skin cancer notes – Flashcards
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largest organ in body
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skin
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about 1mm thick when born then 2mm by adult
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skin
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as we age, skin becomes
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thinner and more susceptible to the sun
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3 main functions of skin
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-protective -sensory -regulatory
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most at risk for skin cancer if:
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-skin type 1 or 2 -one or more blistering sunburns as a child -alot of moles -freckles -red/blonde hair -light-colored eyes -fair skin -family history
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almost all skin cancers are
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preventable, and curable if treated early
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most dangerous form of skin cancer is
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melanoma. if found early, curable, but can kill if it is detected late. (can develop in soles, anal areas)
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amount of sun exposure is cumulative, lag time of
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10-30 years for clinical appearance of skin cancer to occur, early prevention is extremely important.
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epidemiology -cancer of skin is the most common form of
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cancer, basal cell carcinoma -most common type of canter 800,000- 900,000, squamous cell carcinoma- less common 200,000-300,000 per year
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start form the pigment-making cells of the skin (melanocytes)
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melanomas
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most melanocytes reside in the
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basal layer of the epidermis
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melanocytes can also from growths that are not cancer called
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moles
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keratinocyte carcinomas -found most often in
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normal skin, start in lining layer of cells such as skin or lining of digestive system.
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keratinocyte carcinomas -two types are most common
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basal cell carcinoma and squamous cell carcinoma
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basal cell carcinoma -begins in the
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lowest layer of the epidermis (stratum basal layer)
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8 out of 10 skin cancers are
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basal cell carcinomas
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basal cell carcinomas -begin on areas
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exposed to the sun, such as the head and neck
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basal cell carcinoma was found mostly in
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middle aged or older people, but now younger too
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grow SLOWLY, rarely spread to distant parts of body (metastasize), if not treated, can grow into nearby areas and spread into bone
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basal cell carcinoma
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after treatment, can recur in same place, or in new places
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basal cell carcinomas
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half of the people who have basal cell cancer
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will get a new skin cancer within 5 yrs !!!!
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~squamous cell carcinoma ~begins in
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upper part of epidermis
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~squamous cell carcinoma ~accounts for 2 out of 10 skin cancers
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~appears on parts of body exposed to sun, likely to spread!! to fatty tissues just beneath skin
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~squamous cell carcinoma ~more likely to spread to
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lymph nodes or distant parts of the body (compared with basal cell) but not common
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most lethal form of skin cancer
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^^MELANOMA
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arises from melanocytes located in the stratum basale layer
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^^melanoma
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most common site -legs of women -trunk and face on men
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^^melanoma
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melanoma -epidemiology
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accounts for less than 5% of skin cancer cases -accounts for most skin cancer deaths
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epidemiology -lifetime risk of getting it is 1 in 50 for whites, 1 in 1,000 for blacks, and 1 in 200 for hispanics
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melanoma
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who is most likely to get melanoma?
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-family history -weak immune system -age -UV exposure -moles (increased #) -fair skin (red hair highest risk) -gender (men)
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melanoma -methods of dianosis
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>clinical appearance >biopsy
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melanoma -biposy
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>punch >excisional >fine needle aspiration >incisional
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melanoma -what is punch biopsy
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1. skin is ANESTHETIZED 2. target is epidermis/dermis layers with upper portion of fat 3. skin is stretched and stabilized 4. punch is inserted with a spin 5. tissue is lifted out and CUT OFF
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melanoma -what is excisional biopsy?
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1. puncture is made at one end 2. partial/full thickness cut is made 3. specimen can be removed by cutting beneath the DERMIS 4. specimen removed with scissors 5. edges of wound pulled together and sutured
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basal cell carcinoma -slow growing
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-asymptomatic -sun exposed areas -most COMMON in US
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basal cell carcinoma -rarely metastatic
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-if left untreated.... can SPREAD and cause considerable damage
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verrucous carcinoma -most commonly found on
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-soles of men
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verrucous carcinoma -slow growing
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cauliflower-like mass, -locally aggressive, may grow large
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verrucous carcinoma -50% appear on the
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ball of the foot, but can occur on face, butt, oral cavity, trunk, extremities
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verrucous carcinoma -soft, "squashy" and
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foul-smelling, may invade soft tissue and bone -rare to metastasize
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leukoplakia -white plaques or pathces on the mucous membranes of the
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oral cavity, including the tongue. -primarily caused by TOBACCO
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leukoplakia -may become cancerous -most common in
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elderly persons
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merkel cell carcinoma -high grade malignant tumor -high rate of local recurrence
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-quick metastasis -most common in 60-80 year age group -common in caucasians -equally effects males/females
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merkel cell carcinoma -rare -arise from merke's cell
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tactical cells -high recurrence -involves regional nodes -firm, non tender, pink-red nodular lesions
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merkel cell carcinoma -treated with chemo/rad/surgery
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-usually appears as flesh-colored or bluish-red nodule on your skin, often on your face***!!!, head or neck
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merkel cell carcinoma -clinical features
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;mostly seen on the head and neck ;treatment ---wide excision ---mohs surgery ---node dissection ---XRT of 50-60 Gy ---chemo is questionable
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merkel cell carcinoma ---wide excision
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cancer is cut from the skin along with some of the healthy tissue around it.
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merkel cell carcinoma ---mohs surgery
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remove skin in several steps 1. thin layer of cancerous tissue is removed 2. second thin layer is removed and viewed under microscope to check for cancer cells, more layers are removed one at a time until the tissue viewed under the microscope shows no remaining cancer. 3. used to remove as little normal tissue as possible/ often used on face
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sentinel lymph node biopsy 1. the removal of the sentinel
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lymph node (the first lymph node the cancer is likely to spread to from tumor) during surgery
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sentinel lymph node biopsy 2. radioactive substance/ blue dye is injected near the tumor
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the substance or dye flows through the lymph ducts to the lymph nodes , the first lymph node to receive the substance or dye is removed for biopsy
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sentinel lymph node biopsy 3. pathologist views the tissue
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under a microscope to look for cancer cells, if cancer cells are not found, it may not be necessary to remove more lymph nodes.
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merkel cell prognosis
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-local recurrence is 43% in 4 months -lymph node metastasis is present in 41% of cases
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merkel cell prognosis
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-86% of recurrence develop nodal metastasis -most patients will develop CNS metastasis and die
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merkel cell prognosis
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-overall 5-yr survival rates -88% 1 yr -72% 2 yrs -55% 3 yrs -30% 5 yrs
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treatment methods for skin cancer
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-surgery (mohs for nonmelanoma) -chemo -rad (bcc, scq) -cryosurgery -laser surgery -photodynamics
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what is cryosurgery
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freezing the liquid nitrogen, 97% cure rate, deep tumors may be shaved or curettage, contraindicated for lesions in hair baring areas
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what is electrosurgery?
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curettage and electrodesiccation, result equal to excision, well circumscribed, superficial, nodular lesions.
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radiation therapy -excellent therapeutic and cosmetic resutls -therapy of choice for
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-eye lid, pinna of ear, nasolabial fold, alar nasi, lip.
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radiation therapy -electrons 3-20 mev depending on depth -surface dose atleast 90-95%
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-field size 2cm margin surrounding tumor is general rule!! -for small BCC's, 1 cm margin acceptable
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chemotherapy -topical applications
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5-FU cream bid, recurrence rate is considerably higher than other treatment methods - interferon, experimental
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kaposi's sarcoma -cutaneous malignancy -formation of new
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blood vessels -violet red to brown nodules and plaques
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kaposi's sarcoma -tumor slow growing -arise from
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vascular tissue seen in: immunosuppressed, transplants, AIDS
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benign skin lesions
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-keloids -keratoacanthoma -actinic keratosis -acanthosis nigricans -seborrheic keratoacanthoma -telangiectasia
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what is kerato-acan-thoma?
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common rapidly growing benign tumor, solitary rapidly growing firm, dome shaped, flesh-colored to slightly pink lesion with a plug of keratin in the central crater.
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what is actinic keratosis?
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solar keratosis or senile keratosis -precancerous lesion -result of prolonged/repeated solar exposure -treatment is cryotherapy *
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what is acan-thosis nigricans?
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symmetrically distributed thickening of the skin with brown pigmentation -hyperkeratosis, and papillomatosis -puberty or early childhood
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what is seborrheic kerato-acan-thoma?
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common benign tumor -pigmented -mainly occurs on trunk and face
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what is telang-giec-tasia?
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-chronic radio dermatitis -received xrt at 8 yr of age for fungal skin infection "ringworm" -alopecia, crusted hyperkeratotic plaques -prominent telangiectasia
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melanoma -5 classifications
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-superficial spreading melanomas SSM** most common -nodular melanomas NM -lentigo maligna melanomas LMM -acral lentiginous melanomas ALM -mucosal lentiginous melanoma MLM
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Superficial spreading melanomas SSM *most common
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"radical spreading melanomas" -arise on anatomical site -horizontal*** growth -with time grows vertically
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Nodular melanomas NM -occur at any site
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-2:1 female to male ratio -raised -vary in color -lethal -invade early and frequently ulcerate
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lentigo maligna melanomas LMM -Hutchinson's freckles
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-chronic sun exposed areas -older WHITE FEMALES -benign radical growth phase -increased vertical growth phase -vertical growth is minimal -lacks RED HUES *
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acral lentiginous melanomas ALM -found on
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palms, soles, nail beds, mucous membranes -most common in blacks and oritental population
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ALM
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-tan or brown flat stain on palms or soles -brown to black discoloration under nails -often mistaken for a fungal infection
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mucosal lentiginous melanoma MLM
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-similar in appearance to ALM, occurs in mucosal sites: oral, esophagus, anus, vagina, conjunctiva -Clarks staging
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staging and grading -melanoma
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stage I 95% stage II 78% stage III 51% stage IV 13%
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metastatic melanoma prognostic factors -tumor location -extremities/feet---better -head and neck---poor -trunk--- worse
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-age--- the younger the better -non ulcerating--- better than ulcerating -sentinel lymph node biopsy -thicker tumors- have poorer prognosis
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facts -melanomas tend to
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spread -direct extension of the primary -regional lymphatics -distant skin and subcutaneous tissue -lung -liver, bone, brain
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radiation -acute complications
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edema, erythema @ 1000 cGy, pigmentation, dry/moist desquamation, epilation/alopeica, decreased sweat/oil production
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radiation -late complications
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brain atrophy, permanent damage, fibrosis, telan-giec-tasia, hypo/hyper pigmentation, sun sensitivity, necrosis.
