Epidermal Cancer ( Squamous, Basal, Pre-Melanoma ) – Flashcards
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Two main NONmelanoma skin cancers
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Basal cell carcinoma Squamous cell carcinoma
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Two main causative agents of NONmelanoma skin cancers
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UV exposure. HPV infection.
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Most common precursor to squamous cell carcinoma
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Solar keratoses
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Pre-cancerous squamous intraepithelial lesions are caused by what?
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HPV
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Solar/Actinic Keratosis Appearance
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Scaly, dry rough lesions that occur on areas of the skin frequently exposed to the sun.
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Cutaneous Horns generally represent what sort of legion?
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Hypertrophic solar/actinic keratosis
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What's often an underlying complication of Cutaneous Horns?
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Squamous cell carcinoma.
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Why must cutaneous horns always be removed?
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Risk of squamous cell carcinoma underneath.
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What toxin can cause formation of Keratoses?
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Arsenic.
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Unique appearance of arsenical keratoses
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Yellow punctate papules on palms and soles ( Non-unique appearance is the same as Actinic/Solar keratoses )
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"Raindrops in the dust" refers to what condition?
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Arsenical Keratoses ( Can cause hypopigmented depressed macules )
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Besides UV-induced keratoses, what other type of lesion may Squamous Cell Carcinoma arise from?
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HPV-Induced Squamous Epithelial Lesions
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Bowen Disease vs Erythroplasia
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Both forms of squamous cell carcinoma IN SITU. Bowen Disease: Pink/red sharply define scaly plaques on the skin. Erythroplasia: Non-scaly lesions on the genitals.
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What's Bowenoid Papulosis?
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Anogenital squamous cell in situ caused by HPV.
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Nodules forming or pain associated with squamous cell cancer in situ can indicate what?
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Progression to actual, invasive squamous cell cancer
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DDX For Squamous Cell Carcinoma In Situ
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Eczema or psoriasis due to the scaling/crusting.
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What's a bowen carcinoma?
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A nodular lesion that pops up within a precancerous lesion indicating invasive squamous cell carcinoma.
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HPV-Induced squamous cell carcinoma in situ most commonly arises in what areas?
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The genitals. Thumb / nail bed.
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Differentiated vs Undifferentiated Sqaumous Cell Carcinoma Appearance
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Differentiated: Hard with hyperkeratosis. Undifferentiated: Soft w/o hyperkeratosis
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Squamous cell carcinoma age of onset
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Generally around 50. But in those closer to the equator, 20/30.
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What previous treatments can leave those at higher risk for developing squamous cell carcinoma
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Methotrexate treatment for psoriasis. Exposure to ionizing radiation.
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How long must a keratotic lesion or eroded papule stick around until it's considered a carcinoma?
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Over a month
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Symptoms of squamous cell carcinoma
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TRICK QUESTION! No symptoms.
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Only type of squamous cell carcinoma that elicits symptoms
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Rapidly evolving ones may be tender. Ones that develop on the ear can also be painful.
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What disease creates ulcers that should always be biopsied to rule out skin cancer?
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Chronic statis dermatitis ( Venous / Arterial insufficiency )
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Squamous cell carcinoma of the lips almost always involve which lip?
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The bottom.
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Generally warning signs of squamous cell carcinoma.
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Heard nodules with keratinization.
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Defining characteristics of high-risk squamous cell carcinomas
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Over 2cm diameter Over 4mm deep Involvement of the bone, muscle, nerves. Location on the ear, lip, or genitals
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Which clark levels are indicative of high risk skin cancers?
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IV or V
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Which squamous cell carcinomas have the highest rate of metastasis?
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Ones arising in the bone, burns, or from radiation.
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What sort of treatment is associated with a 40x-50x greater risk of developing skin cancer?
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Organ transplants.
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Clark Classification for Squamous Cell Carcinoma
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I: Inside the epidermis only. II: Papillary dermis invaded partially III: Total span of papillary dermis invaded IV: Reticular dermis invaded. V: Subcutaneous fat invaded.
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What is a keratoa-canthoma?
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A variant of squamous cell carcinoma that rarely metasizes and frequently regresses on its own.
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Keratoa-canthoma appearance
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Rapidly growing domed nodule with a central keratotic plug. Grows over 2cm in a few weeks. When it dies off it leaves a crater filled with keratin, the rim surrounding it with a 'lip-like' manner.
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Possible causes of Keratoa-canthoma
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HPV and UV exposure. Chemical carcinogens like tar/pitch too.
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Most common skin cancer in humans
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Basal cell carcinoma
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Main cause of basal cell carcinoma
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UV exposure PTCH gene mutation ( No HPV this time )
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Characteristic behavior of basal cell carcinoma
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Aggressive and destructive, yet slow growing with no metastasis.
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Main sign of basal cell carcinoma
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Erosion and/or easy bleeding.
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Five clinical types of Basal Cell Carcinoma
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1) Nodular 2) Ulcerating 3) Sclerosing 4) Supersficial 5) Pigmented
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Nodular BCC appearance
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Papule/nodule that has a pearly sheen. Contains telangiectasia and may also have erosion present.
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Ulcerating BBC appearance
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A firm rolled border containing telangiectasia with a pearly sheen. Border surrounds the ulceration.
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"Rodent Ulcer" is associated with what condition?
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Ulcerating BBC appearance
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Sclerosing BCC Appearance
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Fingerlike strands of tumor extending into surrounding tissue. Ill-defined. Peppered with pigmentation. Fibrous.
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Superficiial Multicentric BCC appearance
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Thin SCALY plaques that easily bleed with a thin border. ( Scaly solar keratosis doesn't really bleed too easilily )
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Pigmented BCC appearance
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Dark colored, hard with a depressed center.
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Why are basal cell carcinomas that develop on the head so dangerous?
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Their propensity to invade deep into the large vessels or meninges.
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Why can't basal cell carcinomas go through metasasis?
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Dependence on growth factor from their stroma.
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Characteristics of skin gland cancers
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Rare, but more invasive/aggressive than other skin cancers.
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What is an atypical fibrosacroma?
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A singular asymptomatic papule, nodule, or plaque that resembles SCC or BCC. Caused by sun damage, rapidly growing - and potentially malignant, but not as dangerous as other forms of cancer.
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The two possible precursors of melanoma
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Dysplastic nevomelanocytic nevi Congenital nevomelanocytic nevi
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Dysplastic Melanocytic Nevis vs Common Moles
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A B C D E E
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What nearly guarantees an occurrence of dysplastic melanocytic nevi?
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Familial predisposition. ( Autosomal dominant gene. )
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Dysplastic Melanocytic Nevi first appear around what age?
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Just before puberty. And they keep coming and never leave. Normal mole stop appearing around middle age and eventually fade.
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Why are dysplastic melanocytic nevi referred to as "out of step"?
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Normal moles are generally in similar stages of development across your body. DNs on the other hand may be a mix of different stages across your body.
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"Fried eggs" and "Targeted" types refer to what condition?
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Dysplastic melanocytic nevus
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What does a dysplastic melanocytic nevi look like as it is converting to melanoma?
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Sharply contrasted colored papule or patch within the precursor lesion. ( Same in Congenital Nevomelancytic Nevus )
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Diameter of malignant melanoma
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Over 6mm.
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What do we cal examination of the skin with an magnifying device?
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Dermoscopy
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Histological appearance of dysplastic melanocytic nevus
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Single file "Lentiginous" pattern of melanocytes.
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When do we excise dysplastic melanocytic nevi?
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When they change size/color/shape. When they're on areas patients cannot keep a close eye on.
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How often do those with familial DN need to be examined compared to those with sporadic DN?
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Familial: Every 3 months. Sporadic: Every 6 months to a year.
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What are congenital nevomelanocytic nevi?
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Pigmented lesions present at birth.
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"Tardive" nevi are referring to what?
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Congenital nevomelanocytic that develop shortly after birth.
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Congenital nevomelaoncytic nevi appearance
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Dark plaques with dark hairs. Irregular borders with clear borders. Soft. Multiple types of surface textures. Usually solitary.
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Pathophysiology of a halo nevus and what they may indicate.
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Lymphocytes trying to kill the nevus. Can indicate vitiligo, or congential nevomelanocytic nevi.
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Characteristics of a giant congenital nevomelancytic nevus
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Huge swaths of darkened skin. Only case we'll see multiple, smaller CNMN throughout the body too.
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Typical diameter of nevomelancytic nevi
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Over 1.5cm
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Histological findings of congenital nvomelanocytic nevi
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Diffuse strands infiltrating the lower third of the dermis and subcutis. ( Giant CNMN may go deeper even into muscle/bone )
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Which type of congenital nefomelanocytic nevus poses a greater risk for melanoma?
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GIANT! Becomes melanoma in half of the people who have it within 3-5 years.
