malignant lesions

Question 1

What is the most common skin CA?

Answer 1

BCC

slow growing and locally destructive

Question 2

where is BCC most common?

Answer 2

face, scalp, ears, neck

Question 3

what are RF for BCC?

Answer 3

sun, white, sunburns before age 14, arsenic ingestion

Question 4

subtypes of BCC

Answer 4

superficial, pigmented, morpheaform, ulcerating, sclerosing

Question 5

most common variant of BCC?

Answer 5

pearly white or pink, translucent, dome-shaped papule w. overlying radom telangiectasias

the center eventually flattens or ulcerates, borders bcome raised or rolled, bleed, and develop crust/scale

Question 6

tx of BCC

Answer 6

ED&C, excision, MMS for recurrent or high risk lesion

Question 7

Superficial BCC

Answer 7

least aggressive variant

trunk/extremities,

resembles o Usually erythematous and scaly papules or plaques, but may or may not have the rolled border
o May resemble psoriasis, eczema, seborrheic keratosis, Bowen’s Disease, or tinea corporis

Question 8

Pigmented BCC

Answer 8

resemble melanoma, contain melanen

thick hard area of variegated pigmentation

Question 9

Morpheaform

Answer 9

least common and most subtle

white to yellow w/ poorly defined borders

Question 10

ulcerated BCC

Answer 10

ulcer with a rolled border, often covered with a crust

Question 11

sclerosing

Answer 11

inflitrating carcinoma, white sclerotic patch with ill defined border

Question 12

SCC

Answer 12

potentially invasive, primary cutaneous malignancy of keratinocytes in the skin
or mucous membranes

20% of all skin cancers

Question 13

SCC most common place

Answer 13

face, scalp, neck , and hands of older pts

Question 14

SCC causes

Answer 14

UV, chemicals (arsenic and hydrocarbons), tobacco, chronic infx, chronic inflammation, HPV infxn

Question 15

what does SCC look like?

Answer 15

flesh-colored, pink, yellowish, or red-colored indurated papules, plaques or nodues w. scale

+/- ulceration or erosion

Question 16

SCC lymphnode metastisis?

Answer 16

palplate regional lymph nodes! (ear, scalp, lips, temples)

Question 17

tx of SCC?

Answer 17

ED&C, excision, or MMS

Question 18

Bowen’s Disease?

Answer 18

SCC in situ

presents as a slow-growin, slightly raised, red plaque w/ scale

Question 19

Erythroplasia of Queyrat’s

Answer 19

SCC in situ of the penis

Question 20

tx of Bowens?

Answer 20

5-FU, cryotherapy, ED&C, excision, MMS

Question 21

Kaposi’s Sarcoma

Answer 21

indolent sarcoma due to HV 8 (think immunocompromised)

Question 22

Kaposi’s sarcoma presentation

Answer 22

painless, pigmented nodules, usually on LE, diffuse pulmonary infiltrates, lymphedema

Question 23

Kaposi’s tx

Answer 23

many lesions resolve after ART, systemic chemo can cause remission in many pts with symptomatic visceral dz

interferon, radiation, chem

Question 24

melanoma

Answer 24

malignancy of melanocytes

most commonly develop as a new growth, but 30% arise w/in a preexisting mole

Question 25

Melanoma appearance

Answer 25

flat, raise, nodular or uclerated, color is variable usually black or dark brown, but can be fleshed colored ** should be in ddx for any new mole presenting in adulthood or any mole changing in size, shape, or color

Question 26

Breslow Depth

Answer 26

*most important prognostic indicator depth of lesion measured in mm best to do a punch bx

Question 27

Clark level

Answer 27

level of anatomic invasion! important in areas w/ thinner skin like eyelids, ears, and genitals

Question 28

most common cancer?

Answer 28

Females age 25-29 yo

Question 29

melanoma RF

Answer 29

PMH or FMH of melanoma or atypical nevus, fair skin, blue eyes, blonde or red hair, UV exposure, many moles, hx of blistering sunburns

Question 30

what should a skin exam always inclue?

Answer 30

LYMPH NODE CHECK

Question 31

what is the most common cause of death from melanoma

Answer 31

CNS mets

Question 32

types of melanoma

Answer 32

lentigo maligna, superficial spreading malignant, nodular malignant, acral lentiginous (palms, soles, nail beds)

Question 33

most common type of melanoma

Answer 33

superficial spreading

Question 34

what is best treatment?

Answer 34

prevention!!!

Question 35

melanoma on nails

Answer 35

dark brown or black pigmentation at proximal nail fold aka (Hutchison's sign)

Question 36

pigmented streaks in nail beds?

Answer 36

longitudinal melanonychia- common in AA, may be sign of melanoma in caucasias