Derm - Skin Cancer

Front 1

What are some of the environmental factors for basal cell carcinoma?

Back 1

Pigmentary phenotype (Fitzpatrick Types I or II), UV light exposure (episodic intense exposure thought to play an important role), radiation exposure, arsenic ingestion, and pre-existing skin lesions (nevus sebaceous)

Front 2

Describe nodular basal cell carcinoma

Back 2

Smooth translucent papule with telangiectasia, +/- pigment, ulcer

Histologically, nodular basal cells typically involve the epidermis with malignant cells extending into the dermis.

Front 3

Describe superficial basal cell carcinoma

Back 3

Erythematous plaque with slightly elevated borders

Histologically, the superficial multifocal type is contiguous with the epidermis

Front 4

Describe morpheaform or sclerosing basal cell carcinoma

Back 4

Light scar like plaque with ill-defined borders

Histologically, the sclerosing type demonstrates small clusters of cells invading dermal collagen and additional collagen in the tumor stroma

Front 5

Basal cell nevus syndrome

Back 5

Uncommon genetic syndrome that is transmitted in an autosomal dominant fashion. The genetic defect has been localized to chromosome 9. Important clinical findings include: moderate to florid BCCs, palmar pitting, mandibular cysts, hypertelorism, bifid ribs, partial ageneis of corpus callosum, medulloblastoma, ovarian fibromas.

Front 6

What characteristics of basal cell carcinoma cause them to be considered high risk?

Back 6

This group includes those located on the nose or ears, size > 2 cm, and certain histological patterns such as infiltrative, sclerosing, or basosquamous type.

Front 7

Mohs micrographic surgery

Back 7

The skin cancer is removed in one piece and mounted to preserve a complete horizontal plane with both deep and lateral margins. Inking is used for orientation. Frozen sections are then prepared and microscopic examination performed intraoperatively. Residual tumor is localized and mapped. Additional tissue is then removed only where residual tumor is found and the process continues until no tumor is present. The result is complete tumor removal with sparing of surrounding normal tissue. The cure rate can be as high as 98-99% (recurrence 1-2%) which is the best of all available treatments.

Front 8

What are the risk factors for squamous cell carcinoma?

Back 8

Pigmentary phenotype, UV exposure (more chronic exposure than BCC), radiation exposure, chemical carcinogens, chronic ulceration or scar, chronic skin disease (lichan planus, etc), chronic thermal damage, HPV, immunosuppression, and genetic syndromes (Xeroderma pigmentosa, epidermodysplasia verruciformis)

Front 9

Actinic keratoses

Back 9

Pre-malignant skin lesion that looks like a scaly erythematous macule or papule on area of chronic sun exposure, usually face and hands. These can remit, remain stable, or progress to SCC.

Front 10

Bowen's disease

Back 10

SCC in situ, confined to epidermis; a red scaling macule or papule

Front 11

Keratoacanthoma

Back 11

Type of SCC with a central keratotic plug (volcano appearance). History typically of rapid growth, and occasionally spontaneous involution should still be regarded as SCC, since the biologic behavior is not always benign or predictable.

Front 12

Verrucous carcinoma

Back 12

Type of SCC; slow growing warty plaque, most often on lower extremity. Indolent but relentless growth and local tissue destruction.

Front 13

Erythroplasia of Queyrat

Back 13

SCC in situ; erythematous moist plaque on genitalia. May be associated with pre-existing chronic skin condition such as lichen planus or balanitis xerotica obliterans.

Front 14

Leukoplakia

Back 14

White patch on mucous membranes that may represent SCC or dysplasia.

Front 15

Xeroderma pigmentosa

Back 15

Rare genetic syndrome associated with accelerated development of cutaneous malignancies. Transmission is autosomal recessive with genetic defect involving 8 distinct complementation groups resulting in defective DNA excision repair. Clinical features include florid cutaneous neoplasia (BCC, SCC, melanoma), photosensitivity, photo damage with premature aging of the skin, photophobia keratitis, and cataracts.

Front 16

DeSanctis-Cachione syndrome

Back 16

Xeroderma pigmentosa with presence of neurologic abnormalities and mental retardation.

Front 17

Which characteristics of SCCs cause it to be regarded as higher risk for metastasis and therefore treated more aggressively with Mohs micrographic surgery?

Back 17

SCC on the lip or ear, recurrent SCC, SCC arising in a scar, large or deep tumors, poorly differentiated histology, or SCC arising in in immunocompromised patients (can be fatal).

Front 18

UV bandwidths for carcinogenesis and wrinkling

Back 18

Carcinogenesis - 300 nm

Wrinkling - 340 nm

Front 19

What are the skins natural defenses against solar radiation?

Back 19

Stratum corneum, melanin, and urocanic acid

Front 20

PTC gene

Back 20

Tumor suppressor gene in the Hedgehog signaling pathway. Mutations lead to loss of suppressor function and activation of the pathway which triggers cellular proliferation. Human PTC gene localized to chromosome 9q22.3. Mutation can lead to BCC.

Front 21

P53

Back 21

P53 mutations occur in 50% of human cancers including skin cancer. It functions as a DNA transcription factor for genes controlling cell cycle and apoptosis. Mutation leads to loss of suppressor function and oncogenic potential.