1. Hyperchromatic pleomorphic nuclei 2. disorganized growth with mitoses 3. invasion through the basal layer. 4. keratin pearls

Skin Cancer (Fisher) Flashcards by Jennifer Watson

What mutation is frequently found in sporatic BCC tumors?

PTCH

tumor suppressor gene which regulated basal epidermal cell prolif

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BCC risk factors:

UV exposure
Fair complexion
H/o sunburns (especially blistering)  
Family history of BCC
Immunosuppression

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Characteristic histology of BCC

peripheral palisade
clefting from adjacent mucinous stroma
Basophilic hyperchromatic cells
nodules, often extending from surface epidermis

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Characteristic gross appearance of BCC

rolled pearly edges
telangiectasias
central erosion

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BCC subtypes

– Nodular
– Superficial
– Pigmented
– Morpheaform (sclerotic) – Micronodular
– Cystic
– Infiltrative

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Disorder which includes:
Mutation of PTCH1 and BCCs at early age (~23yo)
musculoskeletal defects and jaw cysts
increased risk of other neoplasms

Basal Cell Nevus Syndrome

Gorlin Syndrome

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BCC treatment:

Treatment 
– Excision
– Electrodessication and curretage
– Cryosurgery
– Radiation
– Topical treatment for superficial BCC

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Do BCC commonly metastasize?

no–exceedingly rare

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Targeted therapy for advanced BCC:

What does “advanced” include?

Vismodegib

Metastatic disease, Recurrent disease (post surgery), Non-surgical candidates

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A 2-hit hypothesis explains what type of abnormality?

squamous cell dysplasia

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2nd most common skin cancer

Sq cell

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How does SCC progress?

Minimal atypia (actinic keratosis)
Full thickness epidermal atypia, above BM (SCC in situ)
Invasive (SCC)**

**ranges from well to poorly differentiated

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What is actinic keratoses?

Thin non- indurated lesions

no induration = clue to superficial nature of lesions

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SCC histology:

Hyperchromatic pleomorphic nuclei
disorganized growth with mitoses
invasion through the basal layer.
keratin pearls

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3 biggest risk factors for SCC development?

UV
HPV
Immunosuppression

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Risk of metastasis of SCC related to:

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

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Vulvar, perineal and penile HPV-induced SCC have a (higher/lower) rate of metastasis than the overall rate.

higher–30% compared to like…1%

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Other “types” of SCC (2)

Keratoacanthoma
Marjolin’s Ulcer

(likely entirely inconsequential)

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What is Keratoacanthoma?

Painful neoplasm of keratinocytes

Grows rapidly over 2-6 weeks

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What is Marjolin’s Ulcer?

ulcerated invasive SCC arising on a background of chronic inflammation, scarring, radiation, trauma

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How do you treat Actinic Keratosis?

cryotherapy

topical therapy

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SCC treatment generally depends on…

degree of progression

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How do you treat SCC in situ?

topical therapy
intralesional
excision

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How do you treat invasive SCC?

excision

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Who is at the highest risk for melanoma?

white men > 50

Melanoma is the most common type of cancer in what population?

25-29yo

Melanoma is the 2nd most common type of cancer in what population?

15-29yo

Horrible fact: 1 American dies every hour from melanoma.

Let's go cherry bomb some tanning beds. And, if we're already at it, let's eliminate a few taco bell's.

Nevi histology?

1. Small 2. Symmetric 3. Well-circumscribed 4. Organized/discrete, uniform size/shape 5. Melanocytes ‘mature’ with descent into dermis 6. No melanocytes above the basal layer

Melanoma histology?

1. Large 2. Asymmetric 3. Poorly circumscribed 3. Nests are confluent, irregular spacing and sizes/shapes 4. Melanocytes do not ‘mature’ with descent 5. Melanocytes located above the basal layer

Melanoma in situ has a ____ growth phase. | Invading melanoma has a _____ growth phase.

radial | vertical

Both nevi and melanoma are/can...

- comprised by melanocytes | - share some mutations (eg BRAF)

~20% of melanoma develop from

pre-existing nevi

High numbers of nevi (esp >50) can increase...

risk of melanoma

Etiology of melanoma (general)

– Genetic predisposition (eg. CDNK2, BRAF) – Environment (eg. UV) – Underlying immune status

Melanoma risk factors:

* Large number of common nevi (esp. >50) * Giant Congenital Nevi * Atypical Nevi * History of blistering sunburns * Family History of Melanoma * Light complexion, tanning bed use * Underlying immune dysfunction

Melanoma screening alphabet

* A Asymmetry * B Borders: irregular, scalloped * C Color: mottled, variegated, not uniform * D Diameter: >6mm * E Elevation * “changing mole” * “ugly duckling sign”

5 melanoma subtypes

* Acral lentiginous * Lentigo Maligna Melanoma * Nodular * Superficial spreading * Amelonotic

What subtype of melanoma is defined by anatomic location on palmar, plantar and subungual skin?

Acral lentiginous

What subtype of melanoma is frequently in older patients on sun-exposed skin?

Lentigo Maligna Melanoma

What subtype of melanoma has a red, white and blue sign?

superficial spreading melanoma

What subtype of melanoma is the most common type in pts with darker skin?

Acral lentiginous

What type of melanoma appears on sun exposed skin, but has no preceding radial growth?

nodular melanoma

What subtype of melanoma has preceding radial growth?

Lentigo Maligna Melanoma

What subtype of melanoma has a lot of color variation, asymmetrical/irregular borders and it large and elevated?

superficial spreading melanoma

Melanocytes are _______ derived cells

neural crest

In addition to skin, melanoma can be found:

inner ear iris vulva

Melanoma metastasis mostly occurs via

lymphatics

#1 organ site for melanoma metastasis

skin

Most common cause of death in melanoma

CNS involvement

Single most important prognostic factor for melanoma:

Lymph node involvment

Most important histological prognostic factors for melanoma:

reslow thickness and ulceration

"Breslow’s thickness" is defined as distance of melanoma involvement from the _______ (top) to the deepest tumor cell (bottom)

stratum granulosum

Melanoma Treatment:

Catch it early and cut it out

50% of melanomas harbor ____ mutations

BRAF

Small molecule inhibitor of BRAF

Vemurafenib

Approved for unresectable or metastatic (stage 4) melanoma

Vemurafenib

New treatment for unresectable or metastatic (stage 4) melanoma involves: Why?

combination therapy, especially with ipilimumab Initial response to Vemurafenib very impressive but melanoma adapts

Forms dimers between neighboring thymine pairs in DNA

UVB

What type of cancer? | Sunlight certainly plays a role, along with genetics, other environmental factors, and immune system

melanoma

What type of cancer? | Cumulative lifelong UV exposure clearly related to development

Squamous Cell CA

What type of cancer? | UV important but not clearly related to cumulative doses.

Basal Cell CA

Xeroderma Pigmentosum is caused by:

Defects in genes that function in nucleotide excision repair of thymine dimers

Skin Cancer (Fisher) Flashcards

(63 cards)