Actinic Keratosis & Squamous Cell Carcinoma

Question 1

Who gets SCC more commonly?

Answer 1

white/fair skin

Question 2

Where is SCC located?

Answer 2

head, neck, forearms, dorsal hands, (sun exposed areas)

Question 3

What increases you risk of SCC?

Answer 3

tanning beds, heat

Question 4

Which has higher motality SCC or BCC?

Answer 4

SCC - higher rate of metastasis

Question 5

What is the cell of origin in SCC?

Answer 5

keratinocytes

Question 6

What causes SCC?

Answer 6

UV expsoure, chemical carinogen exposures

Question 7

What is the SCC clinical manifestation?

Answer 7

papule, plaque, nodule
pink, red, skin colored
exophytic
indurated
horn
friable
asymptomatic, pruritic/tender

Question 8

What is Bowen’s disease?

Answer 8

in situ SCC, pink to red patch or thin plaque with scaly or rough surface >1 cm size, only epidermis

Question 9

Who get SCC of the nail?

Answer 9

males 50-69

Question 10

A premalignant neoplasm of the epidermis caused by excessive exposure to sunlight and manifesting as an ill-marginated, erythematous, scaling, rough papule or patch.

Answer 10

Actinic Keratosis

Question 11

A malignant neoplasm of keratinocytes derived from stratified squamous epithelium. These usually present as indurated, scaling, erythematous papules, nodules or plaques that occasionally ulcerate and bleed.

Answer 11

squamous cell carcinoma

Question 12

What is the initial treatment for actinic keratosis?

Answer 12

incisional biopsy

Question 13

What does incisional biopsy show in actinic keratosis?

Answer 13

dermal extension of well differentiated keratinocytes, keratin pearls

Question 14

What can cause SCC in non sun exposed areas?

Answer 14

chemical carcinogen exposure

Question 15

What are the various morphologies of SCC?

Answer 15

papules, plaque, nodule
pink red or skin colored
exophytic
indurated
cutaneous horn

Question 16

What does friable mean?

Answer 16

bleed with minimal trauma and then crust

Question 17

How does SCC of nail present?

Answer 17

warty, subungual hyperkeratosis, onycholysis, oozing, destruction of nail plate

Question 18

What is the best for dx SCC?

Answer 18

Mohs

Question 19

What does invasive squamous cell carcinoma mean?

Answer 19

SCC cells in dermis

Question 20

What is atypical squamous proliferation?

Answer 20

biopsy is superficial, rebiopsy may be needed

Question 21

What are the surgical options for SCC?

Answer 21

surgical excision - best for invasive SCC

Curettage and electrodesiccation or cryosurgery

Question 22

What are the non surgical treatment options for SCC?

Answer 22

radiation

5-fluorouracil cream, imiquimod cream, diclofenac gel, ingenol mebutate, photodynamic therapy

Question 23

What is 5-fluorouracil?

Answer 23

antimetabolite taht interferes with DNA synthesis
1,2,5% approved for actinic keratosis treatment
5% for superficial basal cell carcinoma

Question 24

What is imiquiod?

Answer 24

synthetic immune response modifers
2.5,3.75, 5 for actinic keratosis
5% for superficial BCC
better inflammaory response = better cure

Question 25

What is diclofenac?

Answer 25

downregulates cyclooxygenase enzymes and increases apoptosis 3,2.5% for actinic keratosis nonsteroidal antiinflammatory

Question 26

What is ingenol mebutate?

Answer 26

cellular death followed by inflammatory response | actici keratosis

Question 27

When do you follow up with non metastatic SCC?

Answer 27

3-6 mo for 2 years, 6-12 mo for 3 years, annually for life

Question 28

What does AK become?

Answer 28

SCC

Question 29

Does AK go to SCC a lot?

Answer 29

not really, 8%

Question 30

What is the cell origin of AK?

Answer 30

keratinocyte

Question 31

What is the actinic keratosis spectrum?

Answer 31

photodamaged sin --> AK --> SCC in situ --> invasive SCC

Question 32

What causes AK?

Answer 32

cummulative and prolonged UV exposure due to p53 mutations

Question 33

What are the AK individual risk factors?

Answer 33

increasing age, fair skin, light eyes/hair, immunosuppression, genetic syndromes (xeroderma pigmentosum and albinism) Fitz I or II

Question 34

What are the clinical manifestations of AK?

Answer 34

tender, located in sun exposed, background of sun damaged skin, erythematous papules or thin plaques with rough gritty scale

Question 35

How does AK appear?

Answer 35

sandpaper

Question 36

How does sun damage appear?

Answer 36

combination of atrophy and hyperatrophy telangiectasia spotty depigmentation and hyperpigmentation lethery and prematurely aged

Question 37

What are small brown macules caused by sun exposed areas, results from UV damage?

Answer 37

solar lentigo (lentigines)

Question 38

What is easy bruising due to extravasated erythrocytes and incrased perivascular inflammation?

Answer 38

actinic (senile) purpura

Question 39

What is actinic cheilitis?

Answer 39

AK of lips, most common lower lip

Question 40

How does actinic cheilitis present?

Answer 40

erythematous patch with rough gritty scale involving the lower lip --> BIOPSY

Question 41

When do AK pts follow up?

Answer 41

regular skin 6-12 mo, due to increase risk of all types of skin cancer