Malignancies of surface epithelial origin

Question 1

most common skin cancer?

Answer 1

BCC - affects over 1 million people in the U.S annually

Question 2

risk factors BCC

Answer 2

40+ yo
fair complexion
hx of chronic sun exposure

Question 3

where does BCC normally affect?

Answer 3

middle 1/3rd of the face

BUT any cutaneous areas of the head and neck can be affected

Question 4

what are the 3 types of BCC?

Answer 4

nodulo-ulcerative

pigmented and sclerosing

Question 5

what is the most common BCC clinical presentation?

Answer 5

nodulo-ulcerative

Question 6

appearance nodulo-ulcerative bcc

Answer 6

umbilicated papule that may show central ulceration

LACK of adnexal skin structures (hair)

Question 7

histopathology noduloulcerative BCC

Answer 7

basaloid cells that appear to “drop off” of the basal cell layer of the epidermis
*large lobules into the superficial CT of tumor cells are characteristic

Question 8

pigmented bcc resembles

Answer 8

melanocytic nevi

*due to benign melanocytic colonization

Question 9

how to distinguish nevus from pigmented bcc?

Answer 9

short duration and lack of hair

Question 10

what is the least common type of BCC?

Answer 10

sclerosing

Question 11

what is the most aggressive form of BCC?

Answer 11

sclerosing

Question 12

what is another name for sclerosing bcc?

Answer 12

morpheaform

Question 13

what does a sclerosing bcc resemble clinically?

Answer 13

a scar (cicatrix)
*due to collagen formation induced by tumor cells

Question 14

histopathology sclerosing bcc?

Answer 14

tiny infiltrative nests of tumor cells in a collagenous background
*hard to assess borders clinically due this infiltrative growth pattern

Question 15

tx bcc

Answer 15

scalpel excision
electrodesiccation and curettage
mohs curgery (pathology and surgery)
cryotherpy
radiation

Question 16

prognosis bcc

Answer 16

generally excellent - 95% of patients cured after 1st tx

metastasis is RARE

Question 17

what lesions require mohs surgery?

Answer 17

larger, recurrent lesions and tumors in areas of embryonic fusion that are more aggressive

Question 18

what is the most common oral malignancy?

Answer 18

SCC

Question 19

SCC is the ___ most common cutaneous malignancy

Answer 19

2nd

Question 20

areas that are most affected by scc

Answer 20

skin and lower vermillion zone of the lip (on the face)

face, helix of the ear, dorsum of hands and arms are common sites

Question 21

causes od cutaneous SCC

Answer 21

chronic sun (UV) exposure or after medical ionizing radiation to a specific site

** arises from pre-exisiting actinic keratosis in many instances

Question 22

tx of cutaneous scc

Answer 22

surgical excision

Question 23

actinically induced scc growth

Answer 23

well differentiated and grow slowly

Question 24

prognosis of scc

Answer 24

generally good if identified early in course

Question 25

what percent of scc are usually associated with tobacco (with or without) alcohol

Answer 25

75-80%

Question 26

20-25% of scc are not associated with identifiable risk factors, where are they located?

Answer 26

lateral tongue of younger people and gingiva of older owmen

Question 27

oncogenic HPV subtypes usually show up where when they turn to scc?

Answer 27

base of tongue and tonsils

Question 28

what type of hpv is implicated in oropharyngeal scc?

Answer 28

type 16

Question 29

does oropharyngeal scc have a better change when it is or is not associated with hpv?

Answer 29

better prognosis if HPV +

Question 30

what percent of cancers does oral scc account for?

Answer 30

3-4

Question 31

oral scc epidemiology

Answer 31

older adults | men 2: 1 to women

Question 32

risk factors oral scc

Answer 32

same as leukoplakia and erythroplakia * alcohol??? or synergistic effect with tobacco NOT alcoholic mouthwash

Question 33

appearance of oral scc?

Answer 33

irregular shape, mixture of red and white clinically often ulcerated exophytic (growing out) or endophytic (growing in) growth pattern FIRMER than surrounding tissues

Question 34

oral scc appearance on an X-ray

Answer 34

ragged moth-eaten radiolucency with ill-defined borderes **bone involvement, so fracture is possible

Question 35

when does oral scc exhibit pain?

Answer 35

late, early lesions are usually asymptomatic

Question 36

prognosis of scc on the lip?

Answer 36

lower lip - good | upper lip - high risk for lymph node metastasis

Question 37

oral scc can develop from what?

Answer 37

1. leukoplakia 2. erythroplakia 3. proliferative verrucous leukoplakia

Question 38

proliferative verrucous leukoplakia

Answer 38

leukopakia that grows laterally and involves multiple sites

Question 39

prolifertive verrucous leukoplakia female predilection

Answer 39

4: 1 | * only 1/3 have traditional risk factors

Question 40

mean age of females and males with proliferative verrucous leukoplakia

Answer 40

65 yo female and 49 yo male

Question 41

oral scc common sites

Answer 41

``` tongue, esp post lateral/ventral floor of the mouth (esp near the frenum) gingiva labial and buccal mucosa hard palate ```

Question 42

what is the most common site of oral scc involvement on the tongue

Answer 42

lateral tongue

Question 43

where does oral scc typically seen in pts that are young and have no risk factors

Answer 43

tongue

Question 44

oral scc in the floor of the mouth is usually where?

Answer 44

near the midline ** about at common as tongue ca

Question 45

is it common to have gingiva/alv mucosa oral scc?

Answer 45

no, but double as common in women at this site **usually in people with no risk factors (i.e no smoking etc..)

Question 46

if oral scc in the hard palate often?

Answer 46

no, usaully arises on the lateral soft palate | **hard to determine if lesion developed in mx sinus and invaded through the floor

Question 47

clincial differential diagnosis of scc

Answer 47

non-specific ulcer specific infections (tb, syphillis, deep fungal) immune-mediated conditions (wegner, crohn)

Question 48

histopath scc

Answer 48

microscopically, invasive cords and nests of malignant sq. epithelial cells arise from dysplatic surface epi *tumor cells show an increased nuclear/cytoplasmic ratio, cellular and nuclear pleomorphism an mitotic activity varying degrees of keratin production may be seen ( well vs. poorly diff)

Question 49

oral scc tx

Answer 49

wide surgical excision and/or radiation therapy chemo does NOT show any impact neoadjuvant therapy to shrink the tumor initially molecular-based targeted therapy are anticipated for the future

Question 50

prognosis oral scc

Answer 50

poor because pts present in stage III or IV and metastasis to regional lymph nodes

Question 51

5 year survival rate for oral scc?

Answer 51

60%, one of the worst prognoses of any major cancer

Question 52

is oral scc follow up necessary?

Answer 52

yes

Question 53

what percent of patients will develop aerodigestive tract malignancies if carcinogenic habits dont stop after oral scc?

Answer 53

10-25%

Question 54

verrucous carcinoma

Answer 54

less aggressive, relatively uncommon FORM of scc

Question 55

when does veruc ca develop

Answer 55

elderly male pts

Question 56

ver carcinoma show a correlation with smokeless tobacco?

Answer 56

No, mentioned as a contributing factor, but no association

Question 57

appearance verruc ca?

Answer 57

diffuse white or mixed red and white plaqiue

Question 58

frequent sites for verruc ca?

Answer 58

alveolar mucosa, hard palate and buccal mucosa

Question 59

verruc ca growth pattern

Answer 59

lateral

Question 60

verruc ca histology

Answer 60

very bland, often misdiagnosed | **Dx based on overall architecture of the tumor rather than the appearance of individual cells

Question 61

verruc ca tx

Answer 61

surgical excision radiation discouraged b/c sporadic reports of transformation of verrucous ca to a more aggressive scc?? --> differing new info

Question 62

what percent of verruc ca (upon COMPLETE excision) shows foci of transformation to routine scc

Answer 62

20-25%