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Derm Malig Lesions
CM Dermatology Malignant Lesions
| Question | Answer |
|---|---|
| Most common Skin cancer | BCC; mets virtually never occur. Common sun exposed areas. |
| Risk factors for BCC | Risk factors include cumulative sun exposure, white-skinned patients with poor tanning, albinos, sunburns prior to age 14, arsenic ingestion, and prior XRT. |
| Epidemiology of BCC | Usually >40 YO and M>F |
| Most common variant of BCC | Nodular. As the papule gradually enlarges, the center flattens or ulcerates, the borders become raised or rolled, and they frequently bleed and develop crust and/or scale. Treatment includes ED&C, excision, and MMS for recurrent or high risk lesions. |
| ED & C | Electrodessication and Curettage |
| pearly pink with central telangectasia is suggestive of | Nodular BCC |
| Least aggressive variant of BCC seen more commonly on the trunk and extremities. Looks like eczema or psoriasis. ROLLED BORDER, scabs within it | Superficial BCC, Tx: ED & C and excision. Often on the trunk |
| BCC that can resemble melanoma | Pigmented BCC |
| Least common BCC, white to yellow patch with poorly-defined borders. | Morpheaform BCC. MMS is the treatment of choice. |
| Pre-cancerous growth caused by cumulative sun exposure. Persistent, Keratotic Growth | Actinic Keratosis. Gritty like sandpaper or really firm |
| Tx for Actinic Keratosis | Treatment options include 5-FU (Efudex), Imiquimod (Aldara), cryotherapy, or ED&C. |
| Cutaneous horns are | cancer until proven otherwise and SHOULD ALWAYS BE BIOPSIED |
| Potentially invasive, primary cutaneous malignancy of keratinocytes in the skin or mucous membranes. Mostly caused by Ultraviolet radiation, also chronic wounds, arsenic, hpv infection | Squamous cell carcinoma |
| 20% of all skin cancers are | Squamous Cell Carcinoma. Palpate regional lymph nodes for mets, especially for lesions on the ear, scalp, lips, and temples.Treatment includes ED&C, excision, and MMS for recurrent or high-risk lesions. |
| Erythroplasia of Queyrat is | squamous cell carcinoma in situ of the penis |
| Bowen's Dz | SCC in situ (on the epidermis). Treatment includes 5-FU (topical chemo), cryotherapy, ED&C, excision, and MMS depending on location, patient, and size of lesion. |
| Common, rapidly growing, solitary, firm, red nodule with a central keratotic plug or cutaneous horn.Cannot be clinically distinguished from an invasive SCC and must be biopsied. | Keratocanthoma. M>F, usually patients>50 yo. Best regarded as a low-grade SCC |
| How can SCC spread? | Hematologically or/and lymphatically |
| Atypical Nevi tx | Lesions with mild atypia can be observed, but aggressive providers will excise them.Lesions with moderate atypia should be excised. Lesions with severe atypia should be treated as though they were melanoma. |
| Patients wiht multiple atypical Nevi may benefit from | mole mapping. |
| Any mole that develops in adulthood or is changing should be in your ddx for any new mole presenting in adulthood or any mole changing in size, shape, or color. | Malignant Melanoma. |
| Malignant Melanoma dx | When in doubt, a punch biopsy or excisional bx should be performed to ensure a full thickness specimen for the pathologist |
| Breslow Level refers to | the depth of the lesion measured in mm from the top of the clinical lesion to the bottom of the lesion in the tissue specimen. |
| ____ is the most important prognostic indicator in malignant melanoma | Breslow depth |
| ______level refers to the level of anatomic invasion and is important, especially in areas with thinner skin like the eyelids, ears, and genitals. | Clark |
| MM is the ___ most common malignancy in the US | 8th |
| the most common cancer in females 25-29 YO and is the second most common cancer in women 30-35 YO. | Malignant Melanoma |
| Malignant Melanoma commonly develops as a | new growth, but 30% arise within a preexisting mole |
| Most common place for mets with MM | skin. CNS mets is the most common cause of death. Majority of people, there is no tx. (chemotherapy has shown modest benefit) |
| _____is melanoma in situ, located in epidermis only. | Lentigo Maligna. represents 5-10% of all melanoma |
| Most common type of Malignant melanoma | Superficial Spreading MM. 70-80% of melanoma. most common in caucasians |
| Nodular MM make up what percent of MM | 10-15%. Grow rapidly and vertically through the skin |
| Most common type of MM in asian americans and african-americans | Acral Lentiginous MM |
| nonpigmented melanoma that is super scary | Amenlanotic MM |
| ________is a topical immune response modifier and acts like a “homing beacon” to stimulate the immune system to destroy precancerous, cancerous, and virus infected cells. | Imiquimod (Aldara) |
| ____is a tissue-sparing, specialized procedure where frozen sections are taken in the office and evaluated to determine clear margins while the patient waits. The defect is then closed. | Mohs Micrographic Surgery (MMS) |
Created by:
ltm12