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Flashcards in skin cancer Deck (43):
1

Basal cell carcinoma is cancer of what cells? what does it resemble?

germinative keratinocytes; resemble basal layer

2

Squamous cell carcinoma is cancer of what cells? what does it resemble?

epidermal keratinocytes; resembles spinous layer

3

Melanoma is cancer of what cells? What leads to the dark color?

melanocytes => more melanomes

4

How does the most common invasive neoplasm in US arise?

BCC arises from PTCH mutations (1/3) which is the basal epidermal cell proliferation regulator

5

What are the risks for BCC?

UV; blistering sunburns; Family Hx; immunosuppression (drugs, disease, transplant)

6

How do BCC present histologically?

basophilic hyperchromatic cells form nodules extending from epidermal surface; cells at periphery form a palisade; nodules are in a mucinous stroma w/ some retraction

7

How does classic BCC present grossly?

well circumscribed nodule with pearly rolled border and central erosion with telangiectasias

8

Why would a germline mutation in PTCH be considered of BCC before 35?

only 20% of BCC presents before age 50 and rare prior to age 35

9

What is associated with Basal cell nevus syndrome?

AD mutation of PTCH1 that presents BCCs around 23 y/o with defects and jaw cysts; increased risk of other neoplasms

10

How likely is BCC to metastasize? Tx?

very very rare; Tx is excision and topical Tx for superficial BCC

11

What is targeted therapy for advanced BCC and its MOA?

Vismodegib; small molecule inhibitor of SMO

12

How does a squamous cell carcinoma typically grossly present?

nodule with crusts

13

What is the likely progression of squamous cell carcinoma?

1) Actinic keratosis; 2) SCC in situ (full thickness epi atypia above basement membrane); 3) SCC invasive based on levels of differentiation

14

How does actinic keratosis present?

thin plaques that are superficial in nature

15

Histologically, how does SCC present?

invasion through basal layers with keratinizing pink cells (keratin pearls)

16

What leaves a person with an increased risk for developing SCC?

UV; HPV; immunosuppression; chronic inflammation

17

***In cutaneous SCC, what is the risk of metastasis related to?***

size of tumor (>2cm), depth of invasion into dermis(>4mm), anatomic site (lips/ears), host immune status

18

Though rare, where does SCC metastasize?

lymph nodes and lung

19

What cancer would be likely to be present on a plaque of leukoplakia and secondary to tobacco use?

SCC

20

What is a keratoacanthoma?

neoplasm of keratinocytes that rapidly grows over weeks then spontaneously goes away

21

What is Marjolin's ulcer?

ulcerated invasive SCC w/ background of chronic inflammation, scarring, radiation, trauma

22

How is SCC treated?

depends on progression: Actinic keratosis (topical, cryo); SCC in situ (topical, intralesional, excision); invasive SCC (excision)

23

Who is at the highest risk for melanoma?

caucasian men > 50yo

24

T/F Melanoma is commonly associated with mole

FALSE, 80% are de novo and not assoc with a mole

25

When can melanoma metastasize?

if it is in the dermis

26

What are the 3 different types of nevi?

junctional, compound, intradermal

27

What is a distinguishing feature of the melanocytes in nevi and melanoma?

maturity with descent into dermis of nevi (none above basal layer)
vs
immaturity of melanocytes on descent (located above basal layer)

28

What type of growth phase is melanoma in situ?

radial growth due to attachment via dendrites so cannot metastasize

29

What is the relationship of nevi and melanoma?

Both comprised of melanocytes, share some mutations (BRAF) => high nevi increase risk of melanoma

30

Describe melanoma's multifactorial etiology

genetic predispostion; environment; underlying immune status

31

How is screening done for melanoma?

Asymmetry;
Borders: irregular, scalloped
Color: mottled, non uniform
Diameter: >6mm
Elevation

32

What type of melanoma will occur in people of dark sin? Where is it located typically?

acral lentiginous melanoma => palms/soles/subungual skin

33

What type of metastatic potential does lentigo maligna have?

slow growing and still in radial growth phase (melanoma in situ)

34

How does a superficial spreading melanoma present grossly?

Red white and blue

35

What is the most common site of melanoma histologically?

dermal-epidermal junction

36

What is the most common organ site for metastatic melanoma?

skin

37

What is the most common cause of death in melanoma?

CNS involvement

38

What is the single most important prognostic factor in melanoma?

lymph node involvement

39

What is the most important histological prognostic factor?

Breslow thickness and ulceration

40

What is breslow's thickness?

distance of involvement from stratum granulosum to deepest tumor cell

41

What is the most common treatment for metastatic melanoma?

IFNa; combo CTX; XRT; vaccine Tx

42

How does the 1st targeted Tx for melanoma work?

Vemurafenib inhibits BRAF in stage 4 melanoma that improves survival benefit but cells adapt

43

What is the pathogenesis of XP?

defects in genes that function in nucleotide excision repair of thymine dimers leading to increase skin cancer from insensitivity to UV light