Skin Cancer and Melanoma – Flashcards
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What are the 3 main types of skin cancers?
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BCC, SCC, Malignant melanoma
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T or F? Skin Cancer is the most common type of malignancy
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T
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About what % of ppl who live to age 65 will develop at least one type of skin ca? What is the ratio of BCC:SCC for men? what is it for women?
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50, 5:1, 10:1,
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T or F? Non-melanoma is increasing due to unreporting of the disease and death rates has been increasing
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F (melanoma are increasing, but death rates has remained steady)
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Non-melanoma outnumbers melanoma by what ratio? Which is more lethal/deadly?
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30:1, melanomas
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Tendencies for people to develop skin cancer are grouped into 4 main categories. What are they?
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Geographic location Skin Type Multiplicity Gender
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With regards to geographic location, those at or near the _____ are at an increased risk. In addition, _____ ____ also increases ones risk.
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equator, high elevation
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Someone who has fair complexion is ___ x greater to develop skin canccer.
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10 (these include Albinos, freckles, light colored eyes),
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What is a defect in which one's DNA cannot repair damage by UV light?
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xeroderma pigmentosum
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What is a —protective substance that gives color to skin and hair?
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melanin
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T or F? In AA BCC occurs much more than SCC.
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F (SCC>BCC)
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Which skin cancer type occurs more often in unexposed body parts?
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scc
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What is a category of the tendencies of skin cancer occurence which is characterized by Prior skin occurrence that increases risk of secondary?
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Multiplicity
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What may mulitiplicity be due to? Getting a second melanoma is _-_ x likely to happen? Getting another Non-melanoma is ___% chance in 1 year and ___% with in 5 years
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same exposure (diff area), immune system (weakness), 5-9 (especially under 40), 17, 50
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T or F? Women are 3 times more likely than men to get non-melanoma What is the exception?
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F (men more likely), legs (women have higher NM on legs)
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Name 3 possible reasons why men are more likely to get non-melanoma (3x) and melanoma (2x) than women?
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work outside more, less sunscreen use, poor skin care
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What is the major cause of skin cancer?
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UV exposure
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T or F? ACS estimates 90% of skin cancers could be prevented
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T
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Risk of _________increases 4-5 times after three or more blistering sun burns during _________10-20 years later "______People" develop melanoma more often than "_______people" who are more likely to get BCC or SCC
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melanomas, adolescence, indoor, outdoor
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Sunlight Contains 2 types of UV rays that are harmful to the skin. what are they?
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UVA (320 -400nm), UVB (290-320nm)
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Other risk factors for NON-MELANOMA include.... 1. exposure to _____ 2. ____ or occupational exposure 3. ___ ___ ___ syndrome: occurs during late teens, multiple BCCs of the skin Other risk factors for SCC include... 1. HPV 2. _____-suppression 3. ___ or chronic heat exposure 4. ___
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arsenic, xrt, basal cell nevus, immuno, burns, scars
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Other risk factors for MELANOMA include.... 1. that these develop form _____ which produce melanin 2. these cells can grow in ____ to form a mole/nevus 3. Larger ____ ___ ___(birth) have a 6-8% risk of developing into melanoma 4. _____of large moles 5. # of moles on a person 6. ____history: Certain types can have a 100% risk of developing melanoma
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melanocytes, clusters, congenital melanocytic nevi, removal, family
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Skin is the largest organ on the body about ___-___ sq. ft. Functions include what (4)? 1. Regulate body ____ 2. Acts as a _______barrier 3. Works in the production of vitamin ____ 4. Provides receptors for external ____
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17-20, temp, protective, D, stimuli
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The skin is an epithelial membrane A connective tissue covered by a layer of epithelial tissue -The connective tissue or the deep layer is the _____ -Epithelial (outer) layer that is extremely thin is the ______ Both are held together by an intermediate layer called the ____ ____. How many layers ? (depends on location)
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dermis, epdermis, basement membrane, 4-5,
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At about what thickness range is the epidermal layer? (hint: ___ to ___mm thick)
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0.1, 1
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what layer of the skin does erythema and desquamation occur at?
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epidermis
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The dermis is 1-2 mm thick and contains what 6 things?
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blood, ln vessels, nerves, nerve endings, sweat glands, hair follicles
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What is Skin pigment that Serves to protect the skin and produced by melanocytes?
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Melanin
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What is absorbs melanin, is made of stratified epithelial cells, and makes up 90% of epidermal cells. It also provides a barrier for the skin but can be damaged by UV rays?
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keratinocytes
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After melanin is absorbed by keratinocytes, the melanin then lies between ____surface and the ___ nucleus. This acts as an umbrella!! Melanoma are classifed by the cells they arise from which are called what?
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skin, cell, melanocytes
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T or F? the more melanin a person has the darker the skin
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T
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Arises from mealanocytes located in the stratum basale Legs of women Trunk and face of men Other sites do occur Eyelids Oral cavity mucosa genitalia ***what skin cancer is this?
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malignant melanoma
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Slow growing Does not tend to met Most prevalent cancer If left untreated can cause extensive damage Arises from stem cells in of stratum basale ****what skin cancer is this?
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BCC
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Fast growing carcinomas Higher likelihood of mets Arise from the more mature keratinocytes of the upper layer of the epidermis Can arise anywhere but is most common in sun exposed areas: arms, face, head, neck and hands ****what skin cancer is this?
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SCC
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What Disease of the t-lymphocytes Resembles eczema and Mycosis fungoides?
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Cutaneous t-cell lymphoma
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What skin cancer is characterized by ... Slow growing Purple lesions Thought to arise from vasculature Common in AIDS pts Single lesion=surgery Multiple lesions=XRT
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kaposi's sarcoma
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Which skin disease can be treated with TSEB—total skin electron beam?
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mycosis fungoides
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which skin cancer is characterized as...... Rare High recurrence after surgery Frequently involves regional nodes Distant mets Similar to small cell carcinomas Surgery, chemo, XRT
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merkel cell carcinoma
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These are precursor to which skin cancer? Lesions that if not treated become cancerous Tend to occur more in SCC Actinic keratoses Arsenical keratoses Bowen's disease Keratocanthoma
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non-melanoma
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These are precursor to which skin cancer? Changes in pre-existing nevus (70%) ABCDE rules
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melanomas
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Identify what each letter of the ABCDE rule stands for regarding the clinical presentation of melanomas?
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asymmetry, border, color, diameter, evolution
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Most melanomas have a diameter of greater than ___ cm
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6
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*changes in the following are describing the _____ of melanoma pre-cursors: Color Surface Texture Change in surrounding skin Sensation Change in normal skin
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Evolution
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T or F? skin cancer is usually caught early due to visibility and education
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T
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What 2 things determines what type of biopsy is done? Large lesions uses what kind of biopsy? For suspicious SCC or melanomas what biopsy is used to determine the depth of extension? ==>if SCC or melanoma is suspected a workup is done for what?
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size, location, incisional, excisional, mets
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what does ELM stand for?
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epiluminescence microscopy, (dermatoscopy)
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These are D & D for which type of diseases? Lymphadenopathy Motor skills Chest X-Ray LFTs Alkaline phosphate levels; bone scan CBC to detect anemia as a result of GI bleed CT and MRI only done when signs and symptoms point to metastatic disease
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mets
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After biopsy, pathologist provides 3 detailed information of specimen, what are they? Additional info may include what? (4)
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Dx, thickness (of tumor), status of margins, subtype, penetration, mitotic, growth pattern (radial, lateral)
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Melanomas has a classification of level of invasion called what? Identify the level according to the description below? _invasion into the reticular dermis _invasion through the basement membrane to the papillary dermis _confinement to the epidermis _invasion into the subcutaneous fat _presence of tumor cells at the papillary-reticular junction of the dermis
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Clark levels (of disease invasion), 4, 2, 1, 5, 3
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What system characterizes melanomas based on tumor thickness (thought to be more accurate)? Identify the level according to the description below? _melanoma in situ, limited to epidermis _1.51mm-4mm _.76mm-1.5mm _>4mm _less than .75mm
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Brelow's, 1, 4, 3, 5, 2
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What is the staging system used for melanomas?
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TNM
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What are the 2 most important prognostic indicators for melanomas?
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tumor thickness, ulceration (others:Age, Location of tumor, Depth, Gender; women 22% survival advantage)
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T or F?The epidermis has no vasculature or lymphatics
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T
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What is the only route of spread for melanomas?
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direct extension
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T or F? Non-melanomas can spread to almost any organ in the body?
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F (melanomas)
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Order the following based on the order melanomas typically spread? a. liver, bone, brain b. regional lymphatics c. lung d. distant skin and subcutaneous tissues e. Direct extension into subcutaneous tissues
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e, b, d, c, a
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What is the TOC for melanomas?
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Surgery (excision)
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Specify what txt is used for melanomas if...... 1. if mets exist or post op for microscopic disease (name 3) 2. palliative disease 3. + LNs
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chemo, immunotherapy, biochemotherapy, xrt, complete resection
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T or F? melanomas are typically radiosensitive
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F (radioresistant)
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What type of txt for melanoma is described below? Tourniquet isolates blood Drained into a machine, oxygenated and heated to above 105.8, melanoma cells cannot survive Large dose of chemo then given to the limb Treated blood returned to body Chemo and XRT used primarily for palliation
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isolated limb perfusion
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NON-MELANOMAS: BCCs do not usually metastasize but can cause damage by _____ _____ if left untreated Usually follow the path of _____resistance Can destroy ___and ____if untreated Mets 1 in 4,000 cases Usually 10 years after treatment
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DIRECT EXTENSION, LEAST, BONE, CARTILAGE
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SCC: Can take on a variety of ______ Can be scaly, ulcerated or nodular and may contain characteristics of ____ Higher propensity to _____ Prognostic Indicators Include: _______________ Etiology; sun exposed pt vs immunosuppressed pt ____and invasion 3-10% metastasis rate High risk patients 30%
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appearances, BCC, MET, differentiation, size
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____and ____are not reportable diseases therefore survival rates for specific stages are _______ Early ___________Lesions are considered to be 100% curable
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BCC, SCC, unknown, NON-MELANOMAS
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what is the txt margins for small lesion non-melanomas? what about larger lesions? Large invasive tumors may require what 2 options?
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3-5mm, 1cm, skin grafts or prosthetics
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Name 3 diff types of surgery options for non-melanomas?
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Moh's, cryosurgery, laser
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Name an advantage of using xrt for non-melanoms? Name 3 disadvantages for NM?
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(normal) tissue sparing, costly, inconvenient (for pt), late changes
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For NM xrt we typically use electrons or kilovoltage. Photons are rare but may be used in certain _____ txts to penetrate deeper lesions. What 2 possible brachytherapy sources can be used?
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scalp, Ir-192, Cs-137
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****Regardless of the radiation used transmission using cerrobend should not be more than what %? XRT txt fields should cover the entire lesion plus ___cm margin ............___cm may be used for small superficial lesions.
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5, 2, 1
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T or F? Shield should be coated with a high atomic number material in order to prevent scatter to the eyelid
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F (low)
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What is the dose limit for eye lens? (most radiosensitive) what about inner ear?
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2 Gy, 10 Gy,
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According to the NCCN Guidelines, what are the margins and txt doses for BCC? /=2cm: ___-__cm; __-__Gy Post op?
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1-1.5, 35-64, 1.5-2, 55-66, 50-60
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According to the NCCN Guidelines, what are the txt doses for SCC? 2cm : __-__Gy >/=2cm: __-__Gy Post op?
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35-64, 50-66, 50-60
