SM_260a: Nonmelanoma Skin Cancer / Photobiology

Question 1

UVA is responsible for ____

Answer 1

UVA is responsible for aging

(photoaging, smoking also plays a role, also tanning)

Question 2

UVB is responsible for ____

Answer 2

UVB is responsible for burning

Question 3

UVC is most ____

Answer 3

UVC is most carcinogenic

Question 4

Photoaging is influenced by ____ exposure and ____

Answer 4

Photoaging is influenced by UVA exposure and smoking

(clinical signs of photoaging: spotty hyperpigmentation and hypopigmentation, rhytids (wrinkles), telangiectasias, skin thickening, and loss of elasticity)

Question 5

Photocarcinogenesis involves ____ and ____

Answer 5

Photocarcinogenesis involves UV-mediated DNA damage and mutation formation

• Direct damage: thymine dimer formation
• Indirect damage: ROS formation
• Mutation formation: inactviation of tumor suppressors, activation of oncogenees, evasion of apoptosis, and limitless replicative potential

Question 6

UVB is important first step of ____ metabolism

Answer 6

UVB is important first step of Vitamin D metabolism

Question 7

Nonmelanoma skin cancer means ____ carcinomas, which include ____ and ____

Answer 7

Nonmelanoma skin cancer means keratinocyte carcinomas, which include basal cell carcinoma and squamous cell carcinoma

(risk factors: environmental exposures, skin type, genetic predisposition, predisposing skin conditions, and immunosuppression)

Question 8

Shave biopsy is the most ____ biopsy, has ____ bleeding, requires ____, and is less likely to ____

Answer 8

Shave is the most superficial biopsy, has minimal bleeding, requires no sutures, and is less likely to scar (dyschromia, hypopigmentation)

Question 9

Punch biopsy is a commonly used diangostic biopsy technique for ___ and ___, provides ___ for histology, and involves using ___ to close

Answer 9

Punch biopsy is a commonly used diagnostic biopsy technique for pigmented lesions (nevi) or deeper lesions (dermal / fat), provides full thickness clean edged specimens for histology, and involves using suture to close

Question 10

Describe basal cell carcinoma

Answer 10

Basal cell carcinoma

• Most common skin cancer
• Locally destructive
• Metastasis is very rare
• Increased risk for developing other keratinocyte carcinomas
• Recommend skin checks at regular intervals (every 6 months)
• Usually occur on the head and neck
• Diagnosis by biopsy
• Treatment depends on clinical and histological features but is often surgical

Question 11

This is ____

Answer 11

This is basal cell carcinoma

Question 12

Diagnosis is ____

Answer 12

Diagnosis is basal cell carcinoma

Question 13

Basal cell carcinoma is treated with ____

Answer 13

Basal cell carcinoma is treated with surgical removal

Question 14

Describe management of basal cell carcinoma

Answer 14

Basal cell carcinoma management

• Surgical excision with 4-5 mm margins
• Mohs micrographic surgery in certain cases
• Photoprotection
• Regular total body skin examination
• Monthly self-skin exams

Question 15

Nodular basal cell carcinoma is a ____ and is most frequently found on the ____ and ____

Answer 15

Nodular basal cell carcinoma is a pearly papule or nodule with rolled border and telangiectasias and is most frequently found on the head and neck

(most common subtype)

Question 16

Superficial basal cell carcinoma is ____ and ____

Answer 16

Superficial basal cell carcinoma is pink / translucent in color with telangiectasia and a slightly rolled border and a patch / thin plaque that may be scaly

(differential diagnosis includes squamous cell carcinoma in situ / Bowman’s disease or actinic keratosis)

Question 17

Ulcerated basal cell carcinoma is ____

Answer 17

Ulcerated basal cell carcinoma is translucent color with telangiectasia, rolled border, and ulceration and crusting (scab)

Question 18

Pigmented basal cell carcinoma is ____ and commonly found in ____

Answer 18

Pigmented basal cell carcinoma is pearly papules with telangiectasias and globules of dark pigment within and commonly found in persons of color

(differential diagnosis may include malignant melanoma, over 50% of basal cell carcinomas in persons of color are pigmented)

Question 19

Morpheaform basal cell carcinoma is ____ with a plaque that ____

Answer 19

Morpheaform basal cell carcinoma is translucent with telangiectasia and rolled border with a plaque that appears white or bound down in scar-like areas

Question 20

Diagnosis is ____

Answer 20

Diagnosis is squamous cell carcinoma

Question 21

Next step in management is ____

Answer 21

Next step in management is shave biopsy

Question 22

Diagnosis is ____

Answer 22

Diagnosis is squamous cell carcinoma

Question 23

Squamous cell carcinoma involves ____, regular ____, monthly ____, and ____

Answer 23

Squamous cell carcinoma management involves surgical excision with 5 mm margins, regular total body skin examinations, monthly self-examinations, and photoprotection

Question 24

Squamous cell carcinoma is most common in people with ____ skin, is found on ____ areas, and has increased mortality compared to basal cell carcinoma due to ____

Answer 24

Squamous cell carcinoma is most common in people with white/fair skin, is found on sun-exposed areas, and has increased mortality compared to basal cell carcinoma due to higher rate of metastasis

Question 25

Squamous cell carcinoma cell of origin is ____ and is common under conditions of \_\_\_\_

Answer 25

Squamous cell carcinoma cell of origin is keratinocytes and is common under conditions of immunosuppression (s/p transplant)

Question 26

Describe clinical manifestations of squamous cell carcinoma

Answer 26

Squamous cell carcinoma clinical manifestations * Variable morphologies: papule / plaque / nodule, pink / red / skin-colored, scale, exophytic (grows outward), indurated, may present as cutaneous horn * Friable: may bleed with minimal trauma * Asymptomatic, painful, or pruritic

Question 27

Squamous cell carcinoma in situ is called ___ and involves keratinocyte atypia that is ___ and does not \_\_\_

Answer 27

Squamous cell carcinoma in situ is called Bowen's disease and involves keratinocyte atypia that is confined to the epidermis and does not invade past the dermal-epidermal junction (circumscribed pink / red patch or thin plaque with scaly or rough surface)

Question 28

Squamous cell carcinoma has higher rates of metastasis if on the ____ or in ____ patients

Answer 28

Squamous cell carcinoma has higher rates of metastasis if on the lips (smoking) or in immunosuppressed patients (s/p transplant)

Question 29

Skin cancer treatment is \_\_\_\_

Answer 29

Skin cancer treatment is complete elimination of the tumor with best cosmetic result

Question 30

Standard excision of basal cell carcinoma or squamous cell carcinoma is \_\_\_\_

Answer 30

Standard excision of basal cell carcinoma or squamous cell carcinoma is elliptical excision with layered suture closure and 4-5 mm margins

Question 31

Mohs micrographic surgery offers ____ and ____ compared to standard surgical excision

Answer 31

Mohs micrographic surgery offers superior histologic analysis of tumor margins and maximal conservation of tissue compared to standard surgical excision

Question 32

Broad spectrum protects against \_\_\_\_, while SPF is related only to \_\_\_\_

Answer 32

Broad spectrum protects against UVA and UVB, while SPF relates only to UVB

Question 33

This is \_\_\_\_

Answer 33

This is actinic keratosis

Question 34

Actinic keratosis originates from ____ , may transform into \_\_\_\_, and has a characteristic \_\_\_\_

Answer 34

Actinic keratosis originates from keratinocytes, may transform into squamous cell carcinoma, and has a characteristic rough gritty scale * May be tender, located in sun-exposed areas, background of sun damaged skin, erythematous papule or thin plaque with characteristic rough gritty scale, and often diagnosd by feel (like sandpaper)

Question 35

Actinic keratosis results from \_\_\_\_

Answer 35

Actinic keratosis results from cumulative and prolonged UV exposure

Question 36

\_\_\_\_ is used as treatment for localized actinic keratosis

Answer 36

Cryosurgery is used as treatment for localized actinic keratosis (side effect of post-inflammatory hyperpigmentation)

Question 37

Many actinic keratoses are treated with ____ or \_\_\_\_

Answer 37

Many actinic keratoses are treated with topical 5-fluorouracil / imiquimod creams or photodynamic therapy

Question 38

Compare basal cell carcinoma, squamous cell carcinoma, malignant melanoma

Answer 38

Basal cell carcinoma, squamous cell carcinoma, malignant melanoma

Question 39

\_\_\_\_, \_\_\_\_, \_\_\_\_, and ____ are genetic syndromes predisposing to skin cancer

Answer 39

Xeroderma pigmentosum, basal cell nevus syndrome (Gorlin's syndrome), familial melanoma, and oculocutaneous albinism are genetic syndromes predisposing to skin cancer

Question 40

Xeroderma pigmentosum is caused by \_\_\_\_, and patients have a ____ risk of skin cancer including melanoma

Answer 40

Xeroderma pigmentosum is caused by mutations in nucleotide excision repair, and patients have a 1000x risk of skin cancer including melanoma

Question 41

Basal cell nevous syndrome involves a gene defect in \_\_\_\_

Answer 41

Basal cell nevous syndrome involves a gene defect in tumor suppressor gene PTCH (Patched)

Question 42

Oculocutaneous albinism is ____ and leads to increased frequency of ____ and \_\_\_\_

Answer 42

Oculocutaneous albinism is a group of genetic disorders with partial or complete absence of melanin and increased frequency of squamous cell carcinoma and melanoma (normal number of melanocytes)