Flashcards in Basal and Squamous Cell CA Deck (89):
What are the two major types of non-melanoma skin cancer?
Basal cell carcinoma
Squamous cell carcinoma
True or false: BCC and SCC is rare in darkly pigmented ethnicities
Which is more common: BCC or SCC?
True or false: BCC rarely mets
What are the issues that arise from BCC, since only rarely does it metastasize?
capable of local aggression and tissue destruction
What areas of the skin are affected with BCC?
Sun exposed areas of the skin, usually the head and neck
What are the skin findings of BCC?
Pearly papules or raised bordered ulcerations, often containing prominent, dilated subepidermal blood vessels (telangiectasias)
Pearly papules with telangiectasia = ?
What is the treatment for BCC?
Excision/ destruction or topical 5FU
What is the MOA of 5FU?
Inhibits thymidylate synthase, interrupting the action of the synthesis of thymidine
What is the morpheaform variants of BCC?
Scarred appearing area that is much more malignant
What does the superficial variant of BCC look like?
What does the pigmented variant of BCC look like?
Seborrheic keratosis or melanoma
What are the histological characteristics of BCC?
Nodules that fill up the epidermis, with peripheral palisading cells
Histology of: Nodules that fill up the epidermis, with peripheral palisading cells, and stromal retraction = ?
What are the histological characteristics of the morpheaform variant of BCC?
Cord or small nests of that infiltrate everywhere
What is Gorlin syndrome?
AD mutation of PTCH gene on chromosome 9
-PTCH is a tumor suppressor gene, that predisposes to BCC
What are the features of Gorlin syndrome?
-Odontogenic keratocysts of jaw
-Rib and vertebral abnormality
What are some of the causes of SCC?
When particularly should SCC be monitored for?
What are the skin characteristics of SCC?
firm, hyperkeratotic plaques with erosions and crusts
firm, hyperkeratotic plaques with erosions and crusts = ?
SCC often arises in or associated with what disease?
What is the usual course of SCC?
Is what areas of the body is SCC more likely to metastasize? (3)?
What is the metastatic potential of most SCC? What increases the risk of metastases?
If in burn scars of osteomyelitis, then 20-60% chance
What is the treatment for SCC?
Excision or radiation
What are the histological characteristics of SCC?
Eosinophilic papillae that invade into the dermis
What are the cells that gives rise to melanoma, SCC, and BCC respectively?
Melanoma = melanocytes
SCC = spinous layer
BCC = Basal cells
What happens when SCC wraps around nerves?
Follow the course of the nerve in the perineural sheath
What are the four major prognostic factors for SCC?
-Depth of invasion
A size greater than how many cm is a poor prognostic indicator for SCC?
More than 4 cm
What type of histological findings are a poor prognostic indicator for SCC? (2)
-Depth of invasion
What is Verrucous carcinoma?
Low grade variant of SCC that recurrs commonly, but rarely metastasizes
What areas of the body are particularly affected with verrucous carcinoma?
Sole of foot or sinus tract
What is the anogenital verrucous carcinoma?
Condyloma variant of HPV infection (usually 6 and 11)
How hard is it to control anogenital verrucous carcinoma?
Is verrucous carcinoma endophytic or exophytic?
What is keratoacanthoma?
Rapidly developing neoplasm that clinically and histologically resembles well differentiated SCC
What are the skin findings of keratoacanthoma?
Flesh colored, dome shaped nodules with a central, keratin-filled plug with a crater like topography
What is the treatment for keratoacanthoma?
How fast does keratoacanthoma progress?
Flesh colored, dome shaped nodules with a central, keratin-filled plug with a crater like topography = ?
Who usually gets keratoacanthoma?
Old people chronically exposed to the sun
What are the histological characteristics of keratoacanthoma?
Keratin filled crater that pushes into the dermis, often with glassy cells
What is actinic keratosis?
Squamous dysplasia of the skin, usually as a result of chronic exposure to sunlight and associated with build up of excess keratin
What are the skin findings of actinic keratosis?
Papules less than 1 cm, tan-brown, red or skin colored lesions that has a sandpaper quality
How do you prevent and treat actinic keratosis?
Prevent : sunscreen
Treat: cryosurgery or 5FU
What is the premalignant lesion for SCC?
What are the histological characteristics of AK?
Dysplasia along the base or the epidermis, without involving the full thickness
What are the histological differences between AK, SCC in situ, and SCC?
-AK= not full thickness dysplasia
-SCC in situ = full thickness dysplasia without BM penetration
-SCC = above + penetration
What is bowenoid papulosis? Who does it occur in? Skin findings?
-Anogenital variant of SCCIS, that usually occurs in sexuallary active adults
-Multiple small, reddish brown papule
Multiple small, reddish brown papules in the anogenital area = ?
What xeroderma pigmentosum? Inheritance pattern? Skin findings?
-AR defect in nucleotide excision repair
-Sunburn with minimal sun exposure, and AKs at early age
What is the median age of skin cancer with xeroderma pigmentosum?
What is the role of Merkel cells in the skin? What cells are they derived from?
-Light touch sensors
-Neural crest cells
What are the areas of body that are affected with merkel cell carcinoma?
head and neck or extremities on old people
What does merkel cell carcinoma resemble?
metastatic small cell CA from lung or certain lymphomas
What is the prognosis for merkel cell carcinoma?
Aggressive CA--poor survival rates, with high recurrences
What is the treatment for merkel cell carcinoma?
Aggressive surgery with sentinel lymph node bx
What are the skin findings of merkel cell carcinoma?
What are the histological characteristic of merkel cell carcinoma?
Sheets of small, basophilic cells
What are the most common cancers that met to the skin in males? (2)
What is the most common cancer that mets to the skin in females?
What are the skin findings of inflammatory breast carcinoma? What causes this?
-inflammatory cells in the lymphatics tethers the skin down
What is the sister mary joseph nodule?
Umbilical nodule, usually related to stomach of pancreatic malignancy
What are the histological findings of metastatic RCC?
Nodules of clear cells separated by thin capillaries
What is mammary Paget's disease associated with?
Underlying mammary ductal CA
What does paget's disease of the breast look like?
Eczema or psoriasis
What is the area of the body that is commonly affected with extramammary Paget's disease?
Which gender is more commonly affected with extramammary Paget's disease?
What are the histological findings of EMPD?
Large, clear cells that percolate through the epidermis
What is atypical fibroxanthoma?
Cutaneous pleomorphic undifferentiated sarcoma
What areas of the body are usually affected with atypical fibroxanthoma?
Sun exposed areas and actinically damaged areas, (head and neck)
What are the skin findings of atypical fibroxanthoma?
Firm, solitary nodule +/- ulcerations
What are the histological characteristics of AFX?
Pleomorphic spindle cell tumor with increased mitotic activity
True or false: AFX is a diagnosis of exclusion
How do you treat AFX?
Cut it out
True or false: AFX usually does not met
What are the three major situations where you will see angiosarcomas?
All forms of angiosarcoma have what mortality rate?
What are the skin characteristics of angiosarcomas?
Black, vascular lesion
What is Stewart Treves syndrome?
A lymphangiosarcoma, a rare complication that forms as a result of chronic, long-standing lymphedema, commonly seen in breast cancer patient that had lymph nodes removed
How do you differentiate between radiation related lymphedema, and Stewart treves syndrome?
radiation related will present much sooner--Stewart treves syndrome takes years to develop
What are the histological characteristics of angiosarcoma?
Irregular blood vessels that infiltrate throughout the dermis, and are lined by pleomorphic cells
What are the 4 major types of kaposi's sarcoma?
-African / sub saharan
What is the infectious agent that is related to Kaposi's sarcoma?
What are the skin findings of Kaposi's sarcoma?
nodules or blotches that may be red, purple, brown, or black, and are usually papular