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Flashcards in DD malignant tumors Deck (17):
1

Basal cell carcinoma subtypes

○ Nodular
○ Superficial (can see bleeding)
○ Infiltrative
○ Sclerosing (morpheaform)

2

Most common pre-malignant skin lesion.

Actinic keratosis

○ Eventually develop into squamous cell carcinoma (1/1000 )

3

Squamous cell carcinoma (SCC) subtypes

- Squamous cell carcinoma in situ (Bowen's disease)
- Keratoacanthoma

4

Melanoma ABCDE

Assymetry
Border
Color
Diameter
Evolving

5

Melanoma subtypes

○ Superficial spreading
○ Nodular
○ Lentigo Maligna Melanoma
○ Acral Lentiginous

6

Kaposi's Sarcoma:
- 3 Types:

○ Classic
○ Lymphadenopathic
○ AIDS associated

7

Smoking is a risk for what type of carcinoma?

• Smoking
○ Risk ONLY for SCC

8

Melanoma risk factors

• Mutation in the BRAF gene, defective DNA repair

○ This is not inherited
○ Occurs during development of melanoma
○70% of the time arise de novo.

9

actinic keratoses (AKs) are precursors to ______

squamous cell carcinoma

10

BCC = patch 1 mutation

• The patch 1 gene is a tumor suppressor gene
○ BCC comes from pluripotent cells due to mutations in the hedgehog pathway

hedgehog pathway unable to signal PTCH1 --> PTCH1 is unable to inactivate SMO (smoothened) --> it goes on to signal tumor growth

11

Vismodegib

cancer drug that inhibits SMO (smoothened) if PTCH1 is faulty

12

BRAF mutation

Normal BRAF - normal cell growth
Mutated BRAF - uncontrolled cell proliferation
• Remember… this is UV damage in melanoma
• It is NOT inherited
• Mutation on the B-Raf protein (most common is V600E mutation)

13

Vemurafenib

inhibits BRAF, causes programmed cell death in melanoma lines → MEK signaling → ↓ cell survival & proliferation

14

Breslow depth

• Maximal thickness of tumor invasion measured by an ocular micrometer
• Measured from top of granular layer of epidermis to the base of neoplasm
• MOST IMPORTANT prognostic factor for melanoma

15

Clark Level:

• How far melanoma has penetrated into the skin without measuring it

• Higher number (5)= deeper
1: confined to epidermis
2. invasion of papillary dermis
3. filling of papillary dermis but not extending to reticular dermis
4. invasion of reticular dermis
5. invasion of the deep, subcutaneous tissue

16

Curettage

Looped blade scrapes tumor away from normal skin
- used for Nodular BCC and superficial BCC

17

• If you have Stage IV or Recurrent melanoma:
treatment?

a. Immunotherapy
i. Ipilimumab to block CTLA-4 which allows T-cell activation
ii. Interleukin-2 response with high-dose regimens
b. Signal transduction inhibitors
i. Vemurafenib
c. Chemotherapy
d. Palliative local therapy