week 8

Question 1

squamous cell carcinoma

• dx how
• eti
• if over what age, high risk
• where on body?
• mets?
• what color skin risky
• location on dark skin ppl

Answer 1

• skin biopsy to dx
• UVB sun exposure
• 75
• exposed areas of skin CUTANEOUS SURFACE … head, neck, trunk, extrem, oral mucoas, periungal skin, anogen.
• low rate of mets
• white ppl … if in dark-skin, cSCCs on non sun-exposed areas and freq assoc w inflamm.
• legs, anus, areas of chronic inflamm/scarring

Question 2

UVA light exposure

Answer 2

• penetrates deeply
• UVA radiation -> DNA damage
• p53 tumor suppressor gene point mutations

Question 3

Other risks for sSCC

Answer 3

ionizing radiation, grenz-rays, gamma rays

- basal layer of epidermis more affected by radiation at higher risk of BCC than cSCC

Question 4

what percent of cutaneous skin CA arise in chronically inflamed skin

Answer 4

1% …. most are squamous (95%)

Question 5

when does cSCC appear after skin damage?

Answer 5

can be super early 6 wks or 60 yrs later

- be suspicious if it’s not healing

Question 6

Arsenic exposure is assoc w …

Answer 6

cSCC, BCC

Question 7

chemo protection w

Answer 7

vitamin A

Question 8

Bowen’s Dz is…

presents as…

Answer 8

SCC in situ

- well-demarcated, scaly patch/plaque, often erythematous, grow slowly, usu asx

Question 9

Invasive cSCC

Answer 9

often Asx, but mb painful, pruritic

- looks gross

Question 10

well-differentiated SCC

Answer 10

• indurated, firm, hyperkeratotic, papules, plaques or nodules
• usu 0.5-1.5cm
• mb ulcerated

Question 11

poorly differentiated SCCS

• looks like
• sxs
• bad sign if invasion into?

Answer 11

fleshy, soft, granulomatous, papules, nodules

• mb ulceration, hemorrhage, areas of necrosis
• NEURO SXS
• perineural

Question 12

Oral SCC

• looks like
• lesion arise in sites of…
• assoc w..

Answer 12

• ulcer, nodule, or indurated plaque
  floor of mouth, lateral, ventral tonuge
• erythroplakia or leukoplakia
• assoc w tobacco heavy alc abuse

Question 13

keratoacanthoma

• cSCC?
• usu found where?
• what makes it different from cSCC

Answer 13

resembles cSCC
controversial whether it is
- usu found on ACTINICALLY-DAMAGED SKIN
- RAPID initial growth, dome-shaped or crateriform nodules w central keratotic core

Question 14

verrucous carcinoma

• looks like
• location

Answer 14

well defined, exophytic, cauliflower-like

- oral, anogenital, epithelioma cuniculatum (plantar foot)

Question 15

cSCC

• location
• looks like

Answer 15

lower lip
nodules, ulcers, indurated white plaques
- lesion on vermillion border is cSCC until proven otherwise!

Question 16

where to SCC mets?

Answer 16

• 5-10%
• regional lymph nodes
• lr, lu, brain, skin, bones
• to skin can look looks like erythematous papule, nodule

Question 17

histopath examine looks for?

Answer 17

• perineural invasion, tumor depth, differentiation

Question 18

if you think SCC, remove by….

Answer 18

full thickness excisional, or punch biopsy

Question 19

Tx SCC

Answer 19

• cryotherapy, etc

Question 20

most common fatal form of skin CA

Answer 20

malign melanoma (5 yr survival rate)
- can mb get a cure if thin stage l

Question 21

if you have atypical nevi risk to develop…

how many put you at risk for melanoma

Answer 21

malign melanoma .. at 2-20 fold

- 25

Question 22

malig melanoma risk

Answer 22

sun, uv exposure, tanning bed, white ppl, etc

Question 23

malig melanoma growth phases

- dangerous?

Answer 23

HORIZONTAL “radial” phase
most superficial confined to epidermis
at this stage, can cure w surgery

Question 24

malig melanoma “vertical” growth

Answer 24

have met potential

NODULAR.. no identifiable radial growth phase… enter vertical growth from their inception

Question 25

4 types of malig melanomas in order of prevalence

Answer 25

1. superficial spreading 2. nodular 3. acral lentiginous 4. lentigo maligna

Question 26

superficial spreading melanoma - pop. - growth - curable

Answer 26

- mc type - young ppl - grows slowly ... long time before penetrating deep - if

Question 27

Nodular melanoma

Answer 27

``` most aggressive 2nd mc most diff. to dx at an early stage when dx usu > 2 mm thick, so bad news all diff colors, amelanotic variants ```

Question 28

Lentigo Maligna Melanoma pop. looks like

Answer 28

remains close to skin surface for a while usu elderly.... face ears arms upper trunk... sun exposed flat or mildly elevated, tan, brown, dark brown common in hawaii

Question 29

acral lentiginous - location - pop. - spread... - caution bc likelihood of invasion

Answer 29

trunk, legs, arms - mc in asians, african - palmar, planta, subungual - spread superficially - raised, develops ulceration, > 5 mm in diameter

Question 30

most importatn Melanoma prognostic factors

Answer 30

- thickness!, mitotic rate, ulceration

Question 31

stage l, ll survival rate of how long

Answer 31

10 yrs

Question 32

Dx Checklist

Answer 32

ABCDE | asym, border, color, diameter, evolution

Question 33

Glasgow seven-point checklist... use mc in europe

Answer 33

major: size minor: >7mm, inflam, crusting, bleeding,

Question 34

biopsy to r/o malign. melanoma | - best method

Answer 34

- excisional biopsy - 1-3 mm margins of normal skin and layer of subq fat - "narrow-margin" excision

Question 35

why superficial shave bx is never approp.

Answer 35

- leaves residual tumor, underestimates thickness - cause fibrosis, scarring - can't identify tumor bc no depth

Question 36

definitive "initial" surgical tx

Answer 36

wide local excision | - no difference than narrower margin - doesn not alter recurrence rate

Question 37

Mohs micrographic surgery for melanoma

Answer 37

ensure complete removal