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Dermatology 2 > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

Actinic keratosis

A
  • precancerous to SCC
  • 10% risk malignant transformation
  • very common
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2
Q

Actinic keratosis

- RF

A
  • caucasion
  • chronic sun exposure
  • immunocompromised
  • Fitz-Patrick I and II
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3
Q

Actinic keratosis

- common location

A
  • sun-exposed areas

- scalp, head, face, dorsal forearms, hands, shins

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4
Q

Actinic keratosis

- epidemiology

A
  • middle aged and older

- M>F 2:1

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5
Q

Actinic keratosis

- pathophys

A

atypical keratinocytes confined to lower portion of epidermis

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6
Q

Actinic keratosis

- S&S

A
  • sometimes easier felt than seen
  • gritty papule, erythematous base
  • white to yellow scale
  • rough like sandpaper
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7
Q

Actinic keratosis

- Dx

A
  • History and PE
  • Bx gen not needed
  • Fluorescence with Woods lamp
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8
Q

Actinic keratosis

- progression

A
  • persist
  • spontaneously regress
  • progress to SCC
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9
Q

Actinic keratosis

- what presentation is most likely to progress to SCC

A
  • tender
  • thick
  • inflamed
  • failure to respond to therapy
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10
Q

Actinic keratosis

- Treatment

A
  • Cryotherapy #1
  • F-fluorouracil 5% cream X 1 month
  • Aldara 5% cream X 16 weeks
  • Picato 0.015% gel X 3 days
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11
Q

Seborrheic keratosis

- overview

A
  • superficial, often pigmented, benign lesions
  • show up around 40s, increase as age
  • trunk and temple MC
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12
Q

Seborrheic keratosis

- presentation

A
  • vary in size
  • grow slowly
  • macular, papular, verrucous
  • round or oval
  • flesh colored, black, brown
  • spares palms, soles, mucosal surfaces
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13
Q

What is concern if large, multiple, rapidly appearing Seborrheic keratosis?

A

Leser-Trelat sign

- associated with internal malignancy

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14
Q

Seborrheic keratosis

  • dx
  • tx
A
  • clinical history and PE

- cryotherapy to remove if bothersome

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15
Q

Basal cell carcinoma

- overview

A
  • MC type skin cancer
  • rarely metastasize
  • cause local destruction
  • from basal cells in skin
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16
Q

Basal cell carcinoma

  • appearance
  • location
A
  • superficial
  • slow growing papule or nodule
  • lesion that doesn’t heal and bleeds when traumatized
  • sun exposed: hands, face, head, and neck region (85%)
  • Periocular: MC lower eyelid
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17
Q

Basal cell carcinoma

- epidemiology

A
  • elderly
  • fair skinned (caucasian has 30% lifetime risk)
  • M>F 2:1
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18
Q

Basal cell carcinoma

- RF

A
  • Long term sun exposure
  • Fitzpatrick type 1
  • immunocompromised
  • prior BCC
  • trauma
  • xeroderma pigmentosum
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19
Q

Basal cell carcinoma

- pathophys

A
  • Basal keratinocytes of epidermis and adnexal structures
  • grows as direct extension
  • unpredictable growth and progression
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20
Q

Basal cell carcinoma

- 4 main patterns

A
  • Nodular (60%)
  • superficial (30%)
  • infiltrative
  • morpheaform
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21
Q

Basal cell carcinoma

- Nodular

A
  • MC form **
  • Pearly white/pink **
  • Dome shaped
  • Rolled border
  • Telangiectasias **
  • Can have central ulceration and crusting
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22
Q

Basal cell carcinoma

- Superficial

A
  • epidermis
  • younger, female
  • trunk and extremities **
  • slow growing, expands peripherally
  • circumscribed, round-to-oval, red, scaling plaque **
  • may resemble eczema or psoriasis **
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23
Q

Basal cell carcinoma

- Morpheaform

A
  • Yellow/waxy *
  • sclertoic
  • no ulcerations usu
  • Firm, flat, slightly raised **
  • resembles scleroderma
  • indistinct borders
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24
Q

Basal cell carcinoma

- Infiltrating

A
  • slow growing
  • sun exposed areas
  • mostly males
  • Irregular, poorly demarcated plaque **
  • can be red and ulcer **
  • infiltrate deeper, involve lymph nodes
  • can grow large, infiltrate nerves, nearby tissue
  • children: assoc. with basal cell nevus syndrome
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25
Q

Basal cell carcinoma

- Pigmented

A
  • melanin

- usually people with darker skin and eyes

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26
Q

Basal cell carcinoma

- cystic

A
  • cystic mass, smooth and round
  • similar to nodular BCC
  • less firm than nodular
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27
Q

Basal cell carcinoma

- Nevoid basal cell carcinoma syndrome

A
  • rare, autosomal dominant
  • multiple BCCs at birth or early childhood

*more on slide but this is what she said to know

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28
Q

Basal cell carcinoma

- Dx

A
  • Bx: shave or punch **

- imaging (CT) only if need or for sx prep

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29
Q

Basal cell carcinoma

- Histology

A

two categories

  • Undifferentiated: solid BCC
  • Differentiated: contain other cell lines also
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30
Q

Basal cell carcinoma

- Treatment

A
  • Surgical excision**
  • MOHS**
  • electrodessication and curettage
  • radiation
  • imiquimod
  • 5-fluorouracil
  • F/U observe 5+ years
  • risk of second BCC within 5 years: 36-50%
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31
Q

Squamous Cell In Situ

  • aka
  • describe
A
  • Bowen’s disease
  • very early form skin cancer
  • superficial SCC
  • sun exposed MC but can be anywhere
32
Q

Squamous Cell In Situ

- presentation

A
  • solitary or multiple
  • scaly patch doesn’t heal
  • slow growth
  • can itch
  • not painful
33
Q

Squamous Cell In Situ

- PE

A
  • red-brown
  • scaly or crusted
  • resembles thin psoriasis plaques, dermatitis, dermatophyte infection
34
Q

Squamous Cell In Situ

- dx

A

bx

35
Q

Squamous Cell In Situ

- tx

A
  • Aldara 5% cream
  • 5-FU 5% cream
  • cyrotherapy
  • excision
  • Sun care practices
36
Q

Erythroplasia of Queyrat

- overview

A
  • Bowen’s dz of the glans penis
  • almost always uncircumsized
  • can progress to invasive SCC
37
Q

Erythroplasia of Queyrat

- signs and sx and PE

A
  • solitary or multiple non healing lesions
  • redness, crusting, scaling, ulceration
  • itching, pain, bleeding
  • phimosis, dysuria, penile discharge
  • can affect adjacent mucosal epithelium/inner surface foreskin
38
Q

Erythroplasia of Queyrat

- dx

A
  • bx
39
Q

Erythroplasia of Queyrat

- tx

A
  • Aldara
  • 5-FU
  • MOHS
  • surgical excision
  • cryotherapy
  • radiation
  • laser treatment
40
Q

Squamous Cell Carcinoma

- overview

A
  • 2nd MC skin cancer

- substantial risk of metastasis **

41
Q

Squamous Cell Carcinoma

- RF

A
  • UVB radiation, esp in childhood
  • light hair and eyes
  • ionizing radiation
  • outdoor occupation
  • immunosuppression
42
Q

Squamous Cell Carcinoma

- MC locations

A
  • sun-exposed
  • scalp
  • back of hands
  • superior pinna
43
Q

Squamous Cell Carcinoma

- epidemiology

A
  • elderly

- M>F 2:1

44
Q

Squamous Cell Carcinoma

- precursors

A
  • Actinic keratosis**

- cutaneous horns

45
Q

Squamous Cell Carcinoma

- pathophys

A
  • atypical squamous cells in epidermis

- from proliferating keratinocytes

46
Q

Squamous Cell Carcinoma

- presentation

A
  • Non healing lesion**
  • sun exposed surface
  • shallow ulcer with elevated margins, often covered by plaque
  • red, soft, freely moveable tumor
  • may have thick and adherent scale
47
Q

Squamous Cell Carcinoma

- Metastatic potential

A
  • depends on location, size, degree differentiation, immunologic status, histology, depth
  • Highest risk: scalp, ears, lips, nose, forehead, areas of chronic inflammation
48
Q

Squamous Cell Carcinoma

- Dx

A
  • Bx: incisional or excisional **

- Imaging (CT/MRI): surrey prep or look for invasion or metastasis

49
Q

Squamous Cell Carcinoma

- Staging

A
  • Important to determine treatment
  • TNM staging used **
  • highest risk >2 mm thickness, invasion to lower dermis/subcut, skin nerves, ear or hair-bearing lip
50
Q

Squamous Cell Carcinoma

- Tx

A
  • Surgical excision with clear margins
  • MOHS if in face
  • radiation adjuvant to sx
  • 5-FU
  • systemic chemo for metastatic SCC
51
Q

Kaposi Sarcoma

- overview

A
  • develops from cells that line lymph or blood vessels
  • usu tumors on skin or mucosal surfaces
  • aka “multiple idiopathic hemorrhagic sarcomas”
  • rare prior to AIDS era
52
Q

AIDS-Associated Kaposi Sarcoma

  • pathogenesis
  • epidemiology
A
  • caused by HHV-8
  • MC type of KS in US
  • HIV pts
53
Q

AIDS-Associated Kaposi Sarcoma

- presentation

A
  • violaceus macules, plaques, nodules
  • head, neck, upper trunk
  • node involvement common **
  • fulminant onset, “AIDS defining”
  • treatment response is poor
54
Q

Karposi Sarcoma

- Dx

A
  • Hx, PE
  • bunch biopsy
  • CXR/bronchoscopy
  • EGD/Colonoscopy
55
Q

Melanoma

- overview

A
  • malignant transformation of melanocytes
  • most serious skin cancer
  • skin, mucous membranes, ocular, GI, GU, lymph nodes, CNS
  • Metastatic correlated with depth of invasion
56
Q

Melanoma

- incidence

A
  • > 50% 20-40 yo
  • median age 62 men 54 women
  • M>F 1.5:1
  • MC in caucasian
57
Q

Melanoma

- Etiology and pathophys

A
  • DNA damage

- initially in epidermis with lateral growth, then growth into dermis with vertical growth

58
Q

Melanoma

- genetics

A
  • RF: dysplastic nevus syndrome
  • 8-12% have fam hx
  • Familial atypical mole malignant melanoma
  • 1/10,000 dysplastic nevi become melanoma annually
59
Q

Melanoma

- RF

A
  • genetics
  • UVA and UVB exposure
  • Hx >5 sunburns doubles risk **
  • Intense intermittent sun exposure **
  • previous pigmented lesions
  • fair complexion, freckles, blue eyes, blond/red hair
  • highest predictor: increased number nevi (>100) **
  • Tannign bed use 75% inc risk 1st exposure <35 yo
  • changing nevus
  • large congenital nevi (>5 cm)
  • other skin ca
  • blistering sunburns in childhood
  • live high altitude
  • exposure to ionizing radiation
    ETC ETC
60
Q

Melanoma

- 7 main types cutaneous melanoma

A
  1. superficial spreading (50-80%): sun exposed areas
  2. Nodular (20-30%): older pts, ulcerate and hemorrhage
  3. Lentigo maligna (melanoma IS): slowest growing, older pts, sun-exposed
  4. Amelanotic melanoma (<5%): can mimic benign conditions
  5. Acral-lentiginous (2-8%): MC in AA and Asian
  6. Subungual: (<5%) dark band in nail bed, Hutchinson sign
  7. Desmoplastic melanoma (1%): sarcoma-like tendencies, hematogenous spread
61
Q

Melanoma

- presentation

A
  • change in pigmented lesion: hypo- or hyper pigmentation, bleeding, scaling, ulceration, change in size or texture
  • fam/personal hx melanoma and non-melanoma skin cancer
  • Social hx: sunbathing, tanning, other sun
62
Q

Melanoma

- PE

A
  • any new/changing or bleeding/ulcerated nevus
  • high risk: ocular exam (iris and retina)
  • Caucasions MC: back and lower leg
  • AA MC: hands, feet, nails
  • may include mucosal surfaces
63
Q

Superficial spreading melanoma

A
  • MC type
  • grow horizontally along top layer of skin
  • can have purple hue
64
Q

Nodular melanoma

A
  • fast growing
  • cause nearly 1/2 melanoma-related deaths
  • Don’t fit ABCDE as well = harder to dx
  • older men MC
65
Q

Lentigo maligna melanoma

A
  • can look like solar lentigo
  • not very common
  • usu >6mm
66
Q

Amelanoic melanoma

A
  • can be pink, red, purple, flesh colored

- often aggressive

67
Q

Acral lentiginous melanoma

A
  • MC asians and AA

- only shaped dot on foot, toe, etc.

68
Q

Subungual melanoma

A
  • MC AA
  • Nail streak
  • usually big toe and thumb
69
Q

Desmoplastic melanoma

A
  • look like scars
  • usually involve nerve fibers
  • “neurotropic melanoma”
  • MC sun exposed areas
  • usually > 6mm
70
Q

Melanoma

- Dx

A
  • Bx: standard of care. Bx ANY suspicious nevus
  • Dermoscopy: giant microscope to see skin more closely
  • Sentinel node biopsy to stage
  • Lactate dehydrogenase (LDH) baseline
  • CT/MRI/PET CT baseline
  • imaging only helpful in detecting/eval progression fo metastatic disease
71
Q

Melanoma

- Staging

A
  • Breslow staging
  • based on thickness of tumor (for staging)
  • msr in mm
72
Q

Melanoma

- Tx

A
  • Full surgical excision (curative for most stage I-III)
  • stage IV can add chemo
  • oncologist for chemo
  • plastic sx for final excision depending on location
  • MOHS
  • Radiotherapy - lentigo maligna, some head and neck lesions
73
Q

Melanoma

- prognosis

A
  • Strongest predictor is breslow depth
  • highest survival <45 women
  • metastatic has ave survival 6-9 months
  • stage I and II have 20-year survival rats of 90% and 80%
74
Q

Melanoma

- prevention

A
  • avoid sunburn
  • use SPF30+
  • avoid tanning beds
  • Screen high-risk pts
  • Proper dx!!
  • Bx all suspicious lesions
75
Q

Melanoma

- PT education

A
  • Teach those at risk how to monitor for change (ABCDE)
  • perform monthly skin self-exams
  • regular total body exams for those with hx of melanoma or dysplastic nevus syndrome
  • Regular use of SPF15+

Dermatology 2 (10 decks)

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