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12/14 non-melanoma skin cancer
Derm
32
Medical
Graduate
12/15/2011

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Cards

Term
cutaneous squamous cell carcinoma

predisposing factors
Definition
UV radiation/fair skin
immunosupression
certain toxins
chronic ulcers, scars, thermal damage
ionizing radiation
HPV
genodermatoses (inherited diseases)
Term
role of UV light as a contributor to skin cancer
Definition
UV light drive accumulation of mutations contributing to cancer

p53 mutation is common
Term
xeroderma pigmentosum
Definition
inherited disease causing defective DNA repair

predisposes to skin cancer
Term
cutaneous SCC

distribution
Definition
head, neck, UE

areas that are the most sun-exposed
Term
cutaneous SCC

appearance
Definition
pink papule, nodule, or plaque
firm to hard
typical lesions have a thick scale
ulcerated lesions have indurated border
Term
cutaneous SCC

histology
Definition
large masses of epithelioid cells infiltrating into dermis

variable degree of keratinization

horn pearls - concentric layers of keratinized cells

aggressive - nuclear pleomorphism and atypical mitotic figures

well differentiated SCC cells resemble epidermal spinous and cornified cells
Term
infiltration of cutaneous SCC
Definition
keratinizing tumor cells infiltrate the dermis

get much thicker epidermis

*epidermal-like structures in the dermis*
Term
stages of SCC
Definition
normal appearing keratinocyte
actinic keratosis
proliferative/recurrent actinic keratosis
SCC in situ
invasive SCC
Term
actinic keratoses
Definition
gritty surface

thin, adherent scale

no substance
Term
SCC in situ
Definition
skin = Bowen's disease

genitalia = erythroplasia of Queyrat
Term
SCC

metastasis
Definition
2-4% rate of metastasis

higher risk in: radiation of burn sites, chronic osteomyelitis sinus tracts, lower lip, genitalia
Term
SCC treatment
Definition
most: cut it out at it's gone

surgical excision
cryosurgery
radiation therapy
local immunotherapy
chemotherapy
Term
SCC follow up
Definition
less that in the past

3-6 months for 2 years, then yearly
Term
SCC pathogenesis
Definition
90% of SCCs have p53 mutations

key additional genetic changes not yet identified
Term
predisposing factors to basal cell carcinoma (BCC)
Definition
UV radiation/fair skin
immunosuppression
arsenic
scars, ionizing radiation
genodermatoses
Term
BCC clinical variants
Definition
nodular BCC

superficial BCC

morpheaform BCC
Term
nodular BCC
Definition
smooth papule with pearly or translucent appearance

prominent superficial vessels (telangiectases)

occasional ulceration

very common on sun-exposed areas

shiny pink-red bumps
Term
superficial BCC
Definition
thin, slightly scaly, pink plaque
Term
morpheaform (sclerosing) BCC
Definition
hypopigmented, depressed, scar-like

rare
Term
BCC histology
Definition
tumor cells arranged in nests in dermis or as epithelial downgrowths

tumor cells resemble epidermal basal cells

characteristic retraction space

*palisading*
Term
histo of morpeaform BCC
Definition
thin strands or tumor cells surrounded by dense, fibrotic stroma

clusters of cells

considered high-risk lesions
Term
BCC metastasis and behavior
Definition
BCC usually grows slowly

very low incidence of metastasis - 0.1%

may cause extensive local damage
-loss of organ function
-perineural spread
-invasion through bone
Term
BCC treatment
Definition
electodessication and curettage
surgical excision
cryosurgery
radiation therapy
Term
high risk BCCs
Definition
require Mohs micrographic surgery

large/recurrent lesions
tumors on central face, ear, chin, jaw
morpheaform
lesion with poor borders
incompletely excised tumors
Term
BCC pathogenesis
Definition
PATCHED1 gene mutation

PTCH1 is a receptor for hedgehog proteins, involved in embryonic signaling

*~100% of BCCs have abnormalities in the hedgehog pathway*

Hh pathway inhibitor prevents new BCC development - stop tx, tumors come back
Term
Hh signaling and BCC
Definition
-constitutive Hh signaling appears to be sufficient for BCC development
-turning off Hh signaling in mouse models of BCC leads to tumor regression
-phase I/II Hh inhibitor trials in BCC are promising, but tumors may grow back after drug is stopped
-additional clinical trials in BCC and other cancers are underway
Term
merkel cell carcinoma (MCC)

predisposing factors
Definition
age
UV radiation
ummunosuppression

rare!
Term
merkel cell carcinoma

distribution
Definition
head, neck extremities most common
Term
merkel cell carcinoma

appearance
Definition
blue to red papule, nodule, or plaque

firm to hard

ulceration is rare

(difficult to make the diagnosis clinically)
Term
merkel cell carcinoma

histology
Definition
-tumor cells arranged in nodules in dermis and SQ fat
-"small blue cell tumor" (minimal cytoplasm)
-high mitotic rate
-vascular invasion
-perineural invasion
-necrosis
-lots of mitotic cells
Term
merkel cell carcinoma

biological behavior
Definition
may exhibit very rapid growth

frequently (20-75%) metastasizes

30-64% 5-year survival rate (more deadly than melanoma)
Term
merkel cell carcinoma

treatment
Definition
surgery

+/- radiation therapy

+/- chemotherapy

poor response to tx in advanced cases
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