Malignant Neoplasms of the skin

Question 1

What are the malignant neoplasms of the skin?

Answer 1

1. Actinic Keratosis
2. Basal Cell Carcinoma
3. Squamous Cell Carcinoma
4. Dysplastic Melanocytic Nevi
5. Malignant Melanoma

Question 2

What % of skin cancers occurs on the head and neck?

Answer 2

80%

Question 3

What is actinic keratosis?

Answer 3

1. Sun induced Premalignancy
2. Seen in older adult pt’s
3. Erythematous scaling papules or plaques
   A. Feels like sandpaper
4. Located on sun exposed skin
   Face, Neck, Dorsal hands/arms

Question 4

How is actinic keratosis dx?

Answer 4

Clinical, Bx if unsure

Question 5

How is actinic keratosis treated?

Answer 5

Cryo, ED&C, Topical 5FU

Question 6

What is basal cell carcinoma most common in?

Answer 6

1. MC form of primary cutaneous malignancy
2. MC in older adults >40yo to sun-exposed skin
3. MC in fair skin pt’s (skin types I & II)
4. MC on face/scalp/ears/neck, trunk/extr’s

Question 7

What are the sxs of basal cell carcinoma?

Answer 7

Persisting lesion, enlarging, painful/bleed/itch

Question 8

What are risk factors for BCC?

Answer 8

High Cumulative UVR, ionizing rad.

Question 9

What are the severe clinical variants of BCC?

Answer 9

1. Nodular, Pigmented, and Micronodular (infiltrative) BCC

2. Superficial BCC and Morpheaform BCC

Question 10

What is the prognosis for BCC?

Answer 10

95% cure rate if detected early, Metastases extremely rare

Question 11

What is the tx for BCC?

Answer 11

Surg Exc., ED&C, Moh’s Surgery

Question 12

How is BCC prevented?

Answer 12

Annual FBE and Educate pt on MoSSE and Sun Prot

Question 13

What are the MC’s for SCC?

Answer 13

1. 2nd MC form of primary cutaneous malignancy
2. MC in older adults >40yo to sun-exposed skin
   May arise from AK’s or KA’s or arise de novo
3. MC in fair skin pt’s (skin types I & II)
4. MC on face/scalp/ears/neck, trunk/extr’s

Question 14

What are the sxs of SCC?

Answer 14

Persisting lesion, enlarging, painful/bleed/itch

Question 15

What are the risk factors of SCC?

Answer 15

High Cumulative UVR, ionizing rad.

Question 16

What are the clinical variants of SCC?

Answer 16

1. Clinical Variants depend on depth of invasion
   A. SCC in situ (Bowens Disease) – Confined with in epidermis
   B. SCC invasive – dermoepidermermal junction is breached

Question 17

What is the prognosis for SCC?

Answer 17

1. Surg exc nonmetastatic SCC PX is excellent

2. Metastatic rate for SCC is 2-6% (check LN’s!)

Question 18

What is the tx for SCC?

Answer 18

Surg Exc., ED&C, Moh’s Surgery

Question 19

How can SCC be prevented?

Answer 19

Annual FBE and Educate pt on MoSSE and Sun Prot

Question 20

What is dysplastic malanocytic nevi?

Answer 20

1. Atypical Nevi considered to be part of a spectrum between benign nevi and melanoma
2. Believed to have incr risk for malignancy depending on the severity of the atypia
   A. Controversy around the exact incidence (1-40%)

Question 21

How are dysplastic melanocytic nevi managed?

Answer 21

1. Recommended to Bx Atypical appearing lesions

A. Surg Exc (2mm margins) if shows signs of dysplasia

Question 22

What are the ABCDEs for dysplastic melanocytic nevi?

Answer 22

A = Asymmetry
B = Border Irregularity
C = Color variation
D = Diameter >6mm
E = Enlarging/Evolving

Question 23

define melanoma

Answer 23

Malignancy of Melanocytes and nevus cells

Question 24

What are the risk factors for melanoma?

Answer 24

1. Fair complexion (skin types I & II)
2. Numerous Atypical Nevi (>50)
3. Large Congenital Nevi
4. PMHx or immediate FAMHx of Melanoma

Question 25

Where is MM found on the body?

Answer 25

1. MM can arise on any part of the body A. MC on trunk for men B. MC on lower extr for women

Question 26

What are the types of MM?

Answer 26

1. Superficial Spreading MM – MC form of MM in lighter skin 2. Nodular MM – Pigmented slowly enlarging ulcerative nodule 3. Acral Lentiginous MM – MC form of MM in darker skin types, hands and feet involvement 4. Lentigo Maligna MM – MC form in elderly, sun exposed areas 5. Amelanotic MM – nonpigment producing variant of MM

Question 27

How is MM dx?

Answer 27

1. Biopsy recommended for any suspicious lesion A. Excisional Bx method of choice (Punch if necessary) B. Do not Shave Bx a suspected MM (miss the vertical)

Question 28

What is MM tx based on?

Answer 28

1. Tx decisions (Margins/SLN Bx) and Prognosis A. Based off of depth of MM invasion -Clark’s Levels or Breslow’s Depth B. Based off of TNM system

Question 29

How is MM followed up?

Answer 29

1. Routine f/u depends on stage of MM A. FBE with LN evaluation q 3, 6, 12 Mo’s B. Labs for CBC and LFT’s C. CXR