Non-melanoma skin cancer

Question 1

Which type of UV light penetrates deepest?

Answer 1

UVA (then UVB and UVC)

Question 2

What is caused by UVA?

Answer 2

It causes tanning and photoaging (A = aging)

Question 3

What type of UV light makes up the majority that reaches the Earth’s surface?

Answer 3

UVA

Question 4

What type of UV is emitted by tanning beds?

Answer 4

UVA

Question 5

What is caused by UVB?

Answer 5

Sunburns (B = burns), delayed tanning, sunspots, some wrinkles, vitamin D synthesis

Question 6

What type of UV ismost involved in vitamin D synthesis?

Answer 6

UVB

Question 7

What does UVC light do?

Answer 7

It is the most cancer causing, but also is blocked by ozone

(C = cancer)

Question 8

What are the two carcinogenic mechanisms of UV radiation?

Answer 8

DNA damage and immunosuppression

Question 9

What type of UV causes the most direct DNA damage?

Answer 9

UVB

Question 10

What is the most common effect of direct UV-mediated DNA damage?

Answer 10

Photoproducts such as TT pyrimidine dimers

Question 11

What is the main cause of indirect DNA damage from UV?

Answer 11

UVA causing reactive oxygen species that cause damage for DNA molecules, cell membranes, and proteins

Question 12

What gene mutations increase susceptibility to squamous cell carcinomas?

Answer 12

Ras, p53

Question 13

What gene mutations increase susceptibility for basal cell carcinomas?

Answer 13

PTCH

Question 14

What gene mutations increase susceptibility to melanoma?

Answer 14

CDKN2A

Question 15

What are three genetic disorders that predispose people to skin cancer?

Answer 15

Xeroderma pigmentosum, basal cell nevus syndrome, oculocutaneous albinism

Question 16

What type of UV exposure predisposes to squamous cell carcinoma?

Answer 16

Lifelong, chronic UV radiation

Question 17

What type of UV exposure predisposes people to basal cell carcinoma?

Answer 17

Intermittent, intense periods of burns

Question 18

What type of skin cancer has the greatest increase in incidence in transplant patients?

Answer 18

Squamous cell carcinoma (though all skin cancers are increased)

Question 19

When should a shave biopsy be used?

Answer 19

Used for raised lesions that will provide a specimen with epidermis and superficial dermis

Question 20

When should a punch biopsy be used?

Answer 20

When you need a full thickness view of the skin that includes subcutaneous fat, dermis, and epidermis

Question 21

What is the presentation of nodular basal cell carcinoma?

Answer 21

Raised pearly or translucent papule with prominent dilated capillaries, possibly ulceration with larger lesions

Question 22

What is the presentation of superficial basal cell carcinoma?

Answer 22

Friable thin plaque or scaly red macules, primarily horizontal growth

Question 23

What is the presentation of morpheaform and infiltrative basal cell carcinomas?

Answer 23

Scar-like flat, atrophic plaques with ill-defined borders

Question 24

What is the main cause of morbiditiy of basal cell carcinomas?

Answer 24

Soft tissue destruction, metastatic or nodal disease is rare

Question 25

What are actinic keratoses?

Answer 25

Lesions that arise on sun-damaged skin that are thought to be premalignant and may progress to squamous cell carcinoma

Question 26

What is the most common presentation of actinic keratoses?

Answer 26

Erythematous thin papules with rough sand-paper texture

Question 27

What is the most superficial form of squamous cell carcinoma?

Answer 27

Bowen's disease (or SCC in situ)

Question 28

What is the presentation of bowen's disease?

Answer 28

Visible scaly red patches or slightly raised crusted or scaly plaques

Question 29

What is erythroplasia of queyrat?

Answer 29

Bowen's diesease of the penile mucosa that is associated with lack of circumcision and HPV 16/18

Question 30

What is the presentation of squamous cell carcinoma?

Answer 30

Scaly or crusted papule or nodule that may be ulcerated

Question 31

What is a marjolin ulcer?

Answer 31

A form of squamous cell carcinoma that develops from areas of chronically sun damaged skin such as ulcers and scars

Question 32

What is xeroderma pigmentosum?

Answer 32

A condition that results from a mutation in one of the nucleotide excision repair genes that predisposes patients to development of keratinocyte carcinoma due to inability to repair UV-induced DNA photoproducts

Question 33

What is nevoid basal cell carcinoma syndrome?

Answer 33

A condition caused by mutations in PTCH protein, a tumor suppressor, that results in constitutive activation of the sonic hedgehog signaling pathway and predisposes them to basal cell carcinoma

Question 34

What is oculocutaneous albinism?

Answer 34

Mutations that result in partial or complete abscence of melanin, thus removing protection from photoaging and photocarcinogenesis that melanin provides, resulting in increased squamous cell carcinoma and melanomas

Question 35

What are the treatment options for keratinocyte carcinoma?

Answer 35

Surgical excision (usually preferred), curettage with electrodesiccation, Mohs micrographic surgery (used for higher risk areas), radiation therapy (only if patients can't tolerate surgery), cryosurgery, topical treatment

Question 36

What are primary prevention methods for keratinocyte carcinoma?

Answer 36

Sun protection, avoidance behaviors

Question 37

What are secondary prevention methods for keratinocyte carcinoma?

Answer 37

Methods to diagnose and treat existent disease before progression to significant morbidity

Question 38

How would you describe this facial growth?

Answer 38

Solitary, 5 mm pearly pink papule with telangiectasias and central umbilication on the right preauricular cheek

Question 39

What is the leading diagnosis for this lesion?

Answer 39

Basal cell carcinoma

Question 40

What should the first step be in evaluating this patient? a) reassurance b) topical antibiotics c) cryotherapy d) shave biopsy e) surgical removal

Answer 40

d) shave biopsy

Question 41

What are the histological features of basal cell carcinoma?

Answer 41

Rounded nests of basaloid cells, peripheral palisading, fibromyxoid stroma, cleft formation

Question 42

What does this biopsy suggest?

Answer 42

Basal cell carcinoma

Question 43

What is the treatment of choice for basal cell carcinoma? a) punch biopsy b) liquid nitrogen cryotherapy c) reassurance with close follow-up d) surgical removal e) topical antibiotics

Answer 43

d) surgical removal

Question 44

What subtype of basal cell carcinoma is this?

Answer 44

Nodular basal cell carcinoma

Question 45

What subtype of basal cell carcinoma is this?

Answer 45

Superficial basal cell carcinoma

Question 46

What subtype of basal cell carcinoma is this?

Answer 46

Ulcerated basal cell carcinoma

Question 47

What subtype of basal cell carcinoma is this?

Answer 47

Pigmented basal cell carcinoma

Question 48

What subtype of basal cell carcinoma is this?

Answer 48

Morpheaform basal cell carcinoma

Question 49

How would you describe this lesion?

Answer 49

Well-circumscribed, 2 cm, deep pink nodule with central ulceration and crust, firm with palpation

Question 50

What is the most likely diagnosis for this lesion?

Answer 50

Squamous cell carcinoma

Question 51

What are the biopsy findings of a squamous cell carcinoma?

Answer 51

Normal epidermis, dermal extension of well-differentiated keratinocytes (bright pink eosinophilic keratin pearls)

Question 52

What is this?

Answer 52

Squamous cell carcinoma

Question 53

What is the most likely diagnosis?

Answer 53

Squamous cell carcinoma

Question 54

What is the most likely diagnosis?

Answer 54

Squamous cell carcinoma

Question 55

What is the most likely diagnosis?

Answer 55

Squamous cell carcinoma in situ (bowen's disease)

Question 56

What is the most likely diagnosis?

Answer 56

Actinic keratosis

Question 57

What is the appropriate treatment for actinic keratosis?

Answer 57

Cryosurgery

Question 58

What is the most likely diagnosis?

Answer 58

Xeroderma pigmentosum

Question 59

What is the most likely diagnosis?

Answer 59

Nevoid basal cell carcinoma syndrome

Question 60

What is the most likely diagnosis?

Answer 60

Oculocutaneous albinism