Skin Cancer (non-melanomas) – Flashcards
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What are the three main types of skin cancer?
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1. Basal Cell Carcinoma 2. Squamous Cell Carcinoma 3. Melanoma
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True or False: Skin cancer is the most common type of malignancy.
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true
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50% of people will develop some type of skin cancer if they live to age ___.
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65
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90% of skin cancers could be prevented, how?
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if exposure to sun's rays were eliminated
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What is the male:female ratio for skin cancers?
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1:5
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Of the three main types of skin cancer, which one is rarely metastatic? Why?
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Basal Cell Carcinoma, because it is closer to the surface of the skin. <1% typically
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True or false: Skin is considered a small organ, measuring only 5-12 square feet and weighing only about 2 lbs.
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False: The skin is the largest organ, measuring about 17-20 square feet and 10-12 pounds.
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For the average person, what percentage does the skin weigh compared to their body weight?
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~15% of their body weight
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Name the 5 functions of the skin.
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1. protection 2. temperature 3. waste removal 4. sensory 5. vitamin D production
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How does the skin remove waste?!
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through the sweat glands, by sweating
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What are the three general layers of the skin?
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1. Hypodermis 2. Dermis 3. Epidermis (outermost layer)
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Hypodermis is what type of tissue?
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Subcutaneous, type of connective tissue
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What does the hypodermis do? & Name the 2 main functions.
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Act as a foundation 1. Padding 2. Shape (the body)
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What makes up the hypodermis? (composition)
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Adipose Tissue (aka fat)
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Name the two layers of the Dermis.
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1. Reticular layer 2. Papillary layer
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What lies within the papillary layer?
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finger prints
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What are the four things the dermis is composed of?
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1. Blood 2. Lymphatic Vessels 3. Sweat glands 4. Hair follicles
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What type of cell is left out from the celluar composition list for the Epidermis: - Keratinocytes - Langerhans cells - ????????????
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Melanocytes
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True or False: The Epidermis is avascular.
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True
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What are the two things that can happen to the Epidermis?
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1. Keratinization 2. Desquamation (where it starts)
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True or False: The Epidermis is the layer of skin that flakes off in everyday activity.
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true
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Name the 5 "Stratum" layers of the Epidermis.
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1. Stratum Basale 2. Stratum Spinosum 3. Stratum Granulosum 4. Stratum Lucidum 5. Stratum Corneum
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Stratum Basale: - Contains what? - Produces what? - Acts as a....? - Constantly renewing....?
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- Contains Stems Cells - Produces Keratinocytes - Acts as a layer of protection - Constantly Renewing dermis cells
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True or False: Stratum Spinosum is where keratinization ends.
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False: Stratum Spinosum is where keratinization begins.
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Stratum Granulosum: - Produces what?
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Produces precursor cells & proteins (thought she said something about- water soluble lipis,too, but I am not sure)
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Where is the Stratum Lucidum found?
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Palms of hands & Soles of feet
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True or False: The Stratum Lucidum is used as protection because it is a thicker layer. This inturn increases friction.
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False: The Stratum Lucidum is used as protection because it is a thicker layer, but it REDUCES friction.
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What layer is the Stratum Corneum? Where is it? What does it do? What type of cancer is typically found in this layer?
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- outermost layer - skin surface - dead flakey skin cells that fall off - BCC
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Name the 5 accessory structures.
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1. Hair (warmth & protection) 2. Muscles 3. Sensory Receptors 4. Glands (oil & sweat) elimates toxins 5. Nails
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What is the muscle layer that surrounds the hair follicle and is responsible for goose bumps when you're cold?
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Arrector Pili
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What are the two Sensory Receptors?
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1. Messiner's 2. Pacinian
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What is the Messiner's Sensory Receptor responsible for?
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More superficial, light touch sensation (barely touching)
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What is the Pacinian Sensory Receptor responsible for?
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Deeper, detects deep pressure (pinching)
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What are the 5 effects of aging that have to do with the skin?
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1. Reduced Blood Flow 2. Thinner Skin (bruises easier, skin tears) 3. Loosened Structure (loss of collagen, flabby) 4. Decreased Activity of the glands (sweat, oil glands) 5. Decrease in Melanin (cannot tan as easily)
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What is the melanin in your skin responsible for?
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the pigment (color)
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Tanning is the body's response to _____.
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damage
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What are the 4 main functions of the skin?
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1. Protection 2. Regulates body temperature 3. Synthesizes important chemicals and hormones 4. Sophisticated Sense Organ
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Basal Cell Carcinoma arises in what type of cells?
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Basal Cells
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True or False: Basal Cell Carcinoma is the most common type of skin cancer.
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True: Accounts for ~75% of all non-melanoma cancers.
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Basal Cell Carcinomas occur in what types of skin?
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Occurs predominantly on the skin exposed to UV Radiation
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Explain how basal cell carcinomas grow.
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Basal Cell Carcinomas typically have a slow growth rate, they can remain unchanged for years. If left untreated, they can become fatal. BCC's grow radially (grow outward), but they must have a good blood supply to do this--the further away they grow, they loose blood supply and then it can become necrotic(black & dead).
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True or False: Basal Cell Carcinomas rarely develop in darker skinned people. But if does happen to develop it is normally found on the hands & feet (generally H&N area).
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True
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Basal Cell Carcinomas are locally invasive and are capable of causing _______ ________ destruction.
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Extensive Tissue
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If mets do occur what region is common for Basal Cell Carcinomas.
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Head & Neck region
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Why would Basal Cell Carcinomas mets to the H&N region?
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very vascular areas with lots of lymphatics
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What two parts of the body would BCCs spread to via the blood?
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1. Lungs 2. Long bones
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What area would BCCs spread to via lymphatics?
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regional lymph nodes
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What are the two reasons why BCC is becoming a disease of the younger generation?
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Fashion & Lifestyle (clothing doesn't cover as much-tanning beds, etc)
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What are the six etiologies associated with BCC?
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1. Sun exposure 2. Geographic location 3. Ionizing Radiation (long latency period) 4. Chemical Factors 5. Immuno-Suppressed Patients (HIV) 6. Basal Cell Nevi Syndrome
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What etiology is one of the main causes of BCC?
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Sun Exposure --Sun or UV
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True or False: Sun exposure associated with BCC etiology is considered cumulative.
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True
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What are the chemicals associated with the etiology of BCC?
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- Arsenic - Topically applied nitrogen mustard
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A patient has Basal Cell Nevi Syndrome--what does that consist of?
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lots of moles
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What are all of the possibilities for the appearance of a BCC?
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May be... - Flesh colored, pink, or pearly gray - Presence of Melanin (darker colored) - Small red scaly growth (like psoriasis) - Ulcerated lesion - Solitary or Multiple lesions
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If you have BCC and it is an ulcerated lesion, this most often will appear in what 4 areas of the body?
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face hands ears arms
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What is the 2nd most common skin cancer?
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Squamous Cell Carcinoma
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Squamous Cell Carcinoma arises in what cells? & What layer of skin?
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Keratinizing Cells of Epidermis
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True or False: Squamous Cell Carcinoma is a disease of the younger generation, usually between the ages of 20-40.
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False: Squamous Cell Carcinoma is a disease of the OLDER generation, usually b/w 68-70 years or older. (few before 40)
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True or False: Incidence increases with age when looking at Squamous Cell Carcinoma.
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True
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When Squamous Cell Carcinoma occurs on the mucosal surfaces and is left untreated, what does it have the potential to do?
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Spread to Regional Nodes & Distant Sites
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What are the 4 etiologies associated with Squamous Cell Carcinoma?
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1. Total Accumulated Dose of Sun Exposure 2. Exposure 3. Immunosuppressed Patients 4. Scars or Chronic Inflammatory Conditions
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If you have excessive exposure to the sun, you increase your risk of having Squamous Cell Carcinoma by what ?
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3-5.5 times
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What are three examples of exposure when looking at etiology of Squamous Cell Carcinoma?
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1. Ionizing Radiation 2. Arsenic 3. Hydrocarbons from coal tar exposure (petroleum)
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What are the two professions that typically get Squamous Cell Carcinoma?
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Radiologists Dentists
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What types of immunosuppressed patients experience higher risk for Squamous Cell Carcinoma?
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- HIV - Lymphoma & Leukemia Patients
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Why are Lymphoma & Leukemia patients at a higher risk for Squamous Cell Carcinoma?
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because they recieve TBI
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What type of skin tone increases your risk for skin cancers?
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fair skin with poor tanning ability
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What would you look for when trying to detect Squamous Cell Carcinoma?
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Scaly raised lesions or non-healing scab
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Where are the common areas of occurence for Squamous Cell Carcinoma?
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- nose - lip - cheek - temple - nail bed - trunk - extremities - genitals
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To prevent Squamous Cell Carcinoma, what are the main lifestyle changes or practices you should do...
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- Minimize exposure to the sun - Use sunscreens (> or =15 SPF) - Wear Protective Clothing - Avoid Tanning Booths!
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True or False: Early detection and treatment will not help to cure your skin cancer.
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False: Be aware of skin changes, early detection and treatment is essential for a cure.
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Non-Melanoma Staging: Tx-?
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cannot be assessed
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Non-Melanoma Staging: T0-?
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No evidence
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Non-Melanoma Staging: Tis -?
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Insitu (pre-cancerous, very early)
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Non-Melanoma Staging: T1-?
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Less than or equal to 2cm in dimension
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Non-Melanoma Staging: T2-?
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Greater than 2cm but less than 5cm
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Non-Melanoma Staging: T3-?
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Greater than 5cm
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Non-Melanoma Staging: T4-?
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Extension to bone, muscle, cartilage
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What are the 8 ways you can treat BCC & SCC (non-melanomas)?
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1. Curettage & Electrodesiccation 2. Mohs' Micrographic Surgery 3. Excision 4. Cryosurgery 5. Lasers 6. Chemotherapy 7. Photodynamic Therapy 8. Radiation Therapy
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What treatment is the most common method of treatment for the non-melanomas?
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Curettage & Electrodesication
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What are the two things your tumor has to be inorder to recieve curettage & electrodesication for your treatment?
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1. 1cm or smaller 2. well defined borders
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Explain how electrodesication works.
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You do not have to do this with curettage, but it is an option. After curettage, they can send electric waves around the site and it will kill any cells that might not have been removed during the curettage.
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True False: If you do not have the electrodesication done after curettage, it will decrease the scarring.
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True
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What area is missing: Curettage & Electrodesication is not recommended for lesions on the: - Eyelid - Nose - Temple - Scalp - Lips - ??????
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Ears
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True or False: Mohs' Microscopic Surgery obtains the lowest cure rate and was developed by Dr. Frederick Mohs' in 1936.
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False: Mohs' Microscopic Surgery obtains the HIGHEST cure rate and was developed by Dr. Frederick Mohs' in 1936.
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What happens during a Mohs' Microscopic Surgery?
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The tumor is removed one layer at a time and is typically examined by a pathologist right on the spot. Once they see that the layer contains no cancer cells, they will stop the surgery.
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What is the Mohs' Microscopic Surgery used for? (4)
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1. Tissue Preservation 2. Areas of high risk for recurrence 3. Where the extent of the disease is unkown 4. Aggressive tumor histology
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Excision is only good for providing what?
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specimen for clinical examination
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Compare the cure rates of Excision to Mohs' Microscopic Surgery.
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Cure rates for Excision are inferior to Mohs' Microscopic Surgery.
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What areas would be preferred for Excision and why?
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1. Scalp 2. Forehead 3. Distal Extremities -Because there is not as much tissue in these areas (you can pretty much feel your bone)
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Explain how Cryosurgery works.
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It is the use of liquid nitrogen or carbon dioxide at very low temperatures (-50C) on the lesion.
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What are the complications of Cryosurgery?
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Scarring, Swelling, Blistering
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How do Lasers work in the treatment of non-melanomas?
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Beam of intense light destorys tissue.
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True or False: Lasers are also used to treat early BCC and insitu SCC.
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True
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What are the three advantages of laser treatment?
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1. Usually blood free surgery 2. Reduced post operative pain 3. Faster healing than conventional surgery
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What is Chemotherapy used for?
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locally aggressive or metastatic disease
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For cases of systemic disease involving the bone, chemotherapy is used how...
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in conjunction with RT & for used for several weeks
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What are the two common Chemotherapy topical agents used for non-melanomas?
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1. Nitrogen Mustard (really bad for skin) 2. 5 FU (MOST COMMON)
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What is Photodynamic Therapy for treatment of non-melanomas?
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Use of visible light and photosensitizer
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Explain the process of Photodynamic Therapy.
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An agent called HPD (hematopreforin?) is injected into the body, absorbed, and selectively retained in the cancer cells. Light from a laser is directed on the tumor area and this causes a reaction within the cells containing the HPD and destroys the cells.
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What is the main disadvantage of Photodynamic Therapy?
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the patient must be protected from all bright light while the HPD levels remain in the body. (~3-6 weeks following Tx)
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True or False: Radiation Therapy is not effective in the treatment of non-melanoma skin cancers.
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False- Radiation therapy is VERY effective in the treatment of non-melanoma skin cancers.
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When is Radiation Therapy used for non-melanoma skin cancers?
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- BCC & SCC where cosmetic results are important - In areas of extensive disease and affected nodes
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True or False: Electrons and superficial treatment are excellent options.
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True
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MV treatment is used when?
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MV treatment rarely used unless tumors are infiltrating into other tissues or in areas of reccurence.
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What are the five main categories used to compare advantages and disadvantages of the Radiation Therapy treatments (Kv, Mv, e-, or orthovoltage)?
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1. Field Sizes 2. Depth of maximum dose d-max 3. Deep tissue dose 4. Differential bone absorption 5. Cosmesis and control rates
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For all five categories used to compare the advantages and disadvantages what is the best treatment method used for Radiation Therapy? - Kv - Mv - e- - Orthovoltage
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Kv is best- it has more pentration
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Why are electrons not the best treatment method used for Radiation Therapy?
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electrons have a very fast fall off, spare skin better
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What are the three types of Brachytherapy used for non-melanoma skin cancers?
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- Temporary Implants - Superficial Treatment - Even permanent implants
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True or False: Brachytherapy has no major advantages over EBT (electron beam therapy).
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True
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What are the four disadvantages of Brachytherapy?
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- Cost - Trauma - Length of Hospital Stay - Risks of Anesthesia
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What type of permanent implants in Brachytherapy have shown good curative and cosmetic results?
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AU 198
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What are the three main doses used for non-melanoma skin cancers?
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- 45-50 Gy (250 per fraction) - 55-60 Gy (200 per fraction) - 6 or 9 e- to Dmax (may bolus to bring doses up to skin level)
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When simulating skin lesions for RT treatment, what is the process? What special equipment is needed?
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- Applicator Cone - Special Equipment-->lead shields, bolus
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What are all of the complications from Radiation Therapy for non-melanoma skin cancers?
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- Erythema - Pigmentation - Dry Desquamation - Moist Desquamation - Temporary Hair Loss (area treated) - Decreased function of sweat or sebaceous glands - Late Reactions
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Skin diseases of the sweat and sebaceous glands are what histology and how do they grow?
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- Adenocarcinomas - slow growing
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For the skin disease of the sweat and sebaceous glands, what is the treatment of choice? Why not RT?
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- Treatment of choice: Surgical Removal - Tumors are most often radioresistant
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True or False: Sweat and sebaceous gland tumors can metastasize to nodes/distant sites.
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True
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Explain what Mycosis Fungoides is?
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Associated with T-cell Lymphocytes and it is a rare chronic lymphatic skin disease
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True or False: Mycosis Fungoides may be called cutaneous B-cell Lymphoma and is associated with Sezary's syndrome.
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False: May be called cutaneous T-cell Lymphoma and it is associated with Sezary's Syndrome.
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What is Sezary's Syndrome?
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Mycosis fungoides and the Sezary Syndrome are diseases in which lymphocytes become malignant and affect the skin.
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Mycosis Fungoides is often followed by _____ ______ in the epidermis.
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Mycosis Fungoides is often followed by MICRO ABSCESSESS in the epidermis.
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Explain Kaposi's Sarcoma.
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Kaposi's Sarcoma is a disease of the Mediterranean regions. They are nodular lesions often found on the extremities and are usually a slow growing disease.
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True or False: Kaposi's Sarcoma has a more aggressive form related to HIV patients that carries a worse prognosis.
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True
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What are the two modalities used to treat Kaposi's Sarcoma? and Why these two?
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Radiation Therapy and Surgery-methods are used to improve quality of life
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Radiation Therapy is used more for what type of lesions?
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RT is used for Multiple Lesions
