Term
| Actinic keratosis and actinic cheilitis (solar keratosis) |
|
Definition
Most common (pre)cancerous neoplasm of skin, pink to red macule or papule; overlying rough scale
Onset 3rd-4th decade, may be in teens with history of high sun exposure; Areas affected: face>ears>dorsum of hands (actinic keratosis) lips (actinic cheilitis) |
|
|
Term
|
Definition
| Higher risk of cacner and higher risk of metastasis; distribution - usually lower lip (large UV exposure); appearance: diffuse, slight scaling; often entire lower lip to commissures; occasionally see leukoplakia; background: blotchy, atrophic appearance, indistinct and irregular vermillion border; vermillion border often has perpendicular wrinkles |
|
|
Term
| Actinic keratosis differential diagnosis |
|
Definition
| Superficial BBC < SCC, seborrheic keratosis; seborrheic dermatitis |
|
|
Term
|
Definition
| Prevention sun protection & avoidance; definitive diagnosis via biopsy (find proliferation of atypical keratinocytes in epidermis w/ no invasion); treatment: prevention, liquid nitrogen, topical 5-fluorouracil |
|
|
Term
| Prognosis of actinic keratosis |
|
Definition
| Premalignant may dev into squamous cell carcinoma; probably of any given AK developing into an SCC is not known (<10%) Risk is higher in immunocompromised pts (organ transplants); actinic cheilitis should be treated, as SCC on lip has a higher risk of metastasis; risk marker for increased risk of skin cancer both SCC and melanoma |
|
|
Term
|
Definition
| Liquid nitrogen - involves destruction of tumor w/ liquid nitrogen (boils at -196 degrees C) |
|
|
Term
| Basal cell carcinoma characteristics |
|
Definition
| Most common skin cancer (2.8 cases/year in US); neoplasm of basal cells; 90% on H&N; high cure rate, locally destructive, spreading along nerves; recurrences may occur, metastases very rare (30 cases/year) |
|
|
Term
| Clinical subtypes of basal cell carcinoma |
|
Definition
| Nodular (most common, 60%); pigmented, superficial "multicentric" 15%; morpheaform/sclerosing - 3%; Fibroepithelioma of Pinkus (rare) |
|
|
Term
| Physical exam of basal cell carcinoma |
|
Definition
| Typically describes "pearly", ulcerated papule or nodule "rodent ulcer"; telangiectasias, may be pigmented, expanding scar without history of trauma, a white atrophic patch, nonhealing superficial ulceration |
|
|
Term
| Differential diagnosis of basal cell carcinoma |
|
Definition
| Sebaceous hyperplasia, seborrheic keratosis, nevus, squamous cell carcionma, melanoma; need to biopsy! |
|
|
Term
| Treatment prevention for basal cell carcinoma |
|
Definition
| Surgery most common; offers best cure rate, standard surgical excision; Mohs micrographic surgery (skin sparing w/ highest cure rates); electrodessication and curettage (ED&C); cryosurgery (liquid nitrogen - 190 degrees); topical therapy (5-fluorouracial, 5% imiquimod); radiation therapy |
|
|
Term
| Risk for recurrence of BCC's |
|
Definition
| Location: nose, ear; Site (>2 cm); specific histology - infiltrative and basosquamous; many lesions on face Mohs surgery is standard of care; lesions elsewhereon the body regular excision is generally considered adequate |
|
|
Term
| Mohs micrographic surgery (MMS) |
|
Definition
| Visible tumor is cut out w/ almost no margin, immediately frozen, sectioned and examined microscopically; margins of specimen checked for evidence of residual tumor. If tumor remains, then skin adjacent to site of positive margin is excised and checked again; process will continue until all margins are clear; results in better cure rates & better cosmetic results |
|
|
Term
| Electrodessication and curettage (ED&C) |
|
Definition
| Visible tumor is repeatedly (2-3 times) scraped out and electrodessicated until no discernible tumor remains; when done correctly, cure rate approaches that of regular excision, cosmetic results are generally poorer; generally used for smaller tumors |
|
|
Term
|
Definition
| Imiquimod (Aldera) cream has been proven effective (75-77% cure rate) in treatment of superficial and nodular basal cell carcionmas. The mechanism of action involves induction of immunologic response against the tumor |
|
|
Term
|
Definition
| Often used in pts with extensive BCC's; or in patients unable to tolerate surgery; may be very effective in certain areas; requires 3 treatments a week for many weeks; tumor may recur in more aggressive form |
|
|
Term
| Characteristics of squmaous cell carcinoma |
|
Definition
| Malignant neoplasm of keratinocytes, second most common form of skin cancer; locally destructive; can metastasize (>BCC) but less likely than oral SCC, a NONmelanoma skin cancer (NMSK); varibale appearance (firm red nodule; scaly growth that bleeds or devs a crust; non-healing sore) |
|
|
Term
| Location and etiology of squamous cell carcinoma |
|
Definition
| Nose, forehead, ears, lower lip, hands, and other sun-exposed areas of the body; curable if diagnosed & treated early; treatment of more advanced tumors depends on the stage of cancer; majority dev on sun-exposed skin --> occupational exposure; industrial workers; immunosuppressed individals, more common than BCC in dark skinned pts |
|
|
Term
| Clinical appearance of squamous cell carcinoma |
|
Definition
| Thickened keratotic papule or nodule w/ erythema, with or without tan overlying cutaneous horn; red persistent macule or patch (lip cancer); actinic cheilitis - a diffuse white plaque w/ loss of vermillino border; recurrent ulceration or focal thickening |
|
|
Term
| Keratoacanthoma squamous cell carcinoma |
|
Definition
| Very common on the face, rapidly growing ulcerating nodule; erythematous nodule, central hyperkeratotic crater |
|
|
Term
| Squamous cell carcinoma diagnosis |
|
Definition
| Actinic keratosis, verruca, BCC, seborrheic keratosis; definitive diagnosis: biopsy --> atypical proliferation keratinocytes (invasion and metastasis); treatment: prevention - excision, Mohs micrographic surgery, liquid nitrogen, 5-fluorourcal |
|
|
Term
|
Definition
| Slow-growing, low grade, SCC variant --> HPV related, locally aggressive; exophytic, verrucous or fungating tumor; usually in genital or oral regions but also found on sole of foot; often deeply invasive and difficult to eradicate; rarely metastasizes; XRT contraindicated |
|
|
Term
| Clinical variants of verrucous carcinoma |
|
Definition
| Mouth (oral florid papillomatosis of Ackerman), skin (carcinoma cutis of Gottron), foot/hand (epithelioma cuniculatum), anogenital (buschke-lowenstein tumor) |
|
|
Term
| Prognosis and clinical course for verrucous carcinoma |
|
Definition
| Metastasis of SCC is uncommon, but not as rare as metastasis of BCC; approx 5% of cutaneous SCC's metastasize. In case w/ BCC, tumors which are large and untreated for long periods of time are most likely to metastasize; SCC in situ has much better prognosis than invasive SCC; SCC of vermillion is intermediate in prognosis w/ oral SCC having worse prognosis |
|
|
Term
|
Definition
| Neoplasm of melanocytes or nevus cells; one of the most common cause of cancer deaths in 20-30 y/o; 4% of skin cancer; 80% of skin cancer deaths; >40,000/yr reported, lifetime risk ~1 in 55; family history or multiple atypical/dysplastic nevi - -> increased risk of melanoma |
|
|
Term
| Clinical features of melanoma - ABCDE |
|
Definition
| Asymmetric, border irregularity, color variability, diameter > 6 mm, elevation |
|
|
Term
| Risk factors associated w/ malignant melanoma |
|
Definition
| Intermittent sun exposure more predisposing to melanoma than chronic sun exposure; fair-skinned pts who sunburn easily; genetic factors (defective p16 tumor suppressor gene increases risk of melanoma); family history, congenital nevi; dysplastic nevi; immunosuppression |
|
|
Term
| Differential for melanoma |
|
Definition
| nevus, pigmented BCC, seborrheic keratosis; biopsy showing an atypical proliferation of melanocytes |
|
|
Term
|
Definition
| Surgical excision of thin melanomas is usually curative; if melanoma has spread treatment chemo or immunotherapy; cure rates are low <12% at 5 yrs; palliative treatment; regular self-skin exams and yearls exams by physician; excision, mohs micrographic surgery, vaccine, BRAF kinase inhibitor FDA approved 2011 |
|
|
Term
|
Definition
| FDA approved for treatment of inoperable or advanced metastatic melanoma; delays progression, shrinks tumor and extends life; targeted therapy (biologic) blocks function of defective V600E BRAF gene present in 40-60% of melanomas; oral tab 960 mg BID |
|
|
Term
|
Definition
| Most common prognostic indicator; mesured from top of granular layer or from base of any ulcer; deeper it goes the less chance of survival |
|
|
Term
|
Definition
| Less common skin cancer, vascular proliferation; skin, mucous membranes and visceral, HHV VIII, weakened immune system (HIV); violaceous patches --> become elevated |
|
|
Term
| Merkel cell carcinoma (neuroendocrine cancer of skin) |
|
Definition
| Rare - firm, painless, shiny papules or nodules; red, pink or blue; sun exposed areas (H&N, arms and legs); occurs mostly in older caucasians; grows rapidly, metastasizes early; even small tumors are capable of metastasizing treatment depends on stage of disease, and pt's age and overal condition |
|
|
