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FITZPATRICK'S DERMATOLOGY 9TH EDITION (SHAMMY) > 20 - 110 - EPITHELIAL PRECANCEROUS LESIONS > Flashcards

20 - 110 - EPITHELIAL PRECANCEROUS LESIONS Flashcards

1
Q

Precursor lesions of cutaneous squamous cell carcinoma (SCC).

A

ACTINIC KERATOSES

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2
Q

most important etiologic factor in the development of actinic keratoses

A

Long-term and cumulative ultraviolet (UV) radiation exposure

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3
Q

Risk factors of Actinic keratoses

A

fair skin, age, cumulative UV radiation exposure, immunosuppression, prior history of non-melanoma skin cancer

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4
Q
A

Actinic Keratoses

Multiple scaly and erythematous plaques on the dorsal hands of a 71-year-old male patient with a history of significant ultraviolet exposure. The lesions were grade II to grade III actinic keratoses.

They typically develop on sun-exposed areas, such as the balding scalp, head, neck, forearms, dorsal hands, and in women, additionally the dorsal legs (Fig. 110-1).

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5
Q
A

Mild actinic keratoses on the face of a fairskinned woman (grade I). The lesions appear as erythematous patches with a rough texture on palpation. Note other signs of actinic skin damage such as perioral wrinkling and the presence of solar lentigines.

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6
Q
A

Field cancerization. There are several ill-defined erythematous and scaly plaques, crusts, and ulcerations affecting a large area (“field”) of the balding scalp. Further alterations, such as mottled hypopigmentation and hyperpigmentation, are present and indicate actinic damage.

Alongside clinically detectable AKs, multiple subclinical lesions may be present (Fig. 110-3). This concept is known as field cancerization and is crucial for the therapeutic approach.

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7
Q
A

A, Multiple well-defined hypertrophic actinic keratoses on the decollete of a middle-aged female. B, A higher magnification reveals the rough and hyperkeratotic texture of some lesions.

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8
Q

main clues to the transition of AK to SCC

A

induration, inflammation, pain, and ulceration

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9
Q

type of hypertrophic AK that presents with a conical hypertrophic protuberance emanating from a skin-colored to erythematous papular base

A

Cutaneous horn, also known as cornu cutaneum, refers to a reaction pattern and not a particular lesion.

A, Cutaneous horn of the ear. Only biopsy will confirm whether this is an actinic keratosis or a squamous cell carcinoma. B, Cutaneous horn of the cheek.

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10
Q

represents confluent AKs on the lips, most often the lower lip

A

Actinic cheilitis

Persons with this condition have red, scaly, chapped lips, and at times erosions or fissures may be present (Fig. 110-6). The vermilion border of the lip is often indistinct, and focal hyperkeratosis and leukoplakia also may be seen. Individuals with this condition often complain of persistent dryness and cracking of the lips.

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11
Q

Classification of Actinic Keratosis

A

Olsen classification

Grade 1 includes lesions that are mild, slightly palpable, and are better seen than felt

Grade 2 represents lesions that are moderately thick and easily seen and felt.

Grade 3 lesions are severe, very thick and/or obvious AKs

Roewert-Huber classification (scheme for grading AK severity)

type AK I, atypical keratinocytes are restricted to the lower third of the epidermis and are only found within the basal and suprabasal layers.

type AK II, atypical keratinocytes are found within the lower two-thirds of the epidermis, alternating with zones of normal epidermis. In the upper papillary dermis buds of keratinocytes can be found

type AK III, atypical keratinocytes extend to the lower two-thirds of the full thickness of the epidermis. They can also involve the epithelia of the hair follicle, infundibula, and acrosyringium.

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12
Q

most important contributing factors for the formation of AKs.

A

Fair skin and exposure to UV radiation

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13
Q
A
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14
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A
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15
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A
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16
Q
A
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17
Q

single most effective means of decreasing the risk of AKs

A

Minimizing UV radiation

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18
Q

squamous cell carcinoma (SCC) in situ

A

Bowen disease (BD)

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19
Q
A
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20
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A
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21
Q
A
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22
Q

Bowenoid papulosis is a precancerous condition of the genitalia caused by infection with high-risk HPV, most commonly with types

A

16, 18 and 33

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23
Q
A
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24
Q

Epidermodysplasia verruciformis (EV) is an inherited skin condition with a high local susceptibility to infection with human papillomavirus (HPV), most commonly with HPV types ________

A

types 5 and 8

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25
Q
A
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26
Q

Anal intraepithelial neoplasia (AIN) is associated with high-grade human papillomavirus (HPV) types, most commonly with types _________________

A

types 16, 18, 31, and 33

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27
Q
A
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28
Q

clinical term that refers to a predominantly white lesion of the oral mucosa that cannot be rubbed off or characterized by any other definable lesion or known disease

A

LEUKOPLAKIA

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29
Q

most common potential malignant lesion of the oral mucosa, with the potential to become oral SCC

A

LEUKOPLAKIA

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30
Q

markers for increased risk for additional oral or upper aerodigestive tract malignancies.

A

Leukoplakia and erythroplakia

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31
Q

strongest risk factor for the development of leukoplakia

A

Tobacco

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32
Q
A
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33
Q

In leukoplakia, if causative agents, such as tobacco or mechanical irritation, are detected, it is recommended to eliminate these factors for a period of

A

2 to 6 weeks

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34
Q
A
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35
Q

clinical term used to describe a red macule or patch on a mucosal surface that cannot be categorized as any other known disease entity caused by inflammatory, vascular, or traumatic factors

A

Erythroplakia (or erythroplasia)

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36
Q

Of all potentially malignant lesions in the oral cavity, _______ is considered to be the most dangerous and carries the greatest risk of progressing to or harboring invasive carcinoma.

A

erythroplakia

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37
Q
A
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38
Q

Precancerous lesions that result from long-term exposure to infrared radiation; can progress to squamous cell carcinoma (SCC).

A

THERMAL KERATOSES

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39
Q

Precursor lesion of thermal keratoses

A

Erythema ab igne

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40
Q

Precancerous lesions resulting from prolonged exposure to tar.

A

HYDROCARBON KERATOSES

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41
Q

precancerous lesions that may arise at irradiated sites years after such exposure and may progress to squamous cell carcinoma.

A

CHRONIC RADIATION KERATOSES

42
Q

All are true in describing AK, except:

a. The overall risk of progression to invasive SCC is 1-5%
b. Risk factors include fair skin, age, cumulative UV radiation exposure, immunosuppression, prior history of non-melanoma skin cancer.
c. Workers with a long history of outdoor occupation, such as farmers, construction workers, or fishermen, have an up to 2.5-fold increased risk compared to indoor workers.
d. The prevalence increases with age in both sexes.However, men are more likely to develop AK than women.

A

ANSWER: A. Page. 1857. The overall risk of progression to invasive SCC is estimated as 5% to 10%.

43
Q

A. Erythematous AK

B. Hypertrophic AK

  1. has a propensity for dorsal hands, arms, and scalp.
  2. It is usually more easily felt than seen
  3. most often found against a background of photodamaged skin
A

ANSWER: B,A,A

P.1858 The typical AK lesion presents most commonly as a 2to 6-mm, erythematous, flat, rough, gritty or scaly papule (Fig. 110-2). It is usually more easily felt than seen. They are most often found against a background of photodamaged skin

p. 1859. A hypertrophic AK presents as a thicker, scaly, rough papule or plaque that is skin- colored, gray-white, or erythematous (Fig. 110-4). It can be found on any chronically sun-exposed body site, but has a propensity for dorsal hands, arms, and scalp

44
Q

LL are main clues to the transition of AK to SCC, except:

a. Induration
b. Inflammation
c. Telangiectasia
d. Pain

A

ANSWER: C; P.1859. Induration, inflammation, pain, and ulceration are the main clues to the transition of AK to SCC.

45
Q

A pyrimidine analog and acts as an antimetabolite and via inhibition of the thymidylate synthetase as a cytostatic drug

a. Imiquimod
b. 5-FU
c. Diclofenac
d. Ingenol mebutate

A

ANSWER: B; p.1866 5-FU is a pyrimidine analog and acts as an antimetabolite and via inhibition of the thymidylate synthetase as a cytostatic drug.

46
Q

EV is a rare inherited skin condition that is characterized by a high susceptibility to infection with some types of HPV, in particular types _ and _

a. 6, 11
b. 16,18
c. 5,8
d. 2,3

A

ANSWER: C; p. 1872 EV is a rare inherited skin condition that is character- ized by a high susceptibility to infection with some types of HPV, in particular types 5 and 8

47
Q

All statements are correct, except

a. treatment is optional for LSIL (AIN 1)
b. AIN is usually asymptomatic
c. Major risk factors for AIN are UV exposure, HPV infection, smoking and immunosuppression
d. AIN is commonly localized within the transitional zone of squamous epithelium of the anus.

A

ANSWER: C.UV EXPOSURE NOT INCLUDED.. p.1874 at a glance. Major risk factors for AIN are HPV infection, high-risk sexual behavior (anal intercourse), HIV infection with low levels of CD4+ T cells, smoking, immunosuppression, a history of genital warts, and a history of cervical cancer in females.

48
Q

a. Genital bowen disease
b. Erythroplasia of queyrat
c. Both
d. None
9. common type of PIN usually associated with HPV 8 and HPV 16 infection.
10. has a higher risk of progression to invasive SCC

A

ANSWER: B, B. p.1875 EQ is a common type of PIN usually associated with HPV 8 and HPV 16 infection; The EQ variant of PIN has a higher risk of progression to invasive SCC (∼30%) than the GBD variant (3% to 6%).

49
Q

Fill in the blanks.

Field cancerization definition.

(a) more than ______ AKs within ___skin area with signs of solar damage,
(b) at least ____ AKs within ____ cm2 of skin, or
(c) more than ____ AKs in ____ body region or field and contiguous areas of chronic actinic sun damage and hyperkeratosis

A

(a) more than** 2 AKs **within **1 skin area **with signs of solar damage,
(b) at least 3 AKs within 25 cm2 of skin, or
(c) more than 5 AKs in 1 body region or field and contiguous areas of chronic actinic sun damage and hyperkeratosis

50
Q

Identify the clinical classification of actinic keratosis (Olsen et al)
Choices:
* Grade 1 (Mild)
* Grade 2 (Moderate)
* Grade 3 (Severe)

Slight palpability

A

Grade 1 (Mild)

51
Q

Identify the clinical classification of actinic keratosis (Olsen et al)
Choices:
* Grade 1 (Mild)
* Grade 2 (Moderate)
* Grade 3 (Severe)

Very thick or obvious AK

A

Grade 3 (Severe)

52
Q

Identify the clinical classification of actinic keratosis (Olsen et al)
Choices:
* Grade 1 (Mild)
* Grade 2 (Moderate)
* Grade 3 (Severe)

Moderately thick AK

A

Grade 2 (Moderate)

53
Q

Identify the clinical classification of actinic keratosis (Olsen et al)
Choices:
* Grade 1 (Mild)
* Grade 2 (Moderate)
* Grade 3 (Severe)

Easily seen and felt

A

Grade 2 (Moderate)

54
Q

Identify the clinical classification of actinic keratosis (Olsen et al)
Choices:
* Grade 1 (Mild)
* Grade 2 (Moderate)
* Grade 3 (Severe)

AK better felt than seen

A

Grade 1 (Mild)

55
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)

Involvement of the lower two-thirds of the epidermis

A

Early in situ SCC (type AK II)

56
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)

Involvement of basal and suprabasal layers of the epidermis

A

Early in situ SCC (type AK I)

57
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)

Alternation with zones of normal epidermis

A

Early in situ SCC (type AK II)

58
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)

Nuclei hyperchromatic and variable in size
Loss of nuclear polarity

A

Early in situ SCC (type AK I)

59
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)

Buds of keratinocytes in the upper papillary dermis

A

BOTH Early in situ SCC (type AK II)
and In situ SCC (type AK III)

60
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)

Involvement of more than two-thirds of the full epidermal thickness

A

In situ SCC (type AK III)

61
Q

Identify the Histologic Classification of Actinic Keratosis (Roewert-Huber et al.)
Choices:
* Early in situ SCC (type AK I)
* Early in situ SCC (type AK II)
* In situ SCC (type AK III)
**
Involvement of hair follicle, infundibula, and acrosyringium**

A

In situ SCC (type AK III)

62
Q

indications for biopsy for AK lesions

A
  • rapidly enlarging lesions,
  • bleeding or ulceration,
  • evidence of inflammation,
  • strong induration,
  • lesions extending beyond 1 cm of size, or
  • resistance to treatment
63
Q

The alternation of hyperorthokeratosis and hyperparakeratosis is common in later stages, a feature that is referred to as “flag sign” or “pink and blue.”

This is seen in what condition?

A

Actinic Keratosis

Initially, a compact packing of basal and suprabasal atypic keratinocytes with hyperchromatic and pleomorphic nuclei can be seen.

Atypic mitotic figures, apoptotic cells and dyskeratosis may be present.

The architecture is increasingly lost in the basal layers, but not the full thickness of the epidermis.

Per definition, the lesion is confined to the epidermis. The underlying dermis often shows solar elastosis and a superficial inflammatory infiltrate.

64
Q

Dermoscopy findings of AK

A

**Nonpigmented lesions **
- scales that appear as whitish or yellowish crystalline structures and a reddish pseudonetwork with erythema and wavy configuration of telangiectasias between enlarged hair follicles.
- The follicles may show a perifollicular halo, resulting in a “strawberry pattern.”
- Hyperkeratotic AK lesions on the face may have prominent keratotic plugs within the hair follicles (targetoid-like pattern).
- The **rosette sign **consists of white dots localized inside the follicular openings, which may reflect alternating orthokeratosis and parakeratosis.

**Pigmented lesions **
- brown dots and globules surrounding the follicular openings

65
Q

Inactivating mutations of the _____________ occur as early and common events in AK

A

tumor-suppressor gene p53

66
Q

are adnexal epithelium involved in actinic keratosis?

A

NO

there is sparing of adnexal epithelium

67
Q

Dermoscopic findings of intense pigmentation and gray rhomboidal lines are diagnostic clues for what condition?

A

Lentigo Maligna

68
Q

Lesion tartgeted therapies for AK

A
69
Q

Topical treatment options for AK

A
70
Q

this vitamin was reported safe and effective in reducing the rates of new nonmelanoma skin cancer and AK in high-risk patients

A

nicotinamide (vitamin B3 )

71
Q

How many percent of bowen disease can progress to Bowen carcinoma (invasive SCC)?

A

5%

72
Q

Men are more likely to have bowen disease on what areaS?

A

balding scalp, ear, and anterior trunk

73
Q

Women commonly have bowen disease on what areas?

A

cheeks and lower legs

74
Q

Sites of predilection of bowen disease

A

sun-exposed areas such as the** head and neck and lower legs, **although any site of the body may be affected.

75
Q

Clinical variants of bowen disease

A

pigmented, intertriginous, periungual, and subungual BD.

76
Q

The most important etiologic factors for the development of BD

A

long history of significant UV exposure and infection with HPV

77
Q

histologic findings of bowen disease

A
  • full-thickness epidermal atypia with loss of the stratified epidermal architecture that is clearly demarcated from the surrounding physiologic structures
  • Abnormal mitoses, acanthosis, and hyperkeratosis
  • parakeratosis is usually present.
  • The degree of cytologic atypia may be variable.
  • Typical are hyperchromatic, pleomorphic, and enlarged nuclei
78
Q

Most common associated HPV types with Bowenoid papulosis (BP)

A

HPV 16,18

79
Q

Most common associated HPV types with Epidermodysplasia verruciformis (EV)

A

HPV 5, 8

80
Q

Most common associated HPV type with Digital/periungual Bowen disease

A

HPV 16

81
Q

Most common associated HPV types with Penile intraepithelial lesions (PIN)

A

HPV 16

82
Q

Most common associated HPV types with Vulvar intraepithelial lesions (VIN)

A

HPV 16

83
Q

Most common associated HPV types with Anal and perianal intraepithelial lesions (AIN, PaIN)

A

HPV 16

84
Q

Most common associated HPV types with Epidermodysplasia verruciformis (EV)

A

HPV 5 & 8

85
Q
A
86
Q

precancerous condition of the genitalia caused by infection with high-risk HPV, most commonly with types 16, 18, and 33.

A

BOWENOID PAPULOSIS

87
Q

Bowenoid papulosis is a precancerous condition of the genitalia caused by infection with high-risk HPV, most commonly with types

A

HPV 16, 18, 33

88
Q

age group and gender most commonly affected with bowenoid papulosis

A

young to middle-aged sexually active individuals with a male predominance

89
Q

T/F. Bowenoid papulosis is highly contagious

A

True

BP is highly contagious and patients with BP and their sexual partners should be followed and examined periodically, because of the increased risk of developing SCC or cervical or vulvar neoplasia.

90
Q

Epidermodysplasia verruciformis (EV) is associated with loss of function mutations of what genes?

A

Loss-of-function mutations of the genes** EVER1 and EVER2**

91
Q

2 different morphologies of Epidermodysplasia verruciformis (EV)

A
  1. EV-plane warts - numerous thin, pink, flat-topped papules and plaques that resemble flat warts (verrucae planae)
  2. widespread scaly, erythematous, or hypopigmented macules and flat papules that appear similar to **tinea versicolor **
92
Q

erythroplasia of Queyrat (EQ) is a common type of Penile intraepithelial neoplasia (PIN) is usually associated with what HPV subtypes?

A

HPV 8 and HPV 16 infection

93
Q

2 Clinical presentations of leukoplakia

A
  1. Homogeneous leukoplakia has been defined as a mostly white, flat, uniform lesion. It may have shallow cracks and a smooth, wrinkled, or corrugated surface (Fig. 110-13).
  2. Nonhomogeneous leukoplakia is defined as a mostly white or white-reddish lesion (“erythroleukoplakia”) that may be irregular and flat, nodular, ulcerative, or verrucous.
94
Q

T or F. Nonhomogeneous leukoplakia has a significant higher risk of malignancy than does homogeneous leukoplakia.

A

True

95
Q

This represents a rare form of leukoplakia, which is most often found in patients who do not use tobacco products. It has a high rate of malignant transformation and recurrence after treatment.

A

Proliferative verrucous leukoplakia

96
Q

the most important indicators for malignant transformation of leukoplakia

A

epithelial dysplasia and nonhomogeneous clinical subtype

97
Q

This has been well described in the chutta smokers (reverse cigar smokers) of India.

A

Erythroplakia

98
Q

In erythroleukoplakia, the red ______ are most prone for malignant transformation.

A

patches

99
Q

After excision of erythroplakia, lesions that exceed ___ mm2 have a significant higher risk of recurrence.

A

80mm2

100
Q

Arsenic keratosis are commonly localized where?

A

Palms and soles

appear as gray-to-yellow keratotic papules

101
Q

umbrella term covering malignant changes within a scar from any cause.

A

Marjolin ulcer

FITZPATRICK'S DERMATOLOGY 9TH EDITION (SHAMMY) (122 decks)

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