B6-030 CBCL Skin Cancers Flashcards
(133 cards)
1
Q
brown/black melanin
A
eumelanin
2
Q
yellow/orange melanin
A
pheomelanin
3
Q
[…] skin color is impacted by solar radiation, UVR, and endocrine system
A
facultative
4
Q
are differences constitutive skin color due to the number of melanocytes?
A
no
5
Q
what amino acid is necessary for pheomelanin synthesis?
A
cysteine
6
Q
TRP1 and DCT contribute to the synthesis of […] melanin
A
eumelanin
7
Q
the expression of […] is a major determinant for blue/brown eye color
A
OCA2
**tyrosinase trafficking/processing enzymes
8
Q
lower MC1R signaling results in
A
more pheomelanin and lighter skin
9
Q
higher MC1R signaling results in
A
relatively more eumelanin and darker skin
10
Q
loss/significantly reduced function of MC1R is associated with
A
red hair phenotype
11
Q
induces MITF, which activates expression of melanin synthesizing enzymes
A
a-MSH
12
Q
MC1R agonist [2]
A
a-MSH
ACTH
13
Q
MC1R antagonist
A
Asip
14
Q
inhibits eumelanin and promotes expression of genes for pheomelanin
A
Asip
15
Q
activates DNA repair signaling
A
MC1R
**deficits increase risk of skin cancer
16
Q
how do deficits in MC1R signaling cause an increased risk of skin cancer? [2]
A
- decreased production of protective eumelanin
- less activation of DNA repair pathways
17
Q
sunburn is mostly caused by UV[…]
A
UVB
18
Q
UVB results in lesions of […] in DNA
A
pyrimidine dimers
19
Q
delayed tanning (sunburn) damages keratinocytes and causes the secretion of […], which stimulate eumelanin production
A
cytokines and chemokines
**mediated by a-MSH and ACTH
20
Q
does sunscreen protect from UVA or UVB?
A
UVB
21
Q
at high SPF values, protection [does/does not] increase proportionally
A
does not
22
Q
are current recommendations promoting UV protection for melanoma prevention in skin of color supported by current research?
A
no, there is little evidence to support this
**however, AAD recommends everyone use sunscreen regardless of skin tone
23
Q
[keratinocytes or melanocytes]
tend to be in stratum basale or even below stratum basale
A
melanocytes
24
Q
[keratinocytes or melanocytes]
small, dark nucleus
light, fluffy cytoplasm
A
melanocytes
25
[keratinocytes or melanocytes]
cleft goes all the way around, or partly around nucleus with no intervening cytoplasm
keratinocyte
26
[keratinocytes or melanocytes]
found in stratum spinosum
keratinocytes
27
melanocytic tumors [3]
benign nevi
dysplastic nevus
malignant melanoma
28
melanocytic nevi located where the dermis and epidermis meet
junctional nevus
29
melanocytic nevi located in epidermis and dermis
compound nevus
30
melanocytic nevi located in dermis
dermal nevus
31
what is this?
dysplastic nevus
32
what is this?
malignant melanoma
33
keratinocytic tumors [5]
lentigo
seborrheic keratosis
actinic keratosis
squamous cell carcinoma
basal cell carcinoma
34
looks like "socks dipped in chocolate"
solar lentigo
35
white pores
seborrheic keratosis
36
feels like sandpaper
precursor to squamous cell carcinoma
actinic keratosis
37
spiky contours
squamous cell carcinoma
38
[...] carcinoma is pink
squamous cell
39
[...] carcinoma is blue
basal cell
40
dense red keratin with preserved nuclei
squamous cell carcinoma
41
basal cell carcinoma
42
occur due to mutations in the Hedgehog signaling pathway, most commonly **PTCH1** or also P53
basal cell carcinoma
43
raised, rolled edges
basal cell carcinoma
44
therapy for metastatic or inoperable basal cell carcinoma [2]
anti- PD1 inhibitor
vismodegib, sonidegib (inhibit Hedgehog pathway)
45
premalignant cutaneous lesions that may progress to squamous cell carcinoma
actinic keratoses
46
[...] mutation is thought to occur early in the development of actinic keratosis
p53
47
treatment options for metastatic squamous cell carcinoma
chemotherapy
EGFR inhibitor (cetuximab)
anti PD1 (cemiplimab, prembolizumab)
48
constitutive activation of RAS or BRAF but growth arrest is mediated by CDK
benign nevi
49
nevi located in the dermo-epidermal junction
junctional nevi
50
nevi located partially in the dermis
compound
51
nevi located completely in the dermis
intradermal nevi
52
50% of patients with congenital [...] will develop melanoma by age 60
dysplastic nevus syndrome
53
loss of CDKN2A is associated with [2]
dysplastic nevus syndrome
familial melanoma syndrome
54
activating mutations in NRAS/BRAF and inactivating mutations in CDKN2A/CDK4 [2]
dysplastic melanocytic nevus
melanoma
55
activating mutations in FGFR3
seborrheic keratoses
56
sudden appearance of several seborrheic keratoses
maybe due to TGF-a
Leser-Trelat sign
**commonly associated with GI adenocarcinomas
57
multiple, small seborrheic keratoses occurring in people of color
dermatosis papulosa nigra
benign finding, can be removed for cosmetic reasons
58
diagnostic steps for melanoma [3]
biopsy-depth of primary lesion
determine sentinel node involvement
staging studies
59
treatment for stage III melanoma BRAF +
BRAF/MEK inhibitor or anti PD-1
60
treatment for stage III melanoma BRAF -
one year anti PD-1 (pembrolizumab)
61
constitutive skin tone is determined by [2]
number, size, distribution of pigment granules in skin
relative amount of eumelanin and pheomelanin in melanosomes
62
solar UVR exposure contributes to [...] skin tone
facultative
63
MC1R signaling activates [2]
expression of pigment synthesizing enzymes
DNA repair enzymes
64
[UVB or UVA]
most effective at producing erythema
UVB
65
[UVB or UVA]
penetrates into dermis
UVA
66
[UVB or UVA]
passes through glass
UVA
67
[UVB or UVA]
production of pyrimidine dimers on DNA
UVB
68
what causes sunburn at the cellular level?
release of inflammatory mediatiors
69
DNA damage triggers [...] that produces the warmth, pain, and erythema of sunburn
inflammatory mediators
70
immediate pigment darkening in the hours following UVR exposure is caused by
redistribution and oxidation of melanin already present in melanosomes
71
aspects of mechanism that induce delayed tanning [2]
DNA damage and subsequent MCR1 activation and signaling
increased expression of enzymes responsible for pigment synthesis
72
what layer of skin are adipocytes found in?
hypodermis
73
what layer of skin is collagen found in?
dermis
74
what layer of skin are melanocytes found in?
epidermis-stratum basale
75
what layer of skin are hair follicles found in?
dermis
76
what layer of skin are keratinocytes found in?
epidermis
77
melanocyte nests located only in the epidermis
junctional nevus
78
melanocyte nests located in epidermis and dermis
compound nevus
79
melanocytes nests located in the dermis
dermal nevi
80
nevi that are lentiginous, broad, and mostly at the junction
dysplastic nevi
81
elongated rete pegs
melanin pigment in dermis within macrophages
spread out (lentiginous)
dysplastic nevi
82
asymmetric appearance with upward scatter of single melanocytes
melanoma
83
hyperpigmented rete pegs
"socks dipped in chocolate"
solar lentigo
84
solar lentigo are derived from
keratinocytes
85
characteristic "sand paper" feel
actinic keratosis
86
keratin pearls visible on histology
squamous cell carcinoma
87
blue nodules with palisading of tumor cells
basal cell carcinoma
88
has potential to progress to squamous cell carcinoma
actinic keratosis
89
a history of immunosuppression leads to an increased risk for
squamous cell carcinoma
90
edges that are shiny, slightly raised, rolled
basal cell carcinoma
91
pigmented nevi often have mutations in
BRAF/RAS
92
transcriptional silencing of [...] is found in 1/5 of non-sun-exposed melanoma
PTEN
93
are solar lentigines cancerous precursors?
no
94
pearly white, skin colored nodule in light skinned people, more darkly pigmented in dark skin people
edges may be shiny, slightly raised, and rolled
basal cell carcinoma
95
ulcerated, tender pink papule with central crust
squamous cell carcinoma
96
precursor for squamous cell carcinoma
actinic keratosis
97
gray elastosis on histology is a feature of [2]
solar lentigo
actinic keratosis
98
keratin pearls on histology is a feature of
squamous cell carcinoma
99
upward sweep of individual cancer cells on histology is a feature of
melanoma
100
even when sunscreen is used properly, [....] can still result in sunburn
long enough exposure to sun
101
number of melanocytes [does/does not] determine skin pigment production
does not
102
MOA of PD-1 inhibitor (pembrolizumab)
killing of tumor cells by T cells
**normally PD-L1 binds to PD-1 on T cells inhibiting T cell mediated destruction of cancer cells
PD-1 inhibitors prevent the binding of PD-1L/PD-1, thus facillitating T cell mediated destruction of tumor cells
103
though UVA is "less damaging" than UVB, it can generate
ROS which can damage DNA
104
upward scatter of single melanocytes
melanoma
105
"socks dipped in chocolate"
solar lentigo
106
long rete pegs
singly spaced letiginous melanocytes
some melanin in dermis
dysplastic nevus
107
architecturally disordered junctional nests and lentiginous spread extending well beyond the dermal component
dysplastic nevus
108
describe the cell signaling pathway that promotes cell proliferation
RTK/RAS ---> BRAF/MEK/ERK ---> cyclin D1-CDK4/6
109
BRAFV600E mutation results in
constitutive activation of BRAF, regardless of RAS signaling. Results in constitutive activation of cell proliferation pathway
110
circular lamellae of keratin
SK (horn cysts)
111
blue nodules in the dermis
basal cell carcinoma
112
keratin pearls
squamous cell carcinoma
113
inactivating mutations in [...] can occur in dysplastic nevi
CDKN2A or CDK4
114
congenital dysplastic nevi syndrome is associated with loss of [...] gene
CDKN2A
115
required to maintain the ends of chromosomes
telomerase
116
overexpression of telomerase would result in
"replicative immortality"
telomerase maintains chromosome length. Usually once telomeres shorten to a certain length, the cell becomes senescent
117
describe the cellular events leading to tanning/sunburn
1. formation of pryrimidine dimers
2. release of inflammatory mediatiors and secretion of ligands for MC1R
118
SCC has [...] risk of metastasis
low
119
in what layer of skin are melanocytes found?
epidermis
120
solar lentigines can develop into
SK
121
BRAF signaling promotes
cellular proliferation
via activation of cyclin dependent kinases
122
BCC has [...] risk of metastasis
low
123
commonly occurs above the upper lip
basal cell carcinoma
124
commonly occurs below the lower lip
squamous cell carcinoma
125
waxy pink pearly nodules
commonly with telangiectasias
rolled borders
BCC
126
can appear as nonhealing ulcers with infiltrative growth/scaling plaque
BCC
127
associated with immunosuppresion, chronic nonhealing wounds, and arsenic exposure
SCC
128
commonly appears on face, lower lip, ears, hands
SCC
129
melanoma has [...] risk of metastasis
high
130
S-100
melanoma
131
in melanoma, [...] of tumor corresponds with risk of metastasis
depth
**Breslow thickness
132
often driven by activating mutation in BRAF kinase
melanoma
133
BRAF inhibitor
vemurafenib
