Actinic Keratoses and Skin Cancers Flashcards
(32 cards)
Actinic Damage-Freckle
- Onset: childhood
- Autosomal dominant trait
- Common in fair skin individuals
- Sun exposed skin
- Will darken with sun exposure
- Tan to light brown macules (increase melanin within basal layer keratinocytes)
- Size: 1-2mm
Actinic Damage-Juvenile lentigines
- Onset: childhood
- Common in fair skin individuals
- Hereditary component
- Seen on sun exposed skin mostly
- Don’t change in number/color with UV exposure (?!)
- Tan to light brown can even be black
- More oval shaped macules (increase # of melanocytes along dermoepidermal junction)
- Size: 2-10mm
Actinic Damage-Solar lentigines
- Sun exposed skin
- Common in fair skin individuals
- Onset: adulthood, especially late
- Increase in number and size with age
- Tan to light brown in color
- They are macules/patches (basal layer keratinocytes are hyper-pigmented and have an increase # of junctional melanocytes)
- Size: 2-20mm
LEOPARD Syndrome
(lentigines, EKG abnormalities, ocular disorders, pulmonary stenosis, abnormalities of genitalia, retardation of growth and deafness)
LAMB or NAME syndrome
(lentigines, atrial and/or mucocutaneous myxomas, neurofibromas, freckles, blue nevi)
Peutz-Jeghers syndrome
Freckles/Lentigines ??
Freckles/Lentigines tx
Bleaching agents
Laser/IPL
Sun protection-Prevention works best
- Use broad spectrum (UVA/UVB) sun protectant of SPF 30 or higher
- Hats, protective clothing
- Seek shade between 10:00 a.m. – 4:00 p.m.
- Avoid intentional tanning
Actinic Damage-Photoaging dx
- Face, neck, chest, dorsal hands
- Epidermis thins
- Skin is uneven in tone
- Fine wrinkles around eyes
- Deep lines on forehead and cheeks
- Telangiectasias
- Bruising on dorsal hands and arms
- Milia, solar comedones
- Poikiloderma of Civatte
- Actinic keratoses
Actinic Damage-Photoaging tx
- Derm for evaluation and monitoring
- Topical retinoids
- Antioxidant serums
- Sun protection measures can prevent AND treat!
- Discourage intentional tanning
- Tanning beds increase risk for SCC 2.5 times, BCC 1.5 times vs those who never used a tanning bed; melanoma risk is increased to 87% if tanning bed used before age 35
Actinic keratosis (es) dx
- Considered a premalignant lesion (precursor to SCC and BCC)
- Common in fair skin individuals, those 40+, transplant patients
- Due to sun exposure
- Face, ears, neck, chest, shoulder girdle, dorsal hands/arms
- Scaly/flakey/rough papule without underlying induration (color can vary from none to red even tan)
- Size: 1-6mm
Actinic keratosis (es) tx
o Cryotherapy o Topical 5-fluorouracil 5% cream o Imiquimod 5% cream o Aminolevulinic acid activated by intense pulse light o Skin checks by derm every 6 months o Sun protection
Basal cell carcinoma dx
(aka Rodent Ulcer) Most common skin CA, arises from basal layer Caucasians >Asians>Africans Face, scalp, ears, neck Pearly/shiny papule with telangiectasia Can be pink, tan or skin colored Can develop into an nodule Can have rolled/raised/rounded borders with a flat center Size: 2mm to >2cm! Basal cell carcinoma types: - Nodular BBC (most common) - Pigmented - Superficial - Morpheaform or sclerosing - Micronodular *All determined by microscopic evaluation
Basal cell carcinoma dx
- Superficial BCC’s can be treated via ED&C or - imiquimod or photodynamic therapy if not a surgical candidate
- All other’s require excision: Moh’s micrographic surgery
- If there are mets, vismodegib is used
- Skin cancer checks twice a year by dermatology
Squamous cell carcinoma dx
- Second most common skin CA; arises from keratinocytes or mucosal surfaces
- Head, neck, hands
- Poorly defined scaly papule
- Will have adherent scale/cutaneous horn
- Can also be a dull red, firm nodule with a crusted center
- Size: 2mm to >2cm
- Risk factors:
o UV radiation, exposure to hydrocarbons, arsenic, tobacco
o Chronic infections/inflammation
o Burns
o HPV/HIV
o Patients on hydrochlorothiazide, triamterene, nifedipine
o Caucasian
o Transplant patient
Squamous cell carcinoma tx
- Excision (Moh’s micrographic surgery)
- Skin cancer checks at least twice a year
- Lymph node palpation
- High risk tumors may require imaging studies
- Radiation therapy for high risk tumors, systemic chemo for regional/distant mets
Bowen’s Disease dx
(variant of SCC)
• Head, neck, hands
• HPV induced will see on genitalia and periungally
• d/t UVR, arsenic, hydrocarbons, chronic heat exposure
• Sun exposed areas: Red, sharply demarcated, scaling, hyperkeratotic papule or plaque
• Genitalia: Red, sharply demarcated, glistening macule/papule, patch /plaque
• Anogenital: tan, brown or black papules
• Size: 6mm - >10mm
Bowen’s Disease tx
o Excision o Electrodesiccation and curettage o Cryosurgery o Topical 5-fluorouracil o Imiquimod o Skin cancer checks at least twice a year
Keratoacanthoma dx
(variant of SCC) • Face, neck, dorsal hands, UE’s and LE’s • Rapidly growing crateriform nodule • Flesh-colored or red • Tender • Size: 0.5-2.0cm • Muir-Torre Syndrome: Multiple KA’s, unusual cysts, visceral malignancy (i.e. uterine, ovarian) • Immunosuppressed patients are at risk
Keratoacanthoma tx
o Excision
o Electrodesiccation and curettage
o Every 6 month skin evaluations
Malignant melanoma (common characteristics & risk factors)
Factors that increase risk:
o Fair skin/blonds and redheads/those with blue or green eyes
o Atypical nevi
o Personal history of melanoma
o Family history of atypical nevi or melanoma
o History of blistering sunburn (5 or more between ages of 15-20)
o Large congenital nevi
o Tanning bed use
They can present in any color (pink, red, any variation of brown or black), and even be variegated in color
Any shape with irregular borders or well-defined borders
Any size
30% arise from a pre-existing melanocytic nevus
70% develop de novo (tend to be more aggressive)
Think about our ABCDE’s
Malignant melanoma types cont.
o Superficial spreading melanoma
o Nodular melanoma
o Lentigo maligna/Lentigo maligna melanoma
o Acral lentiginous melanoma
Superficial Spreading Melanoma dx
- Most often trunk and extremities
- Most likely to arise from a nevus
- Affects Caucasians mostly
- Females>males
- Any color
- Macular with irregular borders
- Size >6mm
Nodular melanoma dx
- Extremities - most common site
- Caucasians mostly
- Females=males
- Papular
- Brown to black
- May have hemorrhagic crusts
- Size: any
Lentigo maligna/Lentigo maligna melanoma dx
- Face, neck, dorsal arms
- Caucasians mostly
- Females=males
- Usually older people
- Irregularly outlined macules/patches
- Brown with some color variation
- Nodules and ulceration=local invasion
Acral/mucosal Lentiginous Melanoma dx
- Nails, hands and feet, mouth, anus, genitalia
- Occurs in darker skin types
- Males>females
- Older people
- Similar to lentigo maligna/lentigo maligna melanoma
