groups.
The foot is the most common site of melanoma in African-Americans.

A

Acral-lentiginous melanoma

52
Q

T or F:

Shave biopsies should never be performed in any case in which the diagnosis of melanoma is possible.

A

True

53
Q

Melanoma Staging is based on _____ classification

A

TNM (tumor-node-metastasis) classification:
Tumor: primarily based upon the Breslow depth of melanoma invasion
Node: number of metastatic lymph nodes
Metastasis: presence of visceral or other distant tissue metastasis

54
Q

What stage of melanoma is this?

Localized melanoma only, no nodal or other metastatic disease

A

Stage I and II

55
Q

What stage of melanoma is this?

Regional nodal metastasis without evidence of distant metastasis

A

Stage III

56
Q

What stage of melanoma is this?

Presence of distant metastasis

A

Stage IV

57
Q

How does melanoma metastasize early vs late in the disease?

A

Early metastasis occurs via lymphatic spread while later metastasis occurs via the bloodstream.

58
Q

What is the chief site for metastatic melanoma?

A

skin

59
Q

What is the most common cause of death in metastatic melanoma?

A

Central nervous system metastasis is the most common cause of death.

Derm Rotation M2 (4 decks)

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