skin CA

Question 1

EPidermis layers

Answer 1

stratum corneum - dead layer
stratum granulosum - epi
stratum spinosum -epi
stratum basalis- above basement membrane then dermis

Question 2

UV rays spectrum

Answer 2

UVC- 100-290- blocked by ozone layer- not earth surface
UVB- 290-315- “ directly damage skin
UVA- 315-400 sun that reaches us! indirectly damages skin

Question 3

non-melanosma skin ca

Answer 3

BCC (most common ca in whites and rarely mets)
 or SCC (2nd most common ca, more common elderly)

Question 4

SCC risk factors

Answer 4

elderly, caucasians, UV exposure, fair skin, male, >50YO, inflammatory skin conditions, smoking, arsenic , HPV infection, immunosuprresion

Question 5

actinic keratosis

Answer 5

pre-cursor lesion of SCC
d/t chronic uv exposure
rough scaly plaques on sun-exposed skin
focal keratinocyte atypia and disorganization in epidermis and upper epi intact, <1% progress to SCC
tx- cryotherapy or topical chemo

Question 6

bowens disease

Answer 6

pre-cursor lesion of SCC
d/t chronic sun exposure or viral infection (HPV 16 or 18)
red or brown plaque wiht crusted scale
25% lead to SCC into dermis, full thickness epidermal atypia and disorganization no dermal invasion
tx chemo cryo or sx

Question 7

SCC tx

Answer 7

surgical excision **GOLD STD
Mohs micrographic sx
radiation (except verrucous carcinoma)

Question 8

Keratoacanthoma

Answer 8

variant of SCC- nodules with crater like center with keratin plug on sun exposed area, tx with sx, grows quickly, resomebles SCC

Question 9

verrucous carcinoma

Answer 9

SCC variant- resembles giant wart, caused by HPV 16 and18 tx with surgery NOT radiation

Question 10

marjolins ucler

Answer 10

SCC variant- develop from chronic ulcer or would or trauma, aggressive to mets (35%), tx with sx

Question 11

Mucosal SCC

Answer 11

SCC variant- smokers, aggressive than traditional SCC, mets 20-70%, tx sx

Question 12

BCC risk factors

Answer 12

high dose UVB exposure (sunburn)
 ionizing radiation  (xray)
carcinogenic chemicals ( arsenic)
genetic syndromes (BC nevus syndrome)

Question 13

BCC differential dx

Answer 13

actinic keratosis, bcc, scc, mmm, dysplastic nevi

Question 14

BCC s&s

Answer 14

sun exposed areas, pearly nodular iwth telangiectasis, central ucler possible with occ bld, as new? bleed? scab? heal? previous skin ca? risk facotrs? painful?

Question 15

SCC s&s

Answer 15

plaques, papules, nodules
red, scaly or ulcerated
full thickenss epidermal atypia wiht invasion into dermis
mets 2-6%
as new? hurt? growing? heal? risk facotrs? hx? painful?

Question 16

SCC differential dx

Answer 16

actinic keratosis
BCC
SCC
MM
dysplastic nevi

Question 17

BCC tx

Answer 17

curettage and electrodesiccation (for superficial BCC <1cm, non-hair bearing skin cure 95% *
cryo- liq nitrogen, cure 90%, *
topcial chemo
radiation therpay
surgical exicison ** GOLD standard
mohs micrographic surgery
vismodegib
*leave hypopigmented and hypertrophic scars

Question 18

BCC referral

Answer 18

suspicious lesions refer to derm, definitive dx use biopsy either shave, punch or excisional
if not tx- will get worse on ear/muscle/neck not mets

Question 19

curettage and electrodesiccation

Answer 19

superficial BCC, <1 cm
non-hair bearing skin trunk/arms
cure 95%
leave hypopigmentation and scars
not morepheaform or infiltrated BCC
recurrence due to skill of person

Question 20

cryosurgery

Answer 20

liquid nitrogen, target tissue, cure 90%, lead to hypopigmentation and scars, recurrence due to skill of person

Question 21

topical chemotherpay

Answer 21

topical 5-flurouracil BID for 3-12 weekds
superficial BCC
cure 75-93%
SE pain, redness, scaring, crusty

Question 22

radiation therapy

Answer 22

poor surgical canidates (elderly, poor helalth, lg lesions)
daily tx for 6 weeks
80-93% cure rate
SE: rash, dry skin

Question 23

surgical exicsion

Answer 23

GOLD standard for BCC
decrease recurrences, margins of gd skin takne
95% cure
SE: bld, infeciton, nerve damage, scarring

Question 24

mohs micrographic sxq

Answer 24

tx for BCC aggressive or on face/scalp/neck
tissue sparing margin control
cure 95%
time consuming
cut horizontal edges

Question 25

vismodegib

Answer 25

app. jan 2012 | local or advance or mets BCC

Question 26

melanoma risk factors

Answer 26

``` intermittent high UV exposure >50 melanocytic nevi FH or dyplastic nevi nevus>20cm lighter skin immuno-suppressant lg congenital nevus ```

Question 27

melanoma differential dx

Answer 27

``` actinic keratosis BCC SCC MM dysplastic nevi ```

Question 28

melanoma s&s

Answer 28

A-asymmetry B- border irregular C-color- variable from brown to black DM- >6mm E- elevation or evolution- raised, changing, evolving pigmented lesions non-healing skin area >3 weeks, ulceration, bleed, weep, abnormal lesions of hands, nails, feet

Question 29

melanoma types

Answer 29

``` melanoma in situ lentigo melanoma superficial spreading nodular melanoma acral lentiginous melanoma subungual melanoma ```

Question 30

melanoma in situ

Answer 30

Irregularly pigmented macule or patch (often fulfills ABCDE) Sun-exposed skin in elderly pts Progresses to Lentigo Maligna-more invasive

Question 31

lentigo maligna

Answer 31

atrophic epidermis loss of rete ridges increases numbers of atypical basilar melanocytes melanocytes vary in size, shape, hyperchromic nuclei Solar elastotic changed in the dermis No atypical melanocytes in dermis

Question 32

lentigo maligna melanoma

Answer 32

15% of melanomas elderly pts Sun damaged skin Identical to lentigo maligna, but possesses a vertical growth (deeper, but not as wide)

Question 33

superficial spreading melanoma

Answer 33

Most common type (70%) Frequently found on the back in men, on legs in women May arise from a nevi Fulfills ABCDE’s

Question 34

Nodular melanoma

Answer 34

``` 2nd most common type of melanoma (15-30%) Rapidly developing nodule Can be ulcerated and bleed Mostly in the vertical growth phase Can rarely be amelanotic (nonpigmented) Sometimes neg ABCD, but possible E ```

Question 35

acral lentiginous melanoma

Answer 35

``` Rarest type (5-10%), but most commonly seen in darkly pigmented pts (70%) Occurs on palms and soles ```

Question 36

subungual melanoma

Answer 36

Variant of acral lentiginous melanoma Can present as hyperpigmented streak on the nail plate (longitudinal melanonychia) Hutchinson’s sign: pigmentation of the proximal nail fold

Question 37

seborrheic keratosis

Answer 37

not mole - benign growth

Question 38

dx of melanoma by..

Answer 38

biopsy (excisional (to get depth) 1st then shave or punch) | immunohistochemical stains can highlight melanocytes in difficult cases

Question 39

Breslow depth

Answer 39

``` most important! depth in mm from top of granular layer clarks levels: 1- within epidermis 2- into pap dermis 3- filing pap dermis 4 into reticular dermis 5 into SQ fat ```

Question 40

factors affecting prognosis in melanoma

Answer 40

``` thickness- breslow depth - see clark levels ulceration? lymph nodes mets (5 yr survival 66%) extra-nodal mets (5 yr survival 10%) br ```

Question 41

clarks levels in melanoma prognosis

Answer 41

``` I- within epidermis II- into pap dermis III- filing papillary dermis IV- into reticular dermis V- into SQ fat ```

Question 42

tx melanoma

Answer 42

1) surgical excision with app margins 2) sentinel lymph node biopsy.. only on tumors>1mm 3) elective lymph node dissection 4) adjutant or palliative chemotherapy

Question 43

surgical excision with appropriate margins

Answer 43

4mm thickness 2-3cm margins

Question 44

Primary skin ca prevention

Answer 44

Decrease sun exposure Minimize exposure during peak UV hrs (10a-4p) Wide brimmed hat,clothing etc. >15 min exposure req protection min30 SPF, broad spectrum (including UVA coverage and zinc), reapply every 2 hours or after swimming Start early in childhood Educated pts to seek med attn for nonhealing sores (>4-6weeks) or changes to lesions/nevi.

Question 45

Secondary skin CA prevention

Answer 45

Early detection Frequent skin ca screening in high risk pts Biopsy of suspicious lesions-when in doubt, cut it out!!! or refer to derm:)

Question 46

breslow staging in melanoma prognosis

Answer 46

stage 1 thin 1mm stage 3 involvement of lymph nodes stage 4 involvement of internal organs