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39 Cards in this Set
- Front
- Back
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What % of BCCs occur on the head and neck?
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85% (25-30% on the nose alone)
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What % of BCC occur in people <50 y/o?
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20% (vs SCC is very uncommon in young pts)
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3-yr cumulative risk of getting BCC after first BCC?
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44%
BCC patients 8Xs more likely to get another BCC than SCC |
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3-yr cumulative risk of getting BCC after first SCC?
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43%
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3-yr cumulative risk of getting SCC after first BCC?
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6%
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3-yr cumulative risk of getting SCC after first SCC?
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18%
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What are the five histologic pattern of BCC?
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Nodular (21%)
Superficial (17%) Micronodular (15%) Infiltrative (7%) Morpheaform (1%) [note - mixed pattern exists in 38.5%] |
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Name the clincal forms of BCC
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Nodular BCC
Pigmented BCC Cystic BCC Sclerosing or Morpheaform BCC Superficial BCC |
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What are the 6 features that Pigmented BCCs can have on dermoscopy?
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large gray-blue ovoid nests, multiple gray-blue globules, maple leaflike area, spoke wheel areas, ulceration, and arborizing "treelike" telangiectasia.
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What Chromosome is Gorlin-Goltz located?
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Chromosome 9q22.3-q31
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What are the major features of Gorlin-Goltz?
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multiple BCCs at birth or early childhood
numerous small pits on the palms and soles epithelium-lined jaw cysts (symptomatic) ectopic calcification with lamellar calcification of falx cerebri a variety of skeletal abnormalities (esp of the ribs, skull and spine) A "coarse face" or characteristic facies relative macrocephaly hypertelorism frontal bossing |
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Describe skin findings in Gorlin-Goltz Syndrome
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Multiple nevoid BCCs
Palmar Pits Milia (both epithelial and sebaceous) |
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Describe face and mouth findings in Gorlin-Goltz
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Jaw cysts
Mandibular prognathism Broadening of the nasal root Frontal/temporoparietal bossing Ocular hypertelorism |
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Describe CNS findings in Gorlin-Goltz
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Lamellar calcification of falx cerebri and tentorium cerebelli;
Bridging of the sella turcica Mental retardation EEG abnormalities |
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Describe Skeletal system abnormalities in Gorlin-Goltz
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Rib anomalies -- bifurcation & splaying, synostotic or partial agenesis, or rudimentary cervical ribs
Vetebrae: kyphoscoliosis, spina bifida occulta; Shortened metacarpals (usu 4th, 5th, or both); "flamed-shaped lucencies of the phalanges, metacarpals and carpals; |
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What size and location BCCs should go to Mohs surgery (or Radiation)?
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Central face, periorbital and periauricular >6mm; Cheeks, forehead, neck, scalp >10mm; trunk, extremities >20mm
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What locations have high risk of recurrence?
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nose, eyelids, chin, jaw and ear
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List the indications for Mohs
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1. extensive, recurrent skin cancers that have not responded to aggressive conventional surgical techniques or radiation
2. large primary skin cancers of long duration 3. poorly differentiated SCC 4. morpheaform or fibrotic BCC 5. poorly demarcated tumors 6. locations where deep invasion along natural skin planes is possible (eyelids, nasal alae, nasolabial folds, circumauricular areas) 7. need to maximize tissue conservation to preserve function (ex., finger or penis). |
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Transplant patients are how many times more likely to develop SCC?
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65 times, usu starts 2-4 years after transplantation
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What % of SCCs arise from AKs?
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60%
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What factors influence metastasis rate in SCC?
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Size (2cm)
Depth (4mm) Differentiation Site of lesion Involvement of scar Previous Rx Perineural involvement Immunosuppression |
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What is considered low risk SCC?
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face (mask area) < 6mm
cheeks, forehead, neck,scalp < 10mm trunk, extremities <20mm depth <4mm |
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What is considered high risk for SCC?
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face (mask area) > 6mm
cheeks, forehead, neck,scalp > 10mm trunk, extremities >20mm depth >4mm |
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What is mets rate of marjolin's ulcers tumors?
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40%
35% ode involvement 5yr survival 30% |
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Is recurrence frequent with Bowen's?
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Yes, due to appendage involvement.
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Is recurrence frequent with Erythroplasia of Queyrat?
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No, b/c lack of foci (hair follicles)
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what % of pts with leukoplakia develop SCC?
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17%
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What three entities does Verrucous Carcinoma encompass?
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Epithelioma cuniculatum
Giant condylomata of Buschke-Lowenstein Oral Florid Papillomatosis |
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What is the length of survival once the tumor phase begins?
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appx 3 years
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How can immunohistochemical studies help in MF Dx?
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It can help determine type of lymphocyte -- CD3+/CD4+ T-helper cells, CD3+/CD8+ T cytoxic/suppressor cells. The hallmark is the T helper/inducer marker CD4+
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Prognosis of MF
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patch-stage, or <10% plaques is good
T3 or T4 stage, >60y/o, elevated LDH levels is bad (median 3years) tumor or erythrodermic stages decreases to appx 40% 5yr survival rate |
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What is the 5 yr survival rate of Sezary syndrome?
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11%
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How can you diagnose sezary syndrome?
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Physical exam plus:
5-20% circulating lymphocytes or more than 1,000/mm3 expanded pupulation of CD4+/CD7- lymphs by flow cytometry, elevated CD4/CD8 ration, or clonal TCR gene rearrangement |
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What % of cases of lymphomatoid papulosis evolve into cancer? what type?
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5-20%
MF, T-immunoblastic lymphoma, Hodgkin's disease |
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what % of paget's disease is the cancer clincally and radiologically undetectable?
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40%
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Pagets has positive immunoreactivity with what?
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Cytokeratin (CAM 5.2)
c-erb B-2 oncoprotein (21N) Carcinoemryonic antigen (CEA) CEA is in all cases of mammary pagets and negative in all melanomas |
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How % of patients have underlying malignancies in extrammary Paget's?
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12% have an underlying internal malignancy
24% have cutaneous adnexal adenocarcinoma |
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Most common cancers for men with skin mets? women?
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Men: Lung, melanoma, colon/rectum, oral cavity, kidney
women: breast, melanoma, colon/rectum, ovary, lung |
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what is carcinoma en cuirasse?
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hard, infiltrated plaque with a leathery appearance that results from fibrosis and lymph stasis seen with breast cancer
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