Dermatology 2 > Neoplasms > Flashcards

Neoplasms Flashcards

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1
Q

Actinic keratosis

A
  • precancerous to SCC
  • 10% risk malignant transformation
  • very common
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2
Q

Actinic keratosis

- RF

A
  • caucasion
  • chronic sun exposure
  • immunocompromised
  • Fitz-Patrick I and II
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3
Q

Actinic keratosis

- common location

A
  • sun-exposed areas

- scalp, head, face, dorsal forearms, hands, shins

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4
Q

Actinic keratosis

- epidemiology

A
  • middle aged and older

- M>F 2:1

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5
Q

Actinic keratosis

- pathophys

A

atypical keratinocytes confined to lower portion of epidermis

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6
Q

Actinic keratosis

- S&S

A
  • sometimes easier felt than seen
  • gritty papule, erythematous base
  • white to yellow scale
  • rough like sandpaper
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7
Q

Actinic keratosis

- Dx

A
  • History and PE
  • Bx gen not needed
  • Fluorescence with Woods lamp
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8
Q

Actinic keratosis

- progression

A
  • persist
  • spontaneously regress
  • progress to SCC
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9
Q

Actinic keratosis

- what presentation is most likely to progress to SCC

A
  • tender
  • thick
  • inflamed
  • failure to respond to therapy
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10
Q

Actinic keratosis

- Treatment

A
  • Cryotherapy #1
  • F-fluorouracil 5% cream X 1 month
  • Aldara 5% cream X 16 weeks
  • Picato 0.015% gel X 3 days
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11
Q

Seborrheic keratosis

- overview

A
  • superficial, often pigmented, benign lesions
  • show up around 40s, increase as age
  • trunk and temple MC
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12
Q

Seborrheic keratosis

- presentation

A
  • vary in size
  • grow slowly
  • macular, papular, verrucous
  • round or oval
  • flesh colored, black, brown
  • spares palms, soles, mucosal surfaces
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13
Q

What is concern if large, multiple, rapidly appearing Seborrheic keratosis?

A

Leser-Trelat sign

- associated with internal malignancy

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14
Q

Seborrheic keratosis

  • dx
  • tx
A
  • clinical history and PE

- cryotherapy to remove if bothersome

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15
Q

Basal cell carcinoma

- overview

A
  • MC type skin cancer
  • rarely metastasize
  • cause local destruction
  • from basal cells in skin
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16
Q

Basal cell carcinoma

  • appearance
  • location
A
  • superficial
  • slow growing papule or nodule
  • lesion that doesn’t heal and bleeds when traumatized
  • sun exposed: hands, face, head, and neck region (85%)
  • Periocular: MC lower eyelid
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17
Q

Basal cell carcinoma

- epidemiology

A
  • elderly
  • fair skinned (caucasian has 30% lifetime risk)
  • M>F 2:1
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18
Q

Basal cell carcinoma

- RF

A
  • Long term sun exposure
  • Fitzpatrick type 1
  • immunocompromised
  • prior BCC
  • trauma
  • xeroderma pigmentosum
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19
Q

Basal cell carcinoma

- pathophys

A
  • Basal keratinocytes of epidermis and adnexal structures
  • grows as direct extension
  • unpredictable growth and progression
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20
Q

Basal cell carcinoma

- 4 main patterns

A
  • Nodular (60%)
  • superficial (30%)
  • infiltrative
  • morpheaform
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21
Q

Basal cell carcinoma

- Nodular

A
  • MC form **
  • Pearly white/pink **
  • Dome shaped
  • Rolled border
  • Telangiectasias **
  • Can have central ulceration and crusting
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22
Q

Basal cell carcinoma

- Superficial

A
  • epidermis
  • younger, female
  • trunk and extremities **
  • slow growing, expands peripherally
  • circumscribed, round-to-oval, red, scaling plaque **
  • may resemble eczema or psoriasis **
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23
Q

Basal cell carcinoma

- Morpheaform

A
  • Yellow/waxy *
  • sclertoic
  • no ulcerations usu
  • Firm, flat, slightly raised **
  • resembles scleroderma
  • indistinct borders
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24
Q

Basal cell carcinoma

- Infiltrating

A
  • slow growing
  • sun exposed areas
  • mostly males
  • Irregular, poorly demarcated plaque **
  • can be red and ulcer **
  • infiltrate deeper, involve lymph nodes
  • can grow large, infiltrate nerves, nearby tissue
  • children: assoc. with basal cell nevus syndrome
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25
Basal cell carcinoma | - Pigmented
- melanin | - usually people with darker skin and eyes
26
Basal cell carcinoma | - cystic
- cystic mass, smooth and round - similar to nodular BCC - less firm than nodular
27
Basal cell carcinoma | - Nevoid basal cell carcinoma syndrome
- rare, autosomal dominant - multiple BCCs at birth or early childhood *more on slide but this is what she said to know
28
Basal cell carcinoma | - Dx
- Bx: shave or punch ** | - imaging (CT) only if need or for sx prep
29
Basal cell carcinoma | - Histology
two categories - Undifferentiated: solid BCC - Differentiated: contain other cell lines also
30
Basal cell carcinoma | - Treatment
- Surgical excision** - MOHS** - electrodessication and curettage - radiation - imiquimod - 5-fluorouracil - F/U observe 5+ years - risk of second BCC within 5 years: 36-50%
31
Squamous Cell In Situ - aka - describe
- Bowen's disease - very early form skin cancer - superficial SCC - sun exposed MC but can be anywhere
32
Squamous Cell In Situ | - presentation
- solitary or multiple - scaly patch doesn't heal - slow growth - can itch - not painful
33
Squamous Cell In Situ | - PE
- red-brown - scaly or crusted - resembles thin psoriasis plaques, dermatitis, dermatophyte infection
34
Squamous Cell In Situ | - dx
bx
35
Squamous Cell In Situ | - tx
- Aldara 5% cream - 5-FU 5% cream - cyrotherapy - excision - Sun care practices
36
Erythroplasia of Queyrat | - overview
- Bowen's dz of the glans penis - almost always uncircumsized - can progress to invasive SCC
37
Erythroplasia of Queyrat | - signs and sx and PE
- solitary or multiple non healing lesions - redness, crusting, scaling, ulceration - itching, pain, bleeding - phimosis, dysuria, penile discharge - can affect adjacent mucosal epithelium/inner surface foreskin
38
Erythroplasia of Queyrat | - dx
- bx
39
Erythroplasia of Queyrat | - tx
- Aldara - 5-FU - MOHS - surgical excision - cryotherapy - radiation - laser treatment
40
Squamous Cell Carcinoma | - overview
- 2nd MC skin cancer | - substantial risk of metastasis **
41
Squamous Cell Carcinoma | - RF
- UVB radiation, esp in childhood - light hair and eyes - ionizing radiation - outdoor occupation - immunosuppression
42
Squamous Cell Carcinoma | - MC locations
- sun-exposed - scalp - back of hands - superior pinna
43
Squamous Cell Carcinoma | - epidemiology
- elderly | - M>F 2:1
44
Squamous Cell Carcinoma | - precursors
- Actinic keratosis** | - cutaneous horns
45
Squamous Cell Carcinoma | - pathophys
- atypical squamous cells in epidermis | - from proliferating keratinocytes
46
Squamous Cell Carcinoma | - presentation
- Non healing lesion** - sun exposed surface - shallow ulcer with elevated margins, often covered by plaque - red, soft, freely moveable tumor - may have thick and adherent scale
47
Squamous Cell Carcinoma | - Metastatic potential
- depends on location, size, degree differentiation, immunologic status, histology, depth - Highest risk: scalp, ears, lips, nose, forehead, areas of chronic inflammation
48
Squamous Cell Carcinoma | - Dx
- Bx: incisional or excisional ** | - Imaging (CT/MRI): surrey prep or look for invasion or metastasis
49
Squamous Cell Carcinoma | - Staging
- Important to determine treatment - TNM staging used ** - highest risk >2 mm thickness, invasion to lower dermis/subcut, skin nerves, ear or hair-bearing lip
50
Squamous Cell Carcinoma | - Tx
- Surgical excision with clear margins - MOHS if in face - radiation adjuvant to sx - 5-FU - systemic chemo for metastatic SCC
51
Kaposi Sarcoma | - overview
- develops from cells that line lymph or blood vessels - usu tumors on skin or mucosal surfaces - aka "multiple idiopathic hemorrhagic sarcomas" - rare prior to AIDS era
52
AIDS-Associated Kaposi Sarcoma - pathogenesis - epidemiology
- caused by HHV-8 - MC type of KS in US - HIV pts
53
AIDS-Associated Kaposi Sarcoma | - presentation
- violaceus macules, plaques, nodules - head, neck, upper trunk - node involvement common ** - fulminant onset, "AIDS defining" - treatment response is poor
54
Karposi Sarcoma | - Dx
- Hx, PE - bunch biopsy - CXR/bronchoscopy - EGD/Colonoscopy
55
Melanoma | - overview
- malignant transformation of melanocytes - most serious skin cancer - skin, mucous membranes, ocular, GI, GU, lymph nodes, CNS - Metastatic correlated with depth of invasion
56
Melanoma | - incidence
- >50% 20-40 yo - median age 62 men 54 women - M>F 1.5:1 - MC in caucasian
57
Melanoma | - Etiology and pathophys
- DNA damage | - initially in epidermis with lateral growth, then growth into dermis with vertical growth
58
Melanoma | - genetics
- RF: dysplastic nevus syndrome - 8-12% have fam hx - Familial atypical mole malignant melanoma - 1/10,000 dysplastic nevi become melanoma annually
59
Melanoma | - RF
- genetics - UVA and UVB exposure - Hx >5 sunburns doubles risk ** - Intense intermittent sun exposure ** - previous pigmented lesions - fair complexion, freckles, blue eyes, blond/red hair - highest predictor: increased number nevi (>100) ** - Tannign bed use 75% inc risk 1st exposure <35 yo - changing nevus - large congenital nevi (>5 cm) - other skin ca - blistering sunburns in childhood - live high altitude - exposure to ionizing radiation ETC ETC
60
Melanoma | - 7 main types cutaneous melanoma
1. superficial spreading (50-80%): sun exposed areas 2. Nodular (20-30%): older pts, ulcerate and hemorrhage 3. Lentigo maligna (melanoma IS): slowest growing, older pts, sun-exposed 4. Amelanotic melanoma (<5%): can mimic benign conditions 5. Acral-lentiginous (2-8%): MC in AA and Asian 6. Subungual: (<5%) dark band in nail bed, Hutchinson sign 7. Desmoplastic melanoma (1%): sarcoma-like tendencies, hematogenous spread
61
Melanoma | - presentation
- change in pigmented lesion: hypo- or hyper pigmentation, bleeding, scaling, ulceration, change in size or texture - fam/personal hx melanoma and non-melanoma skin cancer - Social hx: sunbathing, tanning, other sun
62
Melanoma | - PE
- any new/changing or bleeding/ulcerated nevus - high risk: ocular exam (iris and retina) - Caucasions MC: back and lower leg - AA MC: hands, feet, nails - may include mucosal surfaces
63
Superficial spreading melanoma
- MC type - grow horizontally along top layer of skin - can have purple hue
64
Nodular melanoma
- fast growing - cause nearly 1/2 melanoma-related deaths - Don't fit ABCDE as well = harder to dx - older men MC
65
Lentigo maligna melanoma
- can look like solar lentigo - not very common - usu >6mm
66
Amelanoic melanoma
- can be pink, red, purple, flesh colored | - often aggressive
67
Acral lentiginous melanoma
- MC asians and AA | - only shaped dot on foot, toe, etc.
68
Subungual melanoma
- MC AA - Nail streak - usually big toe and thumb
69
Desmoplastic melanoma
- look like scars - usually involve nerve fibers - "neurotropic melanoma" - MC sun exposed areas - usually > 6mm
70
Melanoma | - Dx
- Bx: standard of care. Bx ANY suspicious nevus - Dermoscopy: giant microscope to see skin more closely - Sentinel node biopsy to stage - Lactate dehydrogenase (LDH) baseline - CT/MRI/PET CT baseline * imaging only helpful in detecting/eval progression fo metastatic disease
71
Melanoma | - Staging
- Breslow staging - based on thickness of tumor (for staging) - msr in mm
72
Melanoma | - Tx
- Full surgical excision (curative for most stage I-III) - stage IV can add chemo - oncologist for chemo - plastic sx for final excision depending on location - MOHS - Radiotherapy - lentigo maligna, some head and neck lesions
73
Melanoma | - prognosis
- Strongest predictor is breslow depth - highest survival <45 women - metastatic has ave survival 6-9 months - stage I and II have 20-year survival rats of 90% and 80%
74
Melanoma | - prevention
- avoid sunburn - use SPF30+ - avoid tanning beds - Screen high-risk pts - Proper dx!! - Bx all suspicious lesions
75
Melanoma | - PT education
- Teach those at risk how to monitor for change (ABCDE) - perform monthly skin self-exams - regular total body exams for those with hx of melanoma or dysplastic nevus syndrome - Regular use of SPF15+
Dermatology 2
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