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Dermatology > 19: Malignant and Pre-Malignant Lesions of Skin - Halverson > Flashcards

19: Malignant and Pre-Malignant Lesions of Skin - Halverson Flashcards

1
Q

only way to definitively diagnose malignancy

A

biopsy

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2
Q

ABCD and other indications of malignancy

A

asymmetry
irregular border
color change
diameter

changing/growing, bleeding, itching

firm, red papule, small, smooth, shiny, pale or waxy papule with telangiectasia

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3
Q

Stages of Skin Cancer

A 
0 = carcinoma in situ
I = less than 2 cm wide
II = greater than 2 cm wide
III = cancer has spread into subcutaneous tissue, such as cartilage, m, bone or to nearby lymph odes. not spread to other places in body
IV = cancer has spread to other places in body METASTATIC
Recurrent = cancer comes back in same area of body
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4
Q

most common malignant cutaneous neoplasm (among caucasians)

A

basal cell carcinoma

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5
Q

describe basal cell carcinoma

A
  • sun exposed areas
  • often multiple
    slow-growing destructive
  • locally invasive, rarely metastasize
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6
Q

origin of basal cell carcinoma

A

basal layer of epidermal keratinocytes

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7
Q

histology indications
peripheral palisading
mucinous stroma
nodular form or morpheaform

A

basal cell carcinoma

Peripheral Palisading: Forms an orderly line around the periphery of tumor nests
Mucinous stroma
Nodular Form: Large nests of tumor cells
Morpheaform: Infiltrative nests and cords within a fibromyxoid stroma

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8
Q

most common form of basal cell carcinoma

A

nodular basal cell carcinoma

  • often flesh-colored, dome-shaped nodule or papule
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9
Q

“rolled borders”

A

nodular basal cell carcinoma

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10
Q

worst type of basal cell carcinoma

A

morpheaform basal cell carcinoma

can be deeply invasive - high recurrence rate

look indurated, often flesh colored plaque

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11
Q

least aggressive form of basal cell carcinoma

A

superficial basal cell carcinoma

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12
Q

most comm basal cell carcinoma of LE and feet

A

superficial basal cell carcinoma

resembles eczema or psoriasis

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13
Q

gorlin’s syndrome

A

nevoid basal cell epithelioma syndrome

multiple BCC b/w puberty and 35 yo
assoc w/ palmar and plantar pits, skeletral abnormalities, jaw cysts, ectopic calcifications,

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14
Q

second most prevalent malignant tumor of skin

A

squamous cell carcinoma

most common among african americans and asian indians

metastasizes to lymph nodes and can be fatal

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15
Q

presents as non-healing ulcer or nodules. chronic ulcers, injury and burn scars are more aggressive and likely metastasize

A

squamous cell carcinoma

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16
Q

“keratin pearls”

A

squamous cell carcinoma

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17
Q

tx of choice squamous cell carcinoma

A

surgical excision

but oncology consult should take place for every pt with confirmed malignant neoplasm

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18
Q

multiple, erythematous to yellow-brown dry scaly lesions

A

actinic keratosis

SCC often develop in background of AK

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19
Q

keratinocytic atypia limited to lower portion of epidermis, often with epidermal budding

A

actinic keratosis histology

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20
Q

etiology of kaposi sarcoma

A

viral HHV8

21
Q

violaveous macules and papules wwith slow progression to plaques

A

kaposi sarcoma (color due to vascular nature of tumor)

22
Q

margin

A

rim of normal skin around the neoplasm

size of margin depends on the type of neoplasm

23
Q

mohs surgery

A

each layer is immediately examined under a microscope. continue to shave away until no cancer cells can be seen under microscope

24
Q

should you do electrodesiccation and curettage or cryosurgery for colored lesions?

A

no

25
Q

most lethal type of skin malignancy

A

melanoma

26
Q

ABCDEs of malignant melanoma

A 
asymmety
border irregularity
color variation
diameter enlargement
evolving/elevated
27
Q

malignant melanoma staging - Clark staging indicates level of invasion

A

I - all tumors above BM (in situ)
II - extends to papillary dermis
III - extends to interface b/w papillary and reticular dermis
IV - extends b/w bundles of collagen of reticular dermis
V - invasion of subq tisssue (87% metastases)

28
Q

breslows depth (malignant melanoma)

A

Tumors are classified into four categories based on the depth:

pT1: Less than or equal to 1.00 mm (equivalent to Clark’s Level II)
pT2: 1.01-2.00 mm (equivalent to Clark’s Level III)
pT3: 2.01- 3.99 mm(equivalent to Clark’s Level IV)
pT4: Greater than or equal to 4 mm (equivalent to Clark’s Level V)

More accurate than Clarks Staging

4mm: 5-year survival is 37-50%

29
Q

TNM

A

tumor, nodes(lymph), metastasized

T – Tumor - Based on the tumor thickness, a number (from 0 to 4) is assigned, and based on the ulceration, a letter (a or b) is assigned. The staging definition of metastatic melanoma when the primary site is unknown is to be categorized as stage III and not stage IV.

N –Nodes (Lymph)– Based on whether or not the melanoma has spread to lymph nodes, a number (from 0 to 3) is assigned. Nodal tumor deposits of any size are to be included in staging nodal disease.

M – Metastasized – Based on whether or not the melanoma has spread to other organs.The M category is primarily defined by the site or sites of distant metastases:M1a - skin/soft tissue/distant nodalM1b - lungM1c - all visceral metastitic sites; patients with an an increased serum lactic dehydrogenase level are all categorized as M1c regardless of the site or sites of distant disease.

30
Q

T categories

A

Stage Tis. The tumor is in situ and remains non-invasive in the epidermis.
Stage T1a. The tumor is invasive but less than or equal to 1.0 mm in Breslow’s thickness, without ulceration and with a mitotic rate of less than 1/mm2.
Stage T1b. The tumor is less than or equal to 1 mm thick. It is ulcerated and/or the mitotic rate is equal to or greater than 1/mm2.

Stage T2a. The tumor is 1.01-2.0 mm thick without ulceration.
Stage T2b. The tumor is 1.01-2.0 mm thick with ulceration.

Stage T3a. The melanoma is 2.01-4.0 mm thick without ulceration.
Stage T3b. The melanoma is 2.01-4.0 mm thick with ulceration.

Stage T4a. The tumor is thicker than than 4.0 mm without ulceration
Stage T4b. The tumor is thicker than 4.0 mm with ulceration

31
Q

when do you automatically get lymph node biopsy?

A

T1b and above

32
Q

The two main factors in determining how advanced the melanoma is into Stage IV

A

the site of the distant metastases (nonvisceral, lung, or any other visceral metastatic sites) and elevated serum lactate dehydrogenase (LDH) level.

33
Q

should you cauterize a pigmented lesion?

A

NEVER

34
Q

melanoma on plams, soles, nails

A

acral lentiginous

35
Q

worst prognosis of melanomas

A

nodular melanoma

36
Q

hutchinsons sign

A

sudden appearance of subungual pigmented and at proximal nail fold

37
Q

misdiagnosed as pyogenic granuloma

A

acral lentiginous melanoma

38
Q

sentinel lymph node biopsy

A

Performed after the biopsy of the melanoma but before the wider excision of the tumor.

A radioactive substance is injected near the melanoma and movement of the substance is viewed on a computer screen.

The first lymph node(s) to take up the substance is called the sentinel lymph node(s). (The imaging study is called lymphoscintigraphy.)

The procedure to identify the sentinel node(s) is called sentinel lymph node mapping. The sentinel node(s) are removed to check for cancer cells.

If a sentinel node contains cancer cells, the rest of the lymph nodes in the area are removed (lymph node dissection). However, if a sentinel node does not contain cancer cells, no additional lymph nodes are removed.

39
Q

cutaneous horn appears as funnel-shaped growth that extends from a red base on the skin

A

cutaneous horns - premalignant lesion

composed of compacted keratin

40
Q

melanoma tx by stage

A

Stage 0
People with Stage 0 melanoma may have minor surgery to remove the tumor and some of the surrounding tissue.

Stage I
People with Stage I melanoma may have surgery to remove the tumor. The surgeon may also remove as much as 2 centimeters (3/4 inch) of tissue around the tumor. To cover the wound, the patient may have skin grafting.

Stage II or Stage III
People with Stage II or Stage III melanoma may have surgery to remove the tumor. The surgeon may also remove as much as 3 centimeters (1 1/4 inches) of nearby tissue. Skin grafting may be done to cover the wound. Sometimes the surgeon removes nearby lymph nodes.

Stage IV
People with Stage IV melanoma often receive palliative care. The goal of palliative care is to help the patient feel better—physically and emotionally. This type of treatment is intended to control pain and other symptoms and to relieve the side effects of therapy (such as nausea), rather than to extend life.

The patient may have one of the following:
Surgery to remove lymph nodes that contain cancer cells or to remove tumors that have spread to other areas of the body
Radiation therapy, biological therapy, or chemotherapy to relieve symptoms

41
Q

describe superficial spreading malignant melanoma

A
  • any body part
  • raised irregular border, uneven pigment
  • slow growing
  • detected early, excellent prognosis
42
Q

describe lentigo maligna

A
  • sun-exposed areas
  • flat, irregular border, tan, black, areas of red, white, blue and gray
  • very slow growing
  • detected early prognosis good
43
Q

describe nodular

A
  • any body part
  • nodule blue, brown or black, or amelanotic
  • grows very rapidly
  • grave prognosis
44
Q

describe acral lentiginous

A
  • palms, soles nail beds
  • flat, sometimes no pigment
  • may remain latent for years
  • greater than 3 mm is poor prognosis
45
Q

describe basal cell carcinoma

A
  • most common malignant skin lesion
  • face, lower legs and feet
  • slow growing
  • good if caught early
46
Q

describe squamous cell carcinoma

A
  • 2nd most common malignant skin lesion
  • sun-exposed wounds, scars
  • may metastasize
  • grade IV worse prognosis
47
Q

describe kaposi sarcoma

A
  • older males, european/mediterranean/jewish, AIDS
  • ankles and feet
  • slow progression
  • good prognosis
48
Q

describe malignant melanoma

A
  • most common malignancy seen by podiatrists
  • any body part
  • metastasize
  • nodular and acral lentiginous worse prognosis

Dermatology (24 decks)

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