Neoplasms and Verrucous Lesions

Question 1

Identify which lesions are benign, pre malignant, and malignant

Answer 1

SK - benign
AK - “precancerous” can become SCC
Nevi - benign
BCC - least likely to metastasize
SCC - can metastasize if untreated
Malignant Melanoma - malignant

Question 2

Describe characteristics and treatment of SK

Answer 2

• Isolated individual lesions
• Appear dried out/crusty
• Vary in color
• Raised
• Vary in size
• Found anywhere in body
  Treatment is not necessary, can consider a biopsy if it is not a clear cut SK. Can be removed by cryotherapy or surgical removal. Can also use a topical antipruritic.

Question 3

Identify the red flag symptom related to SK

Answer 3

Sudden onset (hundreds within weeks) is a sign of Leser-Trelat. Can be associated with various malignancies (mostly GI cancer)

Question 4

Describe clinical features of AK

Answer 4

• Pre Skin Cancer
• Caused by excess sun exposure (as a kid/teen)
• Common on face, ears, scalp, forearms, chest, upper back, hands
• Initially, lesions may come and go
• Scaly, flaky, rough, red/pink background, sensitive

Question 5

Discuss treatments for AK

Answer 5

• Consider biopsy depending on nature of lesion
• Destruction with liquid nitrogen or topical chemotherapy or photodynamic therapy (dependent on location, number and size of lesions)
• Sun safety

Question 6

Differentiate clinical features of BCC and SCC

Answer 6

BCC
- Caused by sun exposure
- Most common
- Least likely to metastasize
- A sore that does not heal
- A pearly shiny bump
- A scar life appearance
- A red scaly crusted patch
- Slow growing
- Biopsy for Dx
SCC
- Second most common
- Can metastasize if untreated
- Caused by sun exposure, radiation exposure and chronic skin trauma
- Immune suppressed people are at higher risk
- Most common affected areas same as above plus the lips
- Thick rough horn like lesions
- Wart like sore
- May bleed
- Irregular rough red patch that persists
- Meaty crater form lesion
- Faster growing than BCC
- Biopsy for Dx

Question 7

Identify treatments for BCC and SCC

Answer 7

Cryotherapy, topical chemotherapy, electrodesiccation & curettage (ED&C), excision, MOHS surgery

Question 8

Identify risk factors for Malignant Melanoma

Answer 8

• Amount of sun exposure
• Heredity: 1st degree relative means having a 50% greater chance of developing MM than general population
• Atypical Nevis increases risk of MM

Question 9

Describe each component of the ABCDEs of melanoma

Answer 9

Asymmetry
Borders
Color/Consistency of color
Diameter
Evolving

Question 10

Identify and differentiate the four main types of melanoma

Answer 10

Superficial Spreading
- In Situ
- Most common
- Trunk in men, legs in women, upper back in both
Lentigo Maligna
- In Situ
- Elderly, chronically damaged skin
- Face, ears, arms, upper trunk
Acral Lentiginous
- In Situ
- Under nails or palms of hands, soles of feet
- Common in African Americans or Asians
Nodular
- Invasive
- Trunk, legs, arms, scalp of men
- Most aggressive

Question 11

Discuss treatment strategies for melanoma

Answer 11

• Must be surgically excised with a margin. Margin is determined by the depth of the lesion.
• Referral to other healthcare providers (malignancy)
• Frequent skin exams
• Sun safety
• Inform family and friends