Neoplasms and Verrucous Lesions Questions

Question 1

Which lesions are considered benign?

Answer 1

SK (verrucous lesion), Nevi (moles)

Question 2

Which lesions are considered pre-malignant?

Answer 2

Actinic Ketosis (verrucous lesion)

Question 3

What lesions are considered malignant?

Answer 3

Neoplasms: basal cell skin cancer, squamous cell skin cancer, malignant melanoma

Question 4

What is seborrheic keratosis (SK)?

Answer 4

A benign verrucous lesion that develops from immature keratinocyte proliferation (can be hereditary: where patients get numerous lesions)

Question 5

What are the characteristics of SK?

Answer 5

Appears in adulthood, appearance can vary, sharply defines, raised/stuck on appearance, tan/black in color (multicolor)

Usually asymptomatic but mild itching and tenderness can occur if the lesion is irritated

(women may get them under the breast)

Question 6

What is the treatment for SK?

Answer 6

No treatment is necessary

Yet, it is good to get a biopsy if the lesion is not a clear cut SK (rule out cancerous lesions)

If symptomatic: freezing,shaving, or slicing off the lesion may relieve itching (Sarna lotion can also help!)

Question 7

What is the RED FLAG symptom of SK?

Answer 7

Leser-Trelat: sudden onset of numerous SK’s, may indicate cancer
Ask about other symptoms: weight loss, night sweats, fatigue, unexplained fever, tarry stool, lymph node swelling

Question 8

What is Actinic Keratosis (AK)?

Answer 8

Considered pre-skin cancer caused by excess sun exposure (usually in childhood or teenage years)

Question 9

What are the clinical features of AK?

Answer 9

Scaly, flaky, rough, red, pink, sensitive and common on face, ears, scalp, forearms, chest, upper back, and hands (may come and go and then be permanent), usually a clinical diagnosis

In finger could be presented as a cutaneous horn

Question 10

What are the treatments for AK?

Answer 10

Because of the high possibility to develop into squamous cell skin cancer, usually treated, consider biopsy
Destruction of lesion using liquid nitrogen or topical chemotherapy (depending on location, #, size)

Question 11

What is a nevi?

Answer 11

A benign mole resulting from proliferation of cutaneous melanocytes (can be pink, flesh colored, brown, raised, or flat)

Question 12

What are the risk factors for developing skin cancer?

Answer 12

Fair skin, light hair, environment, sunburn tendency, personal history of skin cancer, family history of melanoma, 50+ moles, immunocompromised

Question 13

What is basal cell skin cancer?

Answer 13

Most common form of skin cancer that is usually non-life threatening (caused by increased sun exposure)
Common on sun exposed skin like the face

Question 14

What are the clinical features of basal cell skin cancer?

Answer 14

Pearly/shiny bump, scar-like appearance, red scaly crusted patch, lesions may bleed, sore throat that does not heal
**slow growing, diagnosed by biopsy

Question 15

What are the treatments for basal cell skin cancer?

Answer 15

Dependent on size, location, and type of carcinoma
ED&C- scraping/burning
Excision- cutting out/stitching
MOHS- layer by layer targeted procedure with high cure rate and better cosmetic outcome

Excellent cure rate :) patient has to return for regular skin exams

Question 16

What is squamous cell skin cancer?

Answer 16

Second most common form of skin cancer, common on skin that has been traumatized (burns, scars, persistent sores)

**immunosuppressed= greater risk

Question 17

What are the clinical features of squamous cell skin cancer?

Answer 17

Thick/rough horn like lesion, warty sore, may bleed, irregular red patch that does not resolve, crater-like/meaty lesion

diagnosed by biopsy

**faster growing

Question 18

What are the treatments for squamous cell skin cancer?

Answer 18

Depends on size, location, type

cryotherapy (freezing)
topical chemo
ED&C- scraping/burning
Excision- cutting & stitching
MOHS- layer by layer

If treatment modalities do not work, resort to radiation

Question 19

What is malignant melanoma?

Answer 19

The most serious skin cancer
Factors: amount of sun exposure, heredity

If diagnosed early, good cure rate
If there’s a delay in diagnosis, cure rates decrease due to spreading (can be fatal)

Question 20

What are the ABCD’s of melanoma?

Answer 20

Warning signs of melanoma (fried egg appearance, variation/change in color, getting larger)
Asymmetry
Borders
Color
Diameter
Evolving
Failure to respond to treatment

Question 21

What are the four main types of melanoma?

Answer 21

Superficial Spreading, Lentigo Maligna, Acral Lentiginous, Nodular

Question 22

What is superficial spreading melanoma? Where is it most commonly found?

Answer 22

Melanoma that is flat, irregular, and different shades of black/brown

Starts in situ

Commonly found on trunk in men, legs in women, upper back in both

Question 23

What is lentigo maligna? Where is it most commonly found?

Answer 23

Melanoma that is often seen as a “sun spot” that can become cancerous, it’s usually found in the elderly that have chronically damaged skin

Starts in situ

Commonly found on the face, ears, arms, and upper trunk

Question 24

What is acral lentiginous melanoma? Where is it most commonly found?

Answer 24

Melanoma that can advance quickly and is commonly found in African Americans and Asians

Starts in situ

Commonly found on soles of feet, palms of hands (can be seen in between toes/fingers), and fingernails

Question 25

What is nodular melanoma? Where is it most commonly found?

Answer 25

Melanoma that starts invasive (worse of a prognosis)
Seen as a blackish blue raised area

Usually found on trunk, legs, arms, scalp of men

*Most aggressive

Question 26

What is the prognosis of melanoma based on?

Answer 26

Depth (Breslow’s thickness), and stage of tumor

Question 27

What is Breslow’s thickness?

Answer 27

A measurement scale that determines the depth of the tumor in mm to further diagnose stage/prognosis of cancer
in situ- epidermis
thin- less than 1mm
intermediate- 1-4mm
thick- greater than 4mm

Question 28

What is stage 0?

Answer 28

In situ (confined to the epidermis)

Question 29

What is stage I?

Answer 29

Confined to skin as thick as 1mm

Question 30

What is stage II?

Answer 30

1.01mm-4mm thick, yet no spreading

Question 31

What is stage III?

Answer 31

Spread to nearby lymph nodes/skin

Question 32

What is stage IV?

Answer 32

Spread to internal organs, far away skin/far away lymph nodes

Metastasis commonly found in skin, soft tissue, lungs, and brain

Question 33

What are the treatment options for malignant melanoma?

Answer 33

Lesions must be surgically excised with a certain border of normal looking skin/tissue taken with them

Margins depend on depth of lesion (breslow’s thickness)

Referral and multi-faced treatment may be necessary for more serious cases

Question 34

What are good practices of sun safety?

Answer 34

Avoid deliberate tanning, wear protective dark clothing/eyewear, avoid mid day sun when at it’s peak

Question 35

When should sunscreen be worn?

Answer 35

All year round

Question 36

What SPF is recommended for sun safety/ when should this be applied?

Answer 36

SPF 30, should be applied 15 minutes before exposure and reapplied every 2 hours (lip balm also!)