Skin Cancer

Question 1

What are some risk factors in the development of skin cancer?

Answer 1

Age (>40)
Race/skin complexion
Sun exposure (especially with certain medications)
Tanning beds
Number of moles and freckles
Atypical nevi
Medical/family history
Smoking
immunosuppression

Question 2

What are some red flags to think of when monitoring/screening for skin cancer?

Answer 2

Sore that does not heal

Spread of pigment from the border of a spot to surrounding skin

Redness or new swelling beyond the border

Change in sensation

Change in surface of a mole

Mole that looks different from other moles

Question 3

What is the most common cancer in humans?

Answer 3

Basal Cell Carcinoma

Question 4

What is the most common type of skin cancer?

Answer 4

Basal Cell Carcinoma

Question 5

Which type of skin cancer is described below?

The most common type

Very limited capacity to metastasize (If it does metastasis, will go to bone)

Age of onset >40 years

Fair-skinned, younger presentation (20-40 y/o)

Males > females

Answer 5

Basal Cell Carcinoma

Question 6

What are some predisposing factors in the development of basal cell carcinoma?

Answer 6

Skin phototypes I and II
Heavy sun exposure as youth
Xray therapy for facial acne
Ingestion of arsenic

Question 7

Which type of basal cell carcinoma is described below?

Most common we’ll see

Papule or nodule

Translucent or “pearly” with telagiectasia

Answer 7

Nodular

Question 8

Which type of basal cell carcinoma is described below?

Depressed or ulcerated center with a rolled border

Translucent or “pearly”

Smooth with telangiectasia

Answer 8

Ulcerating

Question 9

Which type of basal cell carcinoma is described below?

Appears as a small patch of morphea or a superficial scar

Often ill defined

Skin colored, whitish but also with peppery pigmentation (fibrotic tissue)

Answer 9

Sclerosing

Question 10

Which type of basal cell carcinoma is described below?

Appear as thin plaques

Pink or red

Characteristic fine threadlike border and telangiectasia

Answer 10

Superficial Multicentric

Question 11

Which type of basal cell carcinoma is described below?

May be brown or black

Smooth, glistening surface (NOT greasy)

Hard and firm

Answer 11

Pigmented

Question 12

What are some differential diagnoses to consider when evaluating for potential basal cell carcinoma?

Answer 12

Actinic keratosis

Squamous cell carcinoma

Question 13

What is the treatment for basal cell carcinoma?

Answer 13

Excisional biopsy for diagnosis and management is preferred
If detected early- Excision
If detected late- Excise but referral

Can use cryosurgery or electrosurgery for small lesions not in danger
sites or on scalp

Radiation treatment

Topical 5-FU or imiquimod

Question 14

Most often caused by UV radiation or HPV infection

Most often asymptomatic, but may bleed

Usually forms a patch or macule

Nodule formation = invasive

Diagnosis - biopsy

Answer 14

Squamous Cell Carcinoma

Question 15

What are some patient characteristics who are diagnosed with squamous cell carcinoma?

Answer 15

Older patients (>55 y/o)

Sun-exposure (daily)

Carcinogen exposures

Immunosuppression

HPV

Question 16

Appears as a sharply demarcated, scaling, or hyperkeratotic macule, papule, or plaque

Solitary or multiple lesions are pink or red in color and have a slightly scaling surface, small erosions, and can be crusted (Bowen’s disease)

Slowly evolving, isolated, keratotic

Eroded plaque/papule

Erythematous, pink, yellow/tan

Answer 16

Squamous Cell Carcinoma

Question 17

Red, sharply demarcated, glistening macular or plaque-like SCC’s on the glans penis or labia minora are called what?

Answer 17

erythroplasia of Queyrat

Question 18

What are some differential diagnoses to consider when evaluating for potential squamous cell carcinoma?

Answer 18

Basal cell carcinoma

Actinic keratosis (May arise from actinic keratosis)

Question 19

Squamous cell carcinoma may arise from what precancerous lesion?

Answer 19

Actinic keratosis

Question 20

What is the treatment for squamous cell carcinoma?

Answer 20

Topical chemotherapy: 5-FU cream or Imiquimod

Cryosurgery - Highly effective

Photodynamic therapy

Surgical excision/excision biopsy - Has the highest cure rates but the
greatest chance of causing cosmetically disfiguring scars (Difficult to excise)

Question 21

Most malignant tumor of skin; most deadly form of skin cancer

Arises from transformation of melanocytes as dermal-epidermal junction, Dysplastic nevi, Congenital nevomelanocytic nevus gone invasive

Typically older patients

Affects men and women equally

Uncommon in blacks

Common sites: posterior trunk, lower extremities

Answer 21

Melanoma

Question 22

What is the most deadly form of skin cancer?

Answer 22

Melanoma

Question 23

What are the four major types of melanoma?

Answer 23

Lentigo maligna (5%)
Spreading superficial (70%)
Acral-lentiginous (5-10%)
Nodular (15%)

Question 24

Does horizontal growth or vertical growth in melanoma have the worst prognosis?

Answer 24

vertical growth

Question 25

What are some risk factors for melanoma?

Answer 25

Older age Skin types I and II (Blonde or red hair, green/blue eyes) UVR exposure CDKN2a mutation (tumor suppressor protein) Past history - severe sunburn in youth; chemical exposure Family history - North European ancestry Number (>50) and size (>5mm) of moles Melanocytic nevi Congenital nevi immunosuppression

Question 26

List some precursor lesions to melanoma

Answer 26

Congenital nevi Dysplastic nevi Lentigo maligna

Question 27

Which type of melanoma is described below? 10-15% Median age approximately 65 Sunlight pathogenic factor Flat macule, border well defined, “geographic” shape Tan to brown/black Lateral growth phase lesion (irregular border) 5% risk of becoming invasive

Answer 27

Lentigo Maligna

Question 28

Which type of melanoma is described below? Most common – 70% Age 30-50 Upper back Elevated plaque Brown, dark brown, black, blue, and red

Answer 28

Superficial Spreading Melanoma

Question 29

Which type of melanoma is described below? <10% Very poor prognosis Median age approximately 65 Most common in Asians and African Americans (most common form in blacks) Soles and palms Mucus membranes Fingernail or toenail

Answer 29

Acral-Lentiginous

Question 30

Which type of melanoma is described below? 10% Complete vertical growth phase (symmetric) Can occur anywhere Typically 40-60 y/o males Uniformly elevated “blueberry-like” nodule or ulcerate or thick plaque “thundercloud” May not be pigmented – could resemble vascular, nevus

Answer 30

Nodular

Question 31

What is the most common type of melanoma?

Answer 31

Superficial Spreading Melanoma

Question 32

What is the most common type of melanoma in African Americans?

Answer 32

Acral-Lentiginous

Question 33

What is the treatment for melanoma?

Answer 33

Excision/excisional biopsy Sentinel node mapping and biopsy Malignant - Pallative treatment Chemotherapy Radiation Aggressive skin exams

Question 34

Multifocal systemic tumor of endothelial cell origin Linked with HHV-8 4 variants Presentation – stage/variant dependent Localized and/or generalized disease: patches, plaques, nodules Course and prognosis based on type

Answer 34

Kaposi Sarcoma

Question 35

Risk is 20,000x greater than the general population Currently 18% incidence in this risk group Young males common (rare in females) CD4 count < 500uL (17%)

Answer 35

HIV/AIDs Associated Kaposi Sarcoma

Question 36

What is the pathogenesis of Kaposi's sarcoma?

Answer 36

Derived from endothelium of blood/lymphatic microvasculature Widespread reactive polyclonal proliferation, then become monoclonal Promotes own growth and growth of other cells - can reroute capillaries causing pooling of blood (makes it purpuracious)

Question 37

Widespread or localized Almost always on hands, feet, and legs Spreads centripetally Trunk rare (except in HIV) In HIV - Early in face, then spreads to trunk

Answer 37

Kaposi Sarcoma

Question 38

What are the treatment options for Kaposi's sarcoma?

Answer 38

Important: control NOT cure Limited Intervention: Radiation, Cryo/laser/excisional surgery, Vincristine injection Aggressive intervention: Single chemo - Adriamycin or Vinblastine Combo chemo - Vincristine + Bleomycin + Adriamycin