Skin Cancers

Question 1

What is the 2 year recurrence rate of SCC in a patient with h/o of SCC

Answer 1

40%

Question 2

What is the prevalence of SCC

Answer 2

1 in 3 people (33%)

Question 3

What is the prevalence of BCC?

Answer 3

1 in 4 people gets BCC (sun and genetics)

Question 4

What is the prevalence of Melanoma in AZ?

Answer 4

1 in 50 people in AZ

Cause: sun and genetics

Question 5

When scheduling pt for cancer excision surgery, what questions must ask that pt?

Answer 5

Do you have any artificial joints, valves?

Question 6

If a patient has an artificial heart valve, what is done before surgery

Answer 6

Take Keflex or Clindamycin (1 hour before?) Doxy ok but prefer those 2

Question 7

In which cancer are negative margins not definitive?

Answer 7

Superficial BCC - it can reoccur because cancer cells skip around like pebbles (or loaf of bread with figs)

Question 8

What is the risk of developing melanoma in a patient with h/o of any skin cancer?

Answer 8

4x risk of developing MM

Question 9

How to treat SCCis (Bowens) to BASE in LE

Answer 9

MOHS

If not to base on LE, ok to excise

Question 10

Not to use in breastfeeding

Answer 10

Rogaine
Gabapentin
Topical class 1 steroids

Dermasmooth ok
IL kenalog OK

Normal to lose hair after pregs x 6 months because of Telogen Effluvium

Question 11

LPP associated pain tx

Answer 11

Can use gabapentin (not if breast feeding)

LPP can regrow if caught early, scars after hair falls out several times (IL kenalog is more effective)

Can use dermasmooth in breast feeding

Question 12

NP with h/o MM

Answer 12

What color was it?
Any FH of MM?
ANy FH of any other cancers (kidney, pancreas, breast cancer is the highest RF for MM)

For genetic saliva test need 3 - either 3 MM on self or 3 among family members

Question 13

Superficial BCC - how to tx

Answer 13

Always EDC but excise if large? (even if positive margins, even if to base)

Question 14

How to tx Nodular BCC with negative margins

Answer 14

Always EDC

Question 15

Nodular BCC with positive margins tx

Answer 15

Excision preferred if pos margins
Can EDC if pos margins and to base!!!
Ok to EDC back leg arm

NEVER EDC ON FACE - face goes to MOHS (+ or - margins))

Question 16

Small Nodular BCC to base tx

Answer 16

Can excise or EDC

Question 17

Ulcerated nodular BCC

Answer 17

EXCISE

Question 18

Nodular BCC tx areas to avoid

Answer 18

Post auricular to base - ok to excise, not MOHS

AVOID: neck and Supra auricular (can cause numbness)

SCM muscle - CNXI Spinal Accessory nerve

Question 19

Which BCC never to EDC

Answer 19

Micro Nodular (>7 mm): excise or MOHS
Invasive (always MOHS if LIza) but can excise if arm or leg

Question 20

SCCis (BOWENS) to base

Answer 20

Excise or Mohs

To base on face or Finger - Mohs
>2 cm - Mohs

Question 21

SCC T1 is how many risk factors and how Tx

Answer 21

0 risk factors

Tx: if WELL differentiated - EXCISE with 4 mm margins
If moderately differentiated = MOHS

All other SCC T2 T3 T4 - must MOHS

Question 22

When to refer for urgent MOHS

Answer 22

SCC that’s MODERATELY differentiated AND (or OR?) in low immunity pt (CLL, HIV, transplant, on biological?)

Question 23

Top 3 Mets to head

Answer 23

MM
Breast cancer
Renal cancer

Question 24

Percent of risk for SCC to metastasize

Answer 24

4%

Question 25

Tell pts with melanoma to do what once per year

Answer 25

Have eyes checked

Question 26

What can be used instead of FUDEX for AKs

Answer 26

Solarace x 3 months (more gentle but less effective)

Aldabra (imiquimod) QD 2 wks on, 1 wk off, 2 wks on
But can cause flu sx

Blue light not effective - gets red x1 week bs 2 weeks on FUDEX