20 - 112 - SQUAMOUS CELL CARCINOMA AND KERATOACANTHOMA

Question 1

What is the most common skin cancer in immunocompetent white individuals?

A. SCC

B. BCC

C. Melanoma

D. Keratoacanthoma

Answer 1

Answer B p 1901

Question 2

What is the most common skin cancer in immunosuppressed organ transplant recepients?

A. SCC

B. BCC

C. Melanoma

D. Keratoacanthoma

Answer 2

Answer A p 1901

Question 3

Metastases in SCC are predominantly ________ .

A. Pulmonary

B. Hepatic

C. Cutaneous

D. Nodal

Answer 3

Answer D p 1901

Question 4

Which of the following is not at higher risk of acquiring SCC?

A. Red hair

B. Blue eyes

C. High latitude

D. High altitude

Answer 4

Answer C p 1902

Question 5

Which of the following photosensitizing drugs increase the risk for SCC?

A. Fluoroquinolones

B. Isoniazid

C. Lithium

D. Terbinafine

Answer 5

Answer A p 1905

Question 6

Which of the following is mismatched?

A. Oral cavity: oral florid papillomatosis

B. Genitoanal region: giant condyloma acuminatum Buschke-Lowenstein

C. Plantar skin: epithelioma cuniculatum

D. Amputation stump: stump papillomatosis

Answer 6

Answer D p 1908

Question 7

High risk features of SCC inludes the following except _______ .

A. >2 mm

B. Clark level >II

C. Perineural invasion

D. Primary site at the lip

Answer 7

Answer B p 1911

Question 8

The primary mode of therapy for SCC is ______ .

A. Wait for spontaneous resolution

B. Conventional standard excision

C. Mohs surgery

D. Radiation therapy

Answer 8

Answer C p1912

Question 9

Which of the following is false regarding keratoacanthoma?

A. It is regarded as a subtype of poorly differentiated SCC

B. It usually erupts rapidly within a few weeks

C. It has the ability to spontaneously regress

D. It clinically presents as a sharply circumscribed firm nodule with a central horn-filled crater that typically arises on the head and sun-exposed areas of the extremities

Answer 9

Answer A p1908

Question 10

The histopathologic hallmark of invasive SCC is __________ .

A. pleomorphic nuclei with a high degree of atypia

B. frequent mitoses

C. the growth of atypical keratinocytes beyond the basement membrane into the dermis

D. very few areas of keratinization

Answer 10

Answer C p1909

Question 11

second most common skin cancer in immunocompetent white individuals

Answer 11

SCC

Question 12

most common skin cancer in immunocompetent white individuals

Answer 12

BCC

Question 13

most common skin cancer in immunosuppressed organ transplantation recipients worldwide

Answer 13

SCC

Question 14

Risk factors for SCC

Answer 14

• ultraviolet (UV) radiation
• genetic predisposition
• physical and chemical carcinogens
• immunosuppression
• drugs
• viral infection
• chronic inflammation
• chronic injury of the skin

Question 15

Precursor lesions of SCC

Answer 15

Actinic keratosis, bowen disease, bowenoid papulosis, erythroplasia of Queyrat

Question 16

High-risk features for local recurrence and the development of metastatic disease for SCC

Answer 16

• > 2 mm thickness;
• Clark level higher than IV;
• perineural invasion;
• lip or ear as primary site;
• poorly or undifferentiated tumor

Question 17

risk of developing metastasis from SCC is generally low, with a 5-year metastatic rate of ?

Answer 17

5%

Question 18

Major route of SCC metastasis

Answer 18

Nodal metastasis

Question 19

predominant etiologic risk factor for skin carcinogenesis in SCC

Answer 19

cumulative lifetime exposure to UVR

Question 20

Sun-sensitive individuals with ______ hair, ____ eyes, and ______ complexion are at higher risk for developing SCC than individuals with darker pigmentation.

Answer 20

red hair, blue eyes, and fair complexion

Question 21

most important environmental risk factor for SCC

Answer 21

UVR

• class I carcinogen, sufficient for the initiation, promotion, and progression of squamous carcinogenesis of the skin

Question 22

UVB-induced mutagenesis of the skin gives rise to specific UV signature mutations (ie, characteristic _______________ dipyrimidine transitions), which constitute the majority of mutations found in SCC. 2

Answer 22

C-T and CC-TT dipyrimidine transitions

Question 23

Syndromes associated with a predisposition for keratoacanthoma

Answer 23

• Muir-Torre syndrome
• Multiple self-healing squamous epithelioma (Ferguson–Smith syndrome)

Question 24

Question 25

Risk Factors for the Development of Squamous Cell Carcinoma

Answer 25

Question 26

Oral SCC may arise on apparently normal mucosa but are usually preceded by

Answer 26

leukoplakia, erythroplakia, or leukoerythroplakia,

Question 27

SCC of the lip occurs more often where?

Answer 27

Lower lip

Question 28

Typical locations of verrucous SCC

Answer 28

- oral cavity: oral florid papillomatosis - genitoanal region: giant condyloma acuminatum Buschke-Löwenstein - plantar skin: epithelioma cuniculatum - amputation stumps

Question 29

hallmark of invasive SCC

Answer 29

growth of atypical keratinocytes beyond the basement membrane into the dermis

Question 30

Basic Features of Histopathology Report of Cutaneous Squamous Cell Carcinoma Diagnosis

Answer 30

Question 31

This variant of SCC bears an increased propensity for metastasis. The main histologic characteristic is extensive acantholysis of the atypical keratinocytes leading to pseudoglandular structures within the tumor area

Answer 31

ACANTHOLYTIC (ADENOID) SQUAMOUS CELL CARCINOMA

Question 32

a well-differentiated variant of SCC that slowly grows and is locally destructive, but with only low metastatic potential

Answer 32

VERRUCOUS SQUAMOUS CELL CARCINOMA

Question 33

Distinct variant of SCC that shows a highly infiltrative growth pattern with abundant mucinous stroma surrounding the tumor cells. This often is associated with perineural or perivascular infiltration, and reveals a high rate of recurrence and metastases

Answer 33

DESMOPLASTIC SQUAMOUS CELL CARCINOMA

Question 34

Question 35

What are the histologic variants of SCC

Answer 35

- SPINDLECELL SQUAMOUS CELL CARCINOMA - ACANTHOLYTIC (ADENOID) SQUAMOUS CELL CARCINOMA - VERRUCOUS SQUAMOUS CELL CARCINOMA - DESMOPLASTIC SQUAMOUS CELL CARCINOMA - KERATOACANTHOMA

Question 36

What are the margins for conventional standard excision of SCC

Answer 36

4 - 6 mm margins - may be acceptable as primary treatment of local, low-risk SCCs

Question 37

A prospective Phase II trial has demonstrated the efficacy of monotherapy with ___________ as a first-line treatment of unresectable SCC (a 29% response rate).

Answer 37

cetuximab

Question 38

frequently found to be the first indicator of aggressive biologic behavior in SCC

Answer 38

Local recurrence at the site of the primary lesion

Question 39

High risk areas for SCC

Answer 39

“mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermilion], chin, mandible, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet.

Question 40

Moderate risk areas for SCC

Answer 40

cheeks, forehead, scalp, neck, and pretibia

Question 41

Low risk areas for SCC

Answer 41

trunk and extremities (excluding pretibia, hands, feet, nail units, and ankles)

Question 42

Question 43

A metaanalysis and systematic review on all published data found that tumor depth (ie, Breslow thickness exceeding _______ mm and invasion beyond subcutaneous fat) is associated with the highest relative risk of local recurrence and metastasis of SCC.

Answer 43

2 mm

Question 44

A tumor diameter exceeding ________mm is associated with the highest relative risk for disease-specific death of SCC

Answer 44

20 mm

Question 45

Tumors larger than________ mm are associated with a high risk of metastasis and local recurrence.

Answer 45

6 mm

Question 46

independent risk factor for local recurrence

Answer 46

Desmoplastic growth

Question 47

Another prospective study found that lesion size equal to or greater than _______ cm and histologic evidence of perineural invasion and deep invasion beyond subcutaneous structures were the factors most significantly associated with disease-specific mortality in cutaneous SCC

Answer 47

4 cm

Question 48

Overall, the 3-year cumulative risk of a subsequent SCC after an index SCC is ____%, at least a 10-fold increase in incidence compared with the incidence of first tumors in a comparable general population

Answer 48

18%

Question 49

Vitamin B suitable fir chemoprevention of NMSC

Answer 49

niacinamide (Vitamin B3) 500 mg twice daily

Question 50

Although there were numerous side effects, this treatment was the first demonstration of effective chemoprevention of cancer in humans.

Answer 50

Systemic retinoids (Vitamin A)

Question 51

associated with the highest relative risk of local recurrence and metastasis of SCC

Answer 51

**tumor depth** (ie, Breslow thickness exceeding 2 mm and invasion beyond subcutaneous fat)

Question 52

associated with the highest relative risk for disease-specific death of SCC

Answer 52

umor diameter exceeding 20 mm