Malignancies Of Surface Epithelium

Question 1

T/F: Neoplasms may be benign or malignant.

Answer 1

True

Question 2

T/F: Basal cell carcinoma is the most common skin cancer.

Answer 2

True

Question 3

T/F: The majority of basal cell carcinomas are found on the head/neck.

Answer 3

True

80%

Question 4

What is the most common location on the head/neck to get basal cell carcinoma?

Answer 4

Middle 1/3 of face (includes ears)

Question 5

What is the most common BCC?

Answer 5

Nodulo-ulcerative BCC

Question 6

What is the least common BCC?

Answer 6

Sclerosing BCC

Question 7

What are the clinical features of nodulo-ulcerative BCC?

Answer 7

• Firm, painless papule
• slow enlargement
• central depression (umbilication) with rolled borders

Question 8

What is a rodent ulcer?

Answer 8

Nodule-ulcerative BCC that enlarges and destroys tissue

Question 9

What is the major histopathological feature of nodulo-ulcerative BCC?

Answer 9

Uniform, dark staining basaloid cells that appear to “drop off” from the surface epithelium

Question 10

Which type of BCC most resembles a nevus?

Answer 10

Pigmented BCC

Question 11

What gives pigmented BCC the pigment?

Answer 11

Colonization by benign melanocytes

Question 12

T/F: Sclerosing BCC is the most aggressive form of BCC.

Answer 12

True

Question 13

What is the major clinical feature of sclerosing BCC?

Answer 13

Tissue resembles scar tissue and is more firm than surrounding skin

Question 14

What differentiates sclerosing BCC from other BCC hisotopathologically?

Answer 14

Sclerosing BCC presents with tiny infiltrative nests of tumor cells

Other BCC have large globules of tumor cells

Question 15

What is the prognosis for BCC?

Answer 15

Generally excellent, over 95% cured with first treatment

Question 16

What is the most common oral malignancy?

Answer 16

Squamous Cell Carcinoma (SCC) - 90% or oral cancer

Question 17

T/F: SCC can arise from salivary ductal epithelium.

Answer 17

True

Question 18

What are three risk factors for cutaneous SCC?

Answer 18

1. UV exposure
2. Medical ionizing radiation
3. Pre-existing actinic keratosis

Question 19

What percentage of cutaneous SCC are found on the head and neck?

Answer 19

70%

Question 20

T/F: Cutaneous SCC will not have keratin on the lesion.

Answer 20

False

Could be keratinized (keratin horn) or nonkeratinized

Question 21

What is the prognosis of a cutaneous SCC?

Answer 21

Good if identified and treated early

Question 22

T/F: Cutaneous SCC are generally well-differentiated under a microscope.

Answer 22

True

Question 23

T/F: SCC of the lip is more common on the upper lip.

Answer 23

False

More common on lower lip

Question 24

T/F: SCC of the upper lip has a worse prognosis than the lower lip.

Answer 24

True

May metastasize to lymph nodes

Question 25

Oral squamous cell carcinoma is responsible for what percentage of all cancers in U.S.?

Answer 25

2%-3%

Question 26

T/F: All OSCC are associated with identifiable risk factors.

Answer 26

False 25% have no risk factor *mostly under 40 years old, and on lateral/ventral tongue

Question 27

T/F: Heredity plays a major role in OSCC etiology.

Answer 27

False

Question 28

What percentage of patients diagnosed with OSCC have history of tobacco smoking?

Answer 28

80%

Question 29

How many years after cessation of smoking does risk of OSCC decrease to that of a non-smoker?

Answer 29

10 years without smoking

Question 30

Which bacteria and viruses can increase risk for OSCC?

Answer 30

Tertiary syphilis HIV, small sub-set of HPV

Question 31

What are some intrinsic risk factors for OSCC?

Answer 31

- male > 50 y.o. - malnutrition - iron deficiency anemia - immunosuppression

Question 32

What are the most common sites for OSCC?

Answer 32

1. Tongue - most common 2. Floor of mouth - near midline 3. Gingiva - more women 4. Soft palate 5. Labial/buccal mucosa 6. Hard palate

Question 33

What are the highest risk sites for OSCC?

Answer 33

Ventro-lateral tongue, floor of mouth, soft palate

Question 34

T/F: OSCC will always present as exophytic.

Answer 34

False May look exophytic or endophytic or both! Exophytic - growing out, mass forming Endophytic - invasive, ulcerating

Question 35

How will OSCC look in a radiograph?

Answer 35

Moth-eaten radiolucency; bone invasion is a late feature

Question 36

Invasive cords and nests of malignant epithelial cells arise from dysplastic epithelium in which type of cancer?

Answer 36

OSCC

Question 37

What are the three options for treating OSCC?

Answer 37

Wide surgical excision, radiation, chemotherapy

Question 38

T/F: Most OSCC present in stage I or II.

Answer 38

False III or IV; poor prognosis

Question 39

What does the TNM staging system stand for?

Answer 39

T - tumor size N - lymph nodes M - metastasis

Question 40

T/F: Recurrent cancer is always stage III.

Answer 40

False Not staged in TNM

Question 41

What is the biggest cause for new upper aerodigestive tract malignancies after cancer treatment?

Answer 41

Continuation of carcinogenic habits

Question 42

T/F: Verrucous carcinoma is a more aggressive form of squamous cell carcinoma.

Answer 42

False Less aggressive

Question 43

Verrucous carcinoma is heavily associated with __________.

Answer 43

Dry snuff

Question 44

T/F: Verrucous carcinoma presents with very dysplastic cells.

Answer 44

False Dx based on overall architecture

Question 45

T/F: Prognosis of verrucous carcinoma is generally guarded.

Answer 45

False 90% disease free after 5 years