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Flashcards in Skin Cancer - Fisher Deck (39):
1

What are some general principles somewhat unique to skin cancer (I know this is vague)?

1) Environmental exposure plays a huge role

2) Potential for early detection

3) noninvasive screening

2

Describe the histologic appearance of basal cell carcinoma

Nodules of blue epithelium in the epidermis; basophilic, pleomorphic, and hyperchromatic

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3

Describe the histologic appearance of squamous cell carcinoma 

Hyperchromatic, pleomorphic nuclei exhibiting disorganized growth. Invasion through the basal layer. Cells are very PINK and keratinizing 

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4

What mutation is very common in basal cell carcinoma?

PTCH

5

What 2 areas confer the greatest risk for metastasis in squamous cell

The lips and ears; good vascular network

6

Why is the risk of skin cancer increasing in young females?

tanning beds

7

Risk factors for basal cell carcinoma?

1) UV exposure

2) fair complexion

3) hx of blistering sunburns

4) family hx

5) immunosuppression

8

3 types of patients at extremely increased risk for squamous cell carcinoma?

HIV, transplant, and rheumatologic patients; both are chronically immunosuppressed

9

What distinct histologic feature is seen in nodular type basal cell?

a palisade of tumor cells clefting (separating) from the adjacent stroma 

(Look at the very right picture) 

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10

What pathway does UV radiation mutation that is critical in skin cancers?

Sonic Hedgehog pathway

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11

Where are superificial basal cell carcinomas located histologically?

In the papillary dermis

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12

Describe the gross appearance of a nodular type BCC

"Pimple-like lesion that does not heal and bleeds"

Translucent, pearly paupule with erythema and telangiectasia  

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13

Where are BCC commonly located

UPPER LIP most common; Head and neck; central face (sun exposure)

14

What is the most common subtype of BCC? The 2nd most common?

Nodular most common; superficial 2nd most

15

Describe the gross appearance of superficial BCC

a flat, very pearly/shiny oval lesion; patient often complains of "chronic area of eczema" 

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16

What happens to the appearance of BCC as they progress?

They can start making pigment, become darker

17

What is important about morpheaform BCC?

It's the most aggressive type; lacks the features of other BCC so they can normally grow deep prior to clinical detection

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Looks like a scar

18

Describe the gross appearance of a morpheaform BCC

scar-like plaque, lightly colored with ill defined borders

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19

What is Basal cell nevus syndrome (Gorlin Syndrome)?

Mutation of the PTCH1 tumor suppressor gene; BCCs at very early ages --> AD inheritance

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Get lots of disfiguring jaw cysts

20

Metastasis rate of BCC?

Almost non-existent 

21

2 commonly used topical agents in treatment of BCC

Imiquimod and 5-flurouracil 

22

Mechanism of action of Imiquimod

Engages the immune system via TLRs to start an interferon storm and upregulate tumor surveillance 

23

What type of treatment will you NEVER consider with morpheaform BCC

Topical; it has to be excised due to risk of vertical invasion 

24

Targeted therapy for advanced BCC?

Vismodegib

25

ADE(s) associated with vismodegib

Patients lose weight because they can't taste food, also experience muscle cramps

26

What is Mohs surgery? Why is it beneficial to the patient?

Dermatologist excises the tumor and examines the margins at the bedside; makes for a more targeted excision and improves cosmetics 

27

Describe the gross appearance of SCC

Extremely keratotic, crusted surface

"Funny lumps and bumps, make lots of crust" 

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28

Common sites of metastasis seen in SCC

Regional lymph nodes and the lungs 

29

What is Bowen's disease?

SCC in situ; does not invade the dermis

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Patch that looks like eczema

30

Gross appearance of Bowen's disease

Looks like an eczematous plaque 

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31

What is Erythoplasia of Queyrat?

SCC in situ on the glans penis (i'll spare you the picture) 

32

What are actinic keratosis?

benign neoplasms of the epidermis commonly on sun exposed skin; they are precursors to non-melanoma skin cancer

33

Describe the gross appearance of actinic keratoses

Scaly/rough, THIN, non-indurated lesions commonly on sun exposed areas 

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34

Most common places for actinic keratoses in women? In men?

Lower legs in women; dorsal forearms and hands in men

35

What if an actinic keratosis feels thick to palpation? What are you now thinking?

That it's SCC

36

Why do burns increase the chance of SCC development

They provide "fertile" ground for malignant development; inflammatory tissue injury with excessive repair 

37

2 dimensions for high risk of SCC metastasis (horizontal and veritcal spread)?

Larger than 2 cm (horizontal) and deeper than 4 mm (vertical) 

38

What is a Marjolin ulcer?

SCC that developed at the edge of a burn

39

What is a keratocanthoma? What commonly is the course?

A neoplasm of keratinocytes; rapidly grows and is painful; involutes spontaneosly