Skin Cancer

Question 1

define this lesion

Answer 1

actinic (solar) keratosis

flat, scaly papule, ill-defined border

may have red base

variable size

coalesce to form plaques

begin as rough localized skin lesions

Question 2

what is the term used for lower lip involvement with actinic keratoses?

Answer 2

actinic cheilitis

Question 3

incidence of malignant transformation to SCC for actinic keratosis

Answer 3

0.01- 5% incidence

Question 4

this erythematous patch histologically would show

Answer 4

actinic keratosis

Question 5

thicker, crustier lesions of actinic keratosis are known as

Answer 5

hypertrophic AK

Question 6

this is a manifestation of AK (T/F)

Answer 6

T - flat, erythematous macule

Question 7

prevention of AK

Answer 7

aggressive sun avoidance

Question 8

treatment of AK

Answer 8

liquid nitrogen cryotherapy/superficial curettage and cautery

5-fluorouracil 5% cream for extensive areas (cause hemorrhagic crusting)

Question 9

describe cryosurgery

Answer 9

liquid nitrogen -196C

blistering and scarring can occur

Question 10

most common skin cancer

Answer 10

basal cell carcinoma

Question 11

BCC is a neoplasm of _______

Answer 11

basal kertinocytes

Question 12

what are the 4 types of BCC

Answer 12

nodular (most common)

infiltrating

pigmented (African, hispanic, asian)

superficial

Question 13

BCC is metastasizing (T/F)

Answer 13

F

Question 14

describe this lesion

Answer 14

nodular BCC

pearly papule

rolled border

may ulcerate

superficial telangiectasias

Question 15

what pathway is affected in BCC

Answer 15

Sonic-hedgehog pathway

inactivation of PTCH1 gene

activation of SMO genes

Question 16

this is also a form of ____ BCC

Answer 16

nodular

central erosion and ulceration

Question 17

this lesion is _____; describe the lesion

Answer 17

superficial BCC

dry, flat papules or plaques that may have raised border

well-defined, pink to red in color

Question 18

this lesion is ______; describe the morphology

Answer 18

pigmented BCC

brown, black, or blue macule, papule, or nodule

can have telangiectasia and translucency

rolled edge with depressed center may be present

Question 19

treatment for BCC

Answer 19

imiquimod

surgical:

electrodessication and curettage, excision

cyrosurgery

radiation

Mohs surgery

Question 20

indications for Mohs surgery

Answer 20

skin cancers cosmetically sensitive areas

high occurrence areas

nose, ears, eyes, mouth, groin

Question 21

describe this lesion

Answer 21

SCC

erythematous, hyperkeratotic papule or nodule

may ulcerate or may be smooth

often develop a depressed center

Question 22

in the immunocompromised patient, SCC occur _____

in fair-skinned transplant patient, SCC occur ____

Answer 22

anywhere on the body

oral, anal, cervical mucosa, male genitals

in areas of prior sun damage

Question 23

what are these lesions indicative of?

Answer 23

Bowen’s disease

slow growing, superficial SCC seen on background of sun damaged skin

Question 24

what are the ABCDEs of melanoma

Answer 24

A - asymmetry (one half of lesion doesn’t mirror other half)

B - border (irregular or indistinct)

C - color (variegated, not uniform)

D - diameter (greater than 5-6mm is concerning)

E - evolving (notable changes raises suspicion for malignancy)

Question 25

describe the lesion below

Answer 25

nodular melanoma dark brown to bluish-black nodule that grows rapidly most likely to ulcertate or bleed

Question 26

describe this lesion

Answer 26

superficial spreading melanoma nodule

Question 27

regression is a result of \_\_\_\_\_\_

Answer 27

body's immune defences

Question 28

describe this lesion

Answer 28

superficial spreading MM asymmetry border exhibits pseudopod ike growth (scalloped border) color variation diamter is \>6mm history of change

Question 29

define this lesion

Answer 29

acral lentiginous MM found on palms, soles, nail apparatus

Question 30

what is Hutchinson's nail sign

Answer 30

pigment in skin surrounding the nail, suggestive of ALMM

Question 31

describe this lesion

Answer 31

lentigo maligna malignant melanoma asymmetric brown to black macule or patch with color variegation and irregular borders slow growing SSMM

Question 32

melanomas have ____ and _____ growth phase

Answer 32

radial and vertical

Question 33

why does nodular melanoma have poorer prognosis than SSMM?

Answer 33

greater depth at time of diagnosis SSMM have longer radial growth phase

Question 34

Tx for MM

Answer 34

surgery margins depend on depth of invasion at least 0.5cm greater than 4mm, 2cm margins

Question 35

define this presentation

Answer 35

solar elastosis (actinic elastosis) common manifestation of chronic sun exposure dermatoheliosis (photoaging) amorphous, yellow, elastin-like material in upper dermis in histology clinically - yellow, thickened, coarsely wrinkled skin telangiectasias

Question 36

describe these lesions

Answer 36

more subtle solar elastosis small yellow papules loss of effective elastin and collagen around opening of pilo-sebaceous units (hair follicle)

Question 37

what is the name of this condition?

Answer 37

cutis rhomboidalis nuchae (CRN) deep furrowing in geometric pattern marker of chronic sun damage damaged collagen and elastic tissue

Question 38

is CRN reversible?

Answer 38

no

Question 39

what is this lesion?

Answer 39

Favre and Racouchot disease (FRD) solar/senile comedones chronic exposure to sun small cysts and large blackheads smoking Hx radiation exposure