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Derm part 1: cancers Flashcards

(52 cards)

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1
Q

What is squamous cell carcinoma?

A

Carcinoma rising from epidermal cells

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2
Q

What are the most common sites of squamous cell carcinoma?

A

Head
Neck
Hands

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3
Q

RFs for squamous cell carcinoma

A 
Sun exposure
Pale skin
Chronic inflammatory process
Immunosuppression
Xeroderma pigmentosum
Arsenic
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4
Q

What is a precursor skin lesion to squamous cell carcinoma?

A

Actinic keratosis

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5
Q

S/sx of squamous cell carcinoma

A

Raised, slightly pigmented skin lesion
Ulceration/exudate
Chronic scab
Itching

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6
Q

How is the diagnosis of squamous cell carcinoma made?

A

Small lesion- excisional bx

Large lesions- incisional bx

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7
Q

What is the tx for squamous cell carcinoma?

A 
Small lesion (<1 cm): excise with 0.5 cm margin
Large lesion: (>1 cm): resect with 1-2 cm margins of nl tissue (large lesions may require skin graft/flap)
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8
Q

What is the sign of metastasis of squamous cell carcinoma?

A

Palpable LNs (remove involved LN basin)

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9
Q

What is Marjolin’s ulcer?

A

Squamous cell carcinoma that arises in an area of chronic inflammation

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10
Q

What is the prognosis of squamous cell carcinoma?

A

Excellent if totally excised

Most pts with pos LN metastasis eventually die from metastatic disease

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11
Q

What is the tx for solitary metastasis in squamous cell carcinoma?

A

Surgical resection

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12
Q

What is basal cell carcinoma?

A

Carcinoma arising in the germinating basal cell layer of epithelial cells

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13
Q

RFs of basal cell carcinoma

A 
Sun exposure
Fair skin
Radiation
Chronic dermatitis
Xeroderma pigmentosum
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14
Q

What are the most common sites of basal cell carcinoma?

A

Head
Neck
Hands

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15
Q

S/sx of basal cell carcinoma

A 
Slow-growing skin mass (chronic, scaly)
Scab
Ulceration
With or without pigmentation
Often described as pearl-like
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16
Q

How is the diagnosis of basal cell carcinoma made?

A

Excisional or incisional bx

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17
Q

What is the tx of basal cell carcinoma?

A

Resection with 5 mm margins (2 mm margin in cosmetically sensitive areas)

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18
Q

What is the risk of metastasis in basal cell carcinoma?

A

Very low (recur locally)

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19
Q

What is melanoma?

A

Neoplastic disorder produced by alignant transformation of the melanocyte

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20
Q

Which pts are at greatest risk for melanoma?

A 
White pts with blonde/red hair
Fair skin
Freckling
Hx of blistering sunburns
Blue/green eyes
Actinic keratosis
F>M
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21
Q

What are the three MC sites of melanoma?

22
Q

What is the MC site of melanoma in AAs?

Study These Flashcards
A

Palms of the hands

Soles of the feet

23
Q

What characteristics are suggestive of melanoma?

Study These Flashcards
A 
Usually a pigmented lesion with an irregular border, irregular surface, or irregular coloration
Other clues:
Darkening of a pigmented lesion
Development of pigmented satellite lesions
Irregular margins or surface elevations
Notching
Recent or rapid enlargement
Erosion or ulceration of surface
Pruritis
24
Q

What are the ABCDs of melanoma?

Study These Flashcards
A

Asymmetry
Border irregularity
Color variation
Diameter >6 mm and dark lesion

25
Associated RFs of melanoma
``` Severe sunburn before age 18 Giant congenital nevi FHx Race (white) UV radiation (sun) Multiple dysplastic nevi ```
26
How does location of melanoma differ in men and women?
Men get more lesions on the trunk | Women on the extremities
27
What locations of melanoma are more unusual?
Noncutaneous regions, such as mucous membranes of the vulva/vagina, anorectum, esophagus, and choroidal layer of the eye
28
What is the MC site of melanoma in women?
Legs
29
What is the MC site of melanoma in men?
Back
30
What are the four major histologic types of melanoma?
Superficial spreading Lentigo maligna Acral lentiginous Nodular
31
Superficial spreading melanoma
Occurs in both sun-exposed and non-exposed areas | Most common of all melanomas
32
Lentigo maligna melanoma
Malignant cells that are superficial, found usually in elderly pts on the head or neck Called Hutchinson's freckle if noninvasive Least aggressive type; very good prognosis Accounts for <10% of all melanomas
33
Acral lentiginous melanoma
Occurs on the palms, soles, subungual areas, and mucous membranes Most common melanoma in AA pts
34
Nodular melanoma
Vertical growth pedominates Lesions are usually dark Most aggressive type/worst prognosis
35
Amelonotic melanoma
Melanoma from melanocytes but with obvious lack of pigment
36
What are the common sites of metastasis of melanoma?
Nodes (local) Distant: lung, liver, bone, heart, and brain Melanoma has a specific attraction for small bowel mucosa Brain metastases are a common cause of death
37
How is dx made of melanoma?
Excisional bx (complete removal leaving only normal tissue) or incisional bx for very large lesions
38
What is the role of shave bx in melanoma?
No role
39
When is elective LN dissection recommended in melanoma?
Controversial- possible advantage in melanomas 1-2 mm in depth but jury still out Sentinel node bx if >1 mm is becoming very common
40
What is the melanomin tumor marker?
S-100
41
``` What is the recommende size of surgical margin for depth of invasion: Melanoma in situ? Less than or equal to 1 mm thick? 1-4 mm thick? >4 mm thick? ```
0.5 cm margin 1 cm margin 2 cm margin 3 cm margin
42
What is the tx for digital melanoma?
Amputation
43
What is the tx of palpable LN metastasis in melanoma?
Lymphadenectomy
44
What factors determine the prognosis of melanoma?
Depth of invasion and metastasis are the most important factors
45
What is the workup to survey for metastasis in the pt with melanoma?
PE LFTs CXR (bone scan/CT scan/MRI reserved for sx)
46
What is the tx of intestinal metastasis in melanoma?
Surgical resection to prevent bleeding/obstruction
47
What is FDA-approved adjuvant therapy for melanoma?
Interferon alpha-2b (for stages IIB/III)
48
What is the tx of unresectable brain metastasis in melanoma?
Radiation
49
What is the tx of isolated adrenal metastasis in melanoma?
Surgical resection
50
What is the tx of isolated lung metastasis in melanoma?
Surgical resection
51
What is the MC symptom of anal melanoma?
Bleeding
52
What is the tx of anal melanoma?
APR or wide excision

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