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SA Skin Tumors Flashcards

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1
Q

what is the most important part of the physical exam of skin tumors?

A

document the lesion!! with calipers!! and pictures!

body maps: keep L and R straight (dog’s left and right not yours)

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2
Q

what percentage of skin tumors are malignant in dogs? in cats?

A

dogs: 20-40%

cats: >50-65%

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3
Q

describe diagnostic process of skin tumors

A
  1. cytology: DONT wait, aspirate!!
  2. pitfalls:
    -inflammation: can make some cells displastic
    -poorly exfoliative tumors
    -benign vs. malignant
  3. impression smears NOT helpful
  4. biopsy: incisional vs excisional
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4
Q

describe actinic keratosis

A

a common precursor to sun-induced skin tumors

shiny, glistening skin that implies some damage to the skin by the sun

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5
Q

describe clinical presentation of squamous cell carcinoma in cats

A
  1. older cats in unpigmented skin or areas with sparse hair coat
  2. white cats 13.4x increased risk
  3. field cancerization effect: whole field of tissue has been affected (as in laying in the sun) so if the whole skin is damaged, gotta stay out of the sun forever
  4. potential association with FIV
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6
Q

describe the behavior of feline SCC

A
  1. crusty, erosive, or proliferative
    -can be misdiagnosed as a scab or a non-healing scratch
  2. 30% present with multiple lesions
  3. locally invasive with low metastatic rate
  4. bowen’s disease (not solar induced, appear as multiple lesions)
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7
Q

describe diagnosis and staging of feline SCC

A
  1. CBC/chem/UA/FeLV/FIV/T4
    -won’t see much for SCC but good to rule out other causes
  2. shave/wedge biopsy
  3. try cytology (very ulcerated = challenging)
  4. thoracic radiographs
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8
Q

describe treatment of feline SCC (6)

A
  1. surgery: best if you can!
    -pinnectomy
    -planectomy
    -prognosis: generally good if you can cut it off
  2. strontium: RT responsive if superficial enough!
    -88% complete response
    -median control 4.7 years
    -usually only need one treatment!
  3. cryotherapy
  4. photodynamic therapy
  5. imiquimod
  6. external beam radiation therapy: if too deep for strontium

generally good prognosis with early diagnosis and treatment

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9
Q

what are prognostic indicators for feline SCC?

A
  1. stage (size + invasion)
  2. location
  3. proliferation
  4. treatment choice

REMEMBER: spontaneous new lesions always possible due to field cancerization effect!

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10
Q

describe clinical presentation of canine SCC

A
  1. increased risk in dogs with lightly pigmented skin
    -dlamations, beagles, white dogs
  2. cutaneous SCC is often solar-induced
    -EXCEPTION: SCC of nasal planum
  3. locally invasive, low metastatic rate
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11
Q

describe treatment of canine SCC

A
  1. surgery is treatment of choice!
  2. monitor and partial thickness laser removal
  3. others:
    -imiquimod
    -piroxicam
    -retinoids
    -RT
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12
Q

describe presentation of dermal hemangiosarcoma

A
  1. signalment:
    -adult dogs
    -whippet, basset hounds, dalmations

2 ecchymotic plaque-like dermal lesions

  1. hairless areas: ventral abdomen
  2. risk factor:
    -sun exposure is biggest RF!
    -sparse/short hair coats
    -fair skin
    -field cancerization effect
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13
Q

describe appearance, ddx, and behavior of dermal hemangiosarcoma

A
  1. dermal plaque-like lesions
  2. ddx: actinic keratosis, hemangiosarcoma, SCC
  3. behavior: locally invasive, lowly metastatic (unlike other HSAs)
    -good in terms of behavior but field cancerization effect complicates treatment
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14
Q

describe diagnosis and staging of dermal HSA

A
  1. CBC/chem/UA
  2. thoracic rads
  3. abdominal ultrasound
  4. +/- echocardiogram
  5. CONFIRM SKIN AS PRIMARY SITE
    -rule out metastatic spread of other HSA!!!!!
    -increased index of suspicion for metastatic if not on light skin or sparse hair area
  6. biopsy
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15
Q

describe treatment and prognosis of dermal HSA

A

treatment:
1. wide surgical excision
2. adjuvant chemo indicated if extends deeper than dermis
3. cryotherapy

prognosis:
-generally good for stage I, more guarded if stage II or III

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16
Q

describe prevention of solar-induced skin tumors

A
  1. keep indoors
  2. out of sunlight: don’t forget windows!
  3. sunscreen
  4. clothes?
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17
Q

describe histiocytoma

A
  1. arise from langerhans cells
  2. young, purebred dogs
  3. pink, hairless, +/- ulcerated
    -look like buttons!
  4. BENIGN round cell tumor
  5. regress spontaneously in approx 3 months
  6. look like fried eggs on cytology
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18
Q

describe presentation of cutaneous lymphoma

Study These Flashcards
A
  1. cutaneous epitheliotropic T cell lymphoma (CETL) most common
  2. mucocutaneous junctions involved in approx 50% of cases
    -lips, into oral cavity
  3. median age at dx: 10 years
  4. median duration of signs before dx: 5 months
    -waxing and waning clinical hustory
  5. can look like many things:
    -diffuse erythema
    -scales
    -hyperpigmentatin
    -mass lesions: plaques, nodules
19
Q

describe diagnosis and staging of cutaneous lymphoma

Study These Flashcards
A
  1. CBC/chem/UA
  2. thoracic rads
  3. abdominal ultrasound
  4. biopsy
  5. REMEMBER: lymphoma is often a systemic disease!
    -if truly cutaneous lymphoma, likely confined to skin (but there’s a lot of skin so still an issue)
20
Q

describe treatment and prognosis of cutaneous lymphoma

Study These Flashcards
A
  1. RT: most common for solitary lesions
  2. lomustine chemotherapy: if systemic or too many skin lesions for surgical removal or RT
    -overall response rate: 80% (mostly partial responses)
    -waxing and waning issue with chemo tx, cancer will probably win :(
21
Q

describe clinical presentation of dermal melanoma

Study These Flashcards
A
  1. dogs with pigmented skin
    -schnauzers, scottish terriers, airedales, labradors
  2. cats: rare, need to differentiate from lentigo
  3. pigmented mass
  4. NOT solar induced
22
Q

describe behavior of dermal melanoma

Study These Flashcards
A
  1. dogs: 85% benign
  2. mitotic index prognostic in dogs
    -if greater than 20MF/10HPF will see increased growth rate and risk of mets
  3. less predictable in cats
23
Q

describe diagnosis and staging of dermal melanoma

Study These Flashcards
A
  1. CBC/chem/UA
  2. cytology of mass
  3. incisional vs excisonal biopsy
  4. cytology of local LNs and thoracic rads of have suspicion of metastasis (rare)
24
Q

describe treatment of dermal melanomas

Study These Flashcards
A
  1. active surveillance most common
  2. surgery
  3. RT if not resectable
25
describe clinical presentation of plasma cell tumors
1. arise from extramedullary plasma cells 2. solitary hairless mass on the head, ears, or feet, or in oral cavity 3. older large breed dogs common -rare in cats 4. treatment: -usually cured with excision (benign) -EXCEPTION: if part of multiple myeloma or multiple PCTs
26
describe cutaneous plasmacytosis
1. syndrome of multiple cutaneous plasma cell tumors 2. treatment: can't cut them all off so chemo 3. can involve bone (spread to or start from) = bad
27
describe canine transmissible venereal tumor
1. horizontal transmission 2. tropical and subtropical climates 3. most commonly occurs on external genitalia or around nose 4. usually localized but can metastasize 5. majority respond to vincristine
28
describe epidermal inclusion cysts
1. NOT A NEOPLASIA -but common in older dogs 2. hairless mass filled with toothpaste like material 3. treatment: -not always necessary -usually cured with excision
29
describe sebaceous hyperplasia/adenomas
1. females potentially overrepresented -schnauzers, beagles, poodles, cocker spaniels 2. occur on limbs, trunk, eyelids 3. treatment: -not always necessary -usually cured with excision
30
describe lipomas
1. COMMON benign skin tumor 2. slide from FNA may look oily 3. fat often washes off during staining so you may not see anything 4. treatment: -not always necessary -usually cured with excision
31
describe basal cell tumors
1. arise from basal epithelium of skin 2. solitary well-circumscribed, hairless 3. most common pigmented tumor of cats 4. usually benign and cured with surgery
32
describe the behavior of SCC and melanoma on the digit
SCC: -locally invasive -low metastatic rate -multiple digits melanoma: -locally invasive -high metastatic rate
33
describe lung digit syndrome
animal comes in with digit lesion and upon thoracic rads is in the chest -tumor starts in the chest, and likes to spread to the digits, esp in cats -most commonly a carcinoma
34
describe diagnosis and treatment of tumors of the digit
diagnosis: 1. CBC/chem/UA 2. cytology/histopath 3. cytology of local LN 4. thoracic rads treatment: 1. digit amputation -REMEMBER: digits 3 and 4 are weight bearing 3. RT: -incompletely excised tumors -non-resectable tumors 3. adjuvant chemo for melanoma or other highly metastatic -prognosis better for SCC than melanoma
35
describe clinical presentation of tumors of the ear canal
1. older animals 2. head shaking/scratching 3. unilateral 4. chronic otitis 5. neurologic signs: horners, vestibular, facial paralysis 6. ddx: -any tumor of the skin -ceruminous gland: adenocarcinoma, adenoma -SCC -undifferentiated carcinoma
36
describe behavior of ear canal tumors
malignant ear canal tumors (majority) -locally invasive (esp SCC), low metastatic rate
37
describe diagnosis and staging of ear canal tumors
1. otic exam: -visual, palpation, otoscopic 2. CBC/chem/UA 3. cytology of lcoal LNs 4. thoracic rads 5. skiull rads 6. advanced imaging: -extent of disease -tx planning -bullae involvement 7. biopsy = definitive
38
describe treatment and prognosis of ear canal tumors
1. surgery = treatment of choice -TECA + bulla osteotomy 2. RT: -definitive protocol -side effects 3. prognosis generally pretty good 4. prognostic indicators: -dogs: bulla involvement (bad), conservative surgery (good) -cats: neuro signs (bad), histopath dx, lymphatic/vascular invasion
39
describe clinical presentation of perianal tumors
1. scooting, itching, straining 2. incidental finding= important to RECTAL ALL DOGS -earlier dx = better prognosis 3. rare in cats 4. ddx: -any tumor of the skin -perianal (sebaceous gland): adenoma, adenocarcinoma (hepatoid tumors, oook like heptocytes) -apocrine gland adenocarcinoma of the anal sac (AGASAC)
40
describe perianal adenomas
1. testoterone-dependent -intact males -if see in neutered male or female, question if there is an adrenal tumor 2. hairless -perianal, tail base, or tail 3. usually resolve with castration 4. most are benign
41
describe AGASAC presentation and behavior
1. older dogs, females and males equally 2. breed disposition: -cocker spaniel, dachshund, GSD 3. mass at anal sac 4. behavior: -locally invasive -common mets to sublumbar LNs -distant mets later -paraneoplastic hypercalcemia COMMON
42
describe diagnosis and staging of AGASAC
1. rectal exam: -mass -LN enlargement 2. cytology of mass 3. excisional biopsy 4. CBC/chem/UA 5. abd US 6. advanced imaging 7. cytology of local LNs 8. thoracic rads
43
describe treatment of AGASAC
1. surgery: -primary tumor + LN resection -risk of incontinence 2. RT: -primary tumor + LN bed -additional local control -less common than used to be 3. chemotherapy -variety of drugs = none are super great 4. prognosis: add chemo to surgery = slight improvement but meh 5. prognostic indicators: -tumor size -hypercalcemia (if present = bad) -pulmonar metastasis (obvi bad) -treatment: surgery = improved over chemo alone

Integument (24 decks)

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