derm 2 cancers (questions)
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Also known as "SCC in situ", it is solitary, slightly elevated, red-brown, appears in scaly plaques and resembles an inflammatory process.
This lesion extends down hair follicles and is most often caused by UVR or HPV infection.
How are bowen's disease lesions treated?
- small: electrodessication & curettage, cryosurgery, excisional surgery
- larger: excisional surgery (TOC if invasive SCC suspected), 5-FU (efudex) cream
- imiquimod (aldara) cream
This occurs on the glans of uncircumcised elderly males, or the labia of elderly females, presents as a moist, red smooth slightly raised plaque and is associated with HPV-8.
erthroplasia of queyrat (bowen's disease)
What is the tx for erythroplasia of queyrat?
This lesion is red, scaly and persistent, can present with or without ulceration, can present as a hypertrophic lesion with ulcer or hyperkeratosis (cutaneous horn), or as a lip ulcer with induration.
Occurs in sun exposed areas, arises from Bowen's anywhere, has a low potential for mets (greatest at the lip), and has malignant potential.
What can be the origin of SCC?
- up to 60% develop from AK
- thermal/radiation burns
- chronic irritation
- infection (HPV)
- keratinocytes/spinous layer epidermis
What is the management of SCC?
- excision with margins
- examine for nodes
- F/U q6 mo for life
Slow growing, asymptomatic, nodular (most common), skin/pink colored, "shiny, pearly papule with telangiectasias and central ulceration" with rolled borders.
Most common CA in the United States, most common skin CA, most common in >40 yrs, pts c/o bleeding lesion that doesn't heal.
Lesion that is sun induced, de novo or pre-existing lesion, d/t malignant proliferation in the basal layer of the epidermis, and can present with looseness and friability.
The most important factor for developing this lesion in the inability to tan.
How is BCC managed?
- detected early: excision w/ small defect
- detected late: excision but referral to derm, plastics
Most deadly form of skin cancer, is responsible for 75% of skin cancer deaths in the US, incidence has tripled in LPP in past 40 yrs, and has shown a dramatic increase in teenagers.
What are the risk factors for malignant melanoma? (there are 13)
- hx of severe sunburn in childhood/adolescence
- N. european ancestry
- blonde/red hair
- green/blue eyes
- reside in regioin w/ intense sun
- large number of moles
- psoralen/PUVA tx
- fam hx of atypical mole syndrome (AMS)
- chemical exposure
- skin irradiation
- chronic skin scars/ulcers
What are the ABCDEs when looking for malignant melanoma?
- A: asymmetry
- B: borders
- C: colors
- D: diameter >6mm
- E: elevation/enlargement
Diagnosed based on presentation of a lesion that is raised with variation in pigment and borders, or alteration of skin markings that requires biopsy or dermoscopy.
malignant melanoma (when in doubt use ABCDE!)
What is the tx for malignant melanoma?
- wide local excision with margins based on histologic depth (breslow measurement)
- sentinel lymph node bx/dissection
- close F/U
The curability of malignant melanoma is directly related to what?
tumor size and depth of invasion
What is the median survival for a pt with malignant melanoma?
6 months :(
What are the 4 types of malignant melanoma?
- lentigo maligna
- spreading superficial
Type of malignant melanoma that is a lateral growth phase lesion, occurs in older pts (60s-70s), and have a 5% risk of becoming invasive.
The most common type of malignant melanoma, can occur at any age >20 but esp in 40s-50s, and nodules appear when lesion is >2.5cm.
superficial spreading melanoma
Type of malignant melanoma that occurs on the palms/fingers, soles, nails or mucous membranes, has a very poor prognosis and is the most common form of MM in DPP.
Malignant melanoma on subungual, mucosa, plantar, and palmer surfaces are most common in which population?
What are the ABCDEFs in looking for malignant melanoma in a DPP?
- A: age (5th-6th decades)
- B: brown/black band
- C: reCent, sudden, rapid development
- D: digit most commonly involved
- E: extension of brown pigment onto cuticle/where a hangnail may develop
- F: fam hx/ person hx of unusual moles or MM
Type of malignant melanoma that makes up the completely vertical growth phase, can arise anywhere, occurs mostly in 40s-60s males, may not be pigmented, could resemble a vascular nevus, and is the most commonly misdiagnosed MM.
What type of malignant melanoma growth phase has a better prognosis?
Once a malignant melanoma lesion begins ________ the prognosis worsens.
When is metastatic development rapid in a malignant melanoma?
after vertical growth begins
Explain levels 1-5 on Clark scale for the depth of invasion of a malignant melanoma.
- Level I: restricted to epidermis (98% 5 yr survival)
- Level II: papillary dermis
- Level III: fills papillary dermis
- Level IV: reticular dermis
- Level V: invades subcutis (44% 5 yr survival)
What is the most important histologic determinant of prognosis for malignant melanoma?
What is the best predictor of prognosis for a malignant melanoma?
lymph node involvement
Where do approx. 80% of malignant melanomas arise?
on clothing covered areas
Lesion with a persistent localized rough feeling to the skin, is pink or erythmatous with scale, can present as a hyperkeratotic lesion on the ears and dorsum of hand.
What is actinic keratosis on the lip called?
If the actinic keratosis lesion is on the superior aspect of the pinna and is tender, what should you think of?
chondrodermatitis nodularis helicis-->CNH (degeneration of underlying collagen)
What are the origins of actinic keratosis?
- chronic UVB exposure
- fair skinned
- superficial atypical squamous cells (limited to epidermis)
How is actinic keratosis managed?
- photoprotection (barrier/chemical)
- complete skin exam for BCC/SCC
How are actinic keratosis lesions treated?
- Few/individual lesions: LN2
- multiple: 5-FU (efudex) or imiquimod (aldara)
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