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40 Cards in this Set

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What are characteristics of malignant skin lesions that should arouse suspicion for malignancy?
• bleeding
• central ulceration
• changes in pigmentation
• crusting
• loss of skin appendages, hair follicles, etc.
• pain, itching, or other discomfort
• raised borders
• rapid growth
• regional lymphadenopathy
• serous exudate
What percentage of skin cancers are basal cell carcinoma? squamous cell carcinoma? melanoma?
• basal cell carcinoma (70%)
• squamous cell carcinoma (25%)
• melanoma (5%)
What is the difference between basal cell carcinoma and squamous cell carcinoma, regarding metastasis?
• BCCs rarely metastasize
• SCC are able to metastasize
What is xeroderma pigmentosum?
a rare, genetically transmitted disease that is characterized by faulty DNA repair of ultraviolet damage
Basal cell carcinoma arises from which layer of skin?
basal layer of germinating cells of the skin epithelium or from epithelial appendages (ex. hair follicles, sebaceous glands)
Name 3 major varieties of basal cell carcinoma
• Nodular BCC
• Pigmented BCC
• Morphealike or fibrosing BCC
Differentiate between nodular BCC and pigmented BCC
• Nodular BCC typically begin as smooth, domeshaped, round, waxy, or pearly papules; may have telangiectases; can form ulcers with central necrosis

• Pigmented BCC is similar to the nodular form except that it contains melanocytes that impart a dark borwn or blue-black color
What are some treatment modalities for BCC or SCC?
• cryotherapy
• electrodesiccation and curettage
• excision
• topical therapy using 5-fluorouracil (5-FU)
What percentage of patients with surgical excision of BCC have recurrance?
• 20% of patients who have a single BCC have a second lesion within 1 year
• 40% of patients who have multiple tumors have an additional BCC within 1 year
What is the most common site for SCC?
• the lower lip is the most common site
• approximately 75% of SCC tumors occur in the head and neck
What is Bowen's disease?
• a skin condition characterized by chronic scaling and occasionally by a crusted, purple, or erythematous raised lesion
• is carcinoma in situ that has not yet broken through the epidermal-dermal junction
What congenital nevus undergoes malignant transfomation to melanoma in 10%-30% of untreated lesions?
congenital giant hairy nevus (bathing trunk nevus)
List different classifications for melanoma
• acral lentiginous melanoma
• lentigo maligna melanoma
• nodular melanoma
• superficial spreading melanoma
Which type of melanoma consititues 10%-15% of cutaneous melanomas and is the most benign cutaneous melanoma?
Lentigo maligna melanoma (Hutchinson's freckle)
What are characteristics of Lentigo maligna melanoma?
• long period of development
• tendency to occur in the sun-exposed areas of the face, head, and neck of older people
This type of melanoma accounts for approximately 70% of all cutaneous melanomas.
superficial spreading melanoma
What areas of the body are most commonly affected by superficial spreading melanoma in men and in women?
• women: the legs
• men: the back
This type of melanoma is the most malignant type and accounts for approximately 12% of all cutaneous melanomas.
nodular melanoma
This type of melanoma occurs on the palms, soles, and in subungal sites.
Acral lentiginous melanoma
What are some lesions that can be confused with cutaneous melanoma?
• BCCs
• blue nevi
• compound nevi
• dermatofibromas
• intradermal nevi
• junctional nevi
• seborrheic keratoses
What are features of a tumor are important in determining prognosis?
• thickness
• ulceration
• nodal metastasis
• distant metastasis
Name 2 systems used to determine tumor depth of invasion of malignant melanomas
• Clark system: based on histologic level of invasion of the tumor

• Breslow system: uses an ocular micrometer to measure the thickness of the tumor in millimeters at the deepest point of its vertical growth
Describe the different classifications of the Clark system
• Level I lesions: confined to the epidermis
• Level II: invade the papillary layer of the dermis
• Level III: reach the junction ofh te papillary and reticular layers
• Level IV: invade the reticular dermis
• Level V: invade the subcutaneous fat
What are the 5 histiologic categories of Hodgkin's lymphoma?
• lymphocyte rich
• lymphocyte depleted
• mixed cellulariy
• nodular lymphocyte predominate
• nodular sclerosis
Describe the appearance of a Reed-Sternberg cell
bilobulated cell with a classic "owl eye" appearance
What chemotherapy regimens are used to treat Hodgkin's lymphoma?
• MOPP
- mustargen
- oncovin (vincristine)
- procarbazine
- prednisone

• ABVD
- adriamycin (doxirubicin)
- bleomycin
- vinblastine
- dacarbazine
What is the most common histiologic type of Hodgkin's lymphoma?
nodular sclerosis
Give examples of viruses that can cause types of non-Hodgkin's lymphoma
• EBV » Burkitt's lymphoma
• human T-cell lymphoma virus-1 » T-cell lymphoma
Sarcomas are rare tumors derived from what tissue layer?
embryonic mesoderm
What are the 3 most common types of sarcoma?
• malignant fibrous histiocytoma (24%)
• leiomyosarcoma (21%)
• liposarcoma (19%)
What are risk factors for sarcomas?
• chronic lymphedema
• mutations in oncogenes and tumor-suppressor genes
• occupational exposure
• radiation
What are some chemical agents that have been linked to sarcomas?
• asbestos
• Agent Organe
• dioxin
• polyvinyl chloride (PVC)
What is Stewart-Treves syndrome?
angiosarcoma in the context of lymphedema from a radical axillary dissection for breast carcinoma
Lymph node metastases are not a common feature of sarcomas. What sarcomas are the exceptions and have an increased likelihood of metastasis?
• angiosarcoma
• clear cell sarcoma
• epithelioid sarcoma
• rhabomyosarcoma
What is the chemotherapy treatment regimen for metastatic disease?
MAID
• Mesna
• Adriamycin (doxirubicin)
• Ifosfamide
• Dacarbazine
What are characteristics of gastrointestinal stromal tumors?
• represents a subgroup of sarcoma of gastrointestinal neural origin
• Tx: resection, tyrosine kinase inhibitors (imatinib mesylate)
What is the most common neoplastic complication of AIDS?
Kaposi's sarcoma
What are the 4 subtypes of Kaposi's sarcoma?
• classic KS
• African endemic KS
• iatrogenic KS (caused by immunosuppresion due to drug therapy)
• epidemic AIDS-associated KS
Describe the appearance of Kaposi's sarcoma lesions
• initially appear as flat, blue patches that resemble a hematoma
• become raised, rubbery nodules
What is the most common site for Kaposi's sarcoma?
• non-AIDS Kaposi's sarcoma is typically found on the lower extremities
• AIDS-related Kaposi's sarcoma often begins in the perioral mucosa (palate is the most common site)