CM- Derm -10- Cutaneous Malignancies
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| intraeptihelial keratinocyte neoplasia precurson to squamous cell carcinoma found on sun exposed skin: face, posterior neck, bald scalp, arms, hands, and lips | actinic keratosis
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| How does actinic karatosis appear | as pink or red macules with adherent scale feels rough when palpated has variant cutaneous horn thick elongated scale
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| how do you treat actinic keratosis | stop sun exposure
liquid nitrogen if a few thin ones
multiple ones can be treated by topical creams
or photodynamic therapy
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| What are the creams used to treat multiple actinic keratosis spots | topical 5-fluorouracil- burns and cause redness
topical imiquimod
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| What is the prognosis of indiviuals with actinic keratosis in regards to squamous cell carcinoma | 20% will develop squamous cell carcinoma somewhere
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| what number of actinic keratoses will transform into squamous cell carcinoma | 1 in 1000
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| how many actinic keratoses remit spontaneously | 25%
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| second most common type of skin cancer, cancer of cells that compose most of the epidermis. typically caused by sun damage | Squamous cell carcinoma
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| Where does squamous cell carcinoma typically present | head and neck but may also occur on lips, genitals and non exposed skin
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| type of squamous cell carcinoma confined to epidermis distinguished by full thickness atypia of the epidermis | Bowen's disease or SCC in situ
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| What is the treatment for SCC in situ | topical chemotherapy/immunomodulators
destructive modalities
excision
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| SCC that is marked by crateriform growth, growth is rapid and were originally thought to be benign | keratoacanthoma (SCC-KA type)
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| What is the classic description of a SCC | hyperkeratotic, flesh colored or pink papules may have ulceration and crusting
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| What are the risk factors that increase SCC | sun exposure: UVB is carcinogenic
fair skin, blue eyes, freckling
arsenic exposure
hydrocarbon exposure
infrared and xray radiation
chronic, non healing wounds
immunosuppression
HPV
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| What are the metastasis rates for SCC Typical Lower lip Scar or non healing ulcer penis/vulva | Typical 8%
lower lip 16-40%
scar or non healing ulcer 25%
penis/vulva 60%
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| with SCC of the lip which lip is typically affected what is the metastasis rate and what is it associated with | Typically affect lower lip
metastasis of 15-40%
associated with sun exposure and smoking
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| What is the treatment for superficial SCC | Superficial SCC liquid nitrogen, electrodissection and curettage
topical imiquimod cream
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| What is the treatment for larger or more aggressive SCC's | excisional surgery- especially crappy for snuff dipping could lose your whole freaking jaw
radiation therapy
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| Cancer that arises from the pluripotent cells in the basal layer of the epidermis or follicular structures | basal cell carcinoma
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| What is the most common skin cancer and most common malignancy in humans | basal cell carcinoma
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| Where is basal cell carcinoma most common | head and neck
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| What percent of basal cell carcinomas metastasize | less than 1%
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| what are the 5 most common characteristics of basal cell carcinoma | 1. an open sore
2. a reddish patch
3. a shiny bump
4. nodular (most common)
5. morpheaform
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| How does open sore characterize basal cell carcinoma | an open sore that doesn't heal is very common sign of an early basal cell carcinoma. It will ooze bleed and crust remains open for three or more weeks
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| how does a reddish patch indicate basal cell carcinoma | it will be a reddish patch that frequently occur on chest, shoulders, arms or legs. sometimes the patch crusts it may also itch or hurt but may not
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| how does a shiny bump indicate possible basal cell carcinoma | the shiny bump or nodule is pearly or translucent and is often pink red or white. The bump can also be tank black or brown and can be confused with a mole
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| What is the classic basal cell carcinoma presentation | nodule; pink growth with a slightly elevated border and a crusted indentation in the center. As the growth enlarges tiny blood vessels may develop on the surface
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| what is the morpheaform presentation of basal cell carcinoma | a scar like area which is white yellow or way and often has poorly defined borders. The skin itself appears shiny and taut this warning sign can indicate aggressive tumor
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| What is the treatment for Basal Cell Carcinoma | superficial BCC:
liquid nitrogen
electrodessication and curettage
topical imiquimod cream
Larger and more aggressive BCC
excisional surgery
radiation therapy
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| What are the indications that BCC is candidate for Mohs micrographic surgery | recurrent tumor
aggressive histolog
tumor size greater than 2cm
ill-defined clinical margins
high risk areas (perioral, periorbital, nasolabial, nasal ala)
tissue conservation
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| Tumor arising from melanocytes 1/5 of patients develop metastatic disease incidence of 15 per 10000 | melanoma
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| What are the ABCDE's of melanoma | A= Asymetry
B= borders irregular
C= Color
D= Diameter >5mm
E= evolution/exposure or enlargment/elevation
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| What are the 4 types of melanoma | superficial spreading melanoma
nodular melanoma
lentigo maligna melanoma
acral lentiginous melanoma
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| Most common type of melanoma, onset 30-50yrs slow horizontal growth phase followed by rapid vertically oriented growth phase 1/3 aris in pre existing nevus | Superficial spreading melanoma
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| Where is superficial spreading melanoma most common in men and women | men: back
Women: lower legs
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| What fraction of superficial spreading melanomas developed from a pre-existing nevus | 1/3
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| Second most common type of melanoma arises in sixth decade of life | nodular melanoma
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| Where do you generally find nodular melanoma | trunk, head, neck
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| Which sex has more nodular melanoma | men have it more than women
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| blue to black nodule that grows rapidly over months | nodular melanoma
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| This melanoma generally develops in the 7th decade of life occurs on chronically sun-damaged sin more common on face (nose and cheek) | lentigo maligna melanoma
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| How does lentigo maligna melanoma develop | slowly growing asymmetric black macule with slow evolution over many years
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| This is a relatively uncommon melanoma occurs on palms and sole or around nails, represents 70% of melanomas in dark skinned races | Acral lentiginous melanoma
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| Melanoma with a faster progression than others killed bob marley | acral lentiginous melanoma
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| What are the followin clarks levels of invasion level 1 2 3 4 5 | 1= confined to epidermis
2= invasion of papillary dermis
3= tumor fills papillary dermis
4= invasion of superficial reticular dermis
5= invasion of fat layer
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| what are the 10 year survival rates for clarkes levels 2 3 4 5 | 2=93%
3=71%
4=59%
5=36%
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| this procedure is performed when tumor thickness is >1mm | sentinel lymph node biopsy
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| how does sentinel lymph node biopsy work | you inject technetium sulfur colloids that get taken up around tumor and transported to lymphatics concentrates in sentinel lymph node. You then resect the radioactive lymph node. if that lymph node has cancer you do a general lymph node disection
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| what are the treatments for melanoma | excision, sentinel node biopsy, interferon alpha, melanoma vaccines, pallative surgery, chemotherapy
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