Actinic Keratosis & Squamous Cell Carcinoma Flashcards Preview

Dermatology - Clinical Medicine IV > Actinic Keratosis & Squamous Cell Carcinoma > Flashcards

Flashcards in Actinic Keratosis & Squamous Cell Carcinoma Deck (41)
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1

Who gets SCC more commonly?

white/fair skin

2

Where is SCC located?

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

3

What increases you risk of SCC?

tanning beds, heat

4

Which has higher motality SCC or BCC?

SCC - higher rate of metastasis

5

What is the cell of origin in SCC?

keratinocytes

6

What causes SCC?

UV expsoure, chemical carinogen exposures

7

What is the SCC clinical manifestation?

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

8

What is Bowen's disease?

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

9

Who get SCC of the nail?

males 50-69

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.

Actinic Keratosis

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.

squamous cell carcinoma

12

What is the initial treatment for actinic keratosis?

incisional biopsy

13

What does incisional biopsy show in actinic keratosis?

dermal extension of well differentiated keratinocytes, keratin pearls

14

What can cause SCC in non sun exposed areas?

chemical carcinogen exposure

15

What are the various morphologies of SCC?

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

16

What does friable mean?

bleed with minimal trauma and then crust

17

How does SCC of nail present?

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

18

What is the best for dx SCC?

Mohs

19

What does invasive squamous cell carcinoma mean?

SCC cells in dermis

20

What is atypical squamous proliferation?

biopsy is superficial, rebiopsy may be needed

21

What are the surgical options for SCC?

surgical excision - best for invasive SCC
Curettage and electrodesiccation or cryosurgery

22

What are the non surgical treatment options for SCC?

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

23

What is 5-fluorouracil?

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

24

What is imiquiod?

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

25

What is diclofenac?

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

26

What is ingenol mebutate?

cellular death followed by inflammatory response
actici keratosis

27

When do you follow up with non metastatic SCC?

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

28

What does AK become?

SCC

29

Does AK go to SCC a lot?

not really, 8%

30

What is the cell origin of AK?

keratinocyte

31

What is the actinic keratosis spectrum?

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

32

What causes AK?

cummulative and prolonged UV exposure due to p53 mutations

33

What are the AK individual risk factors?

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

34

What are the clinical manifestations of AK?

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

35

How does AK appear?

sandpaper

36

How does sun damage appear?

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

37

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

solar lentigo (lentigines)

38

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

actinic (senile) purpura

39

What is actinic cheilitis?

AK of lips, most common lower lip

40

How does actinic cheilitis present?

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

41

When do AK pts follow up?

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