Sbl - Oncology - Skin Cancers

Front 1

First modern description of cancer from environmental exposure:

Effect of UV light on DNA?

Rare autosomal recessive genetic disorders that conspicuously involve the skin:

How should you do a skin self exam?

Back 1

1774 - SCC of scrotum in London chimney sweeps

creates pyrimidine dimers - misread in DNA replication - C-T mutations

genodermatoses

involve spouse, monthly in patients over 30-40, check all skin, physician check yearly

Front 2

SCC usually seen in which patients?

What are some precursor lesions?

Treatment?

Back 2

fair-skinned, excessive sun exposure - more common in men (3:1)

Bowen's disease (carcinoma in situ), cutaneous horns

Cryosurgery, excision, topical chemo (5-FU), systemic chemo (5-FU)

Front 3

Cancer that arises from immature pluripotential cells of the epidermis:

Clinical presentation?

5% of skin cancer, 3 times as many deaths:

Arm presentation on men, women?

Causes genetic predisposition to melanoma in families:

Back 3

basal cell carcinoma

older patients, slow growing, ulcerates, forms ROLLED BORDERS

melanoma

Man - left, woman - right (driving in car)

dysplastic nevus syndrome

Front 4

Most common type of melanoma (70%), characteristic notching/indentation on edge of lesion:

2nd most common type, more aggressive, raised/dome shaped:

Hutchinson's freckle, low potential for metastasis, usually large:

Characteristically on palms/soles/nailbeds, more common in non-whites:

Back 4

superficial spreading

nodular

lentigo maligna

Acral lentiginous

Front 5

Critical first step in melanoma development?

2nd step?

3rd step?

4th step?

Back 5

genetic instability - disruption of DNA

deregulated proliferation - involves p53 (over-regulated)

invasive potential - normal tissue disrupted, no inhibition, autocrine growth factors from melanoma

metastatic potential - new blood vessels via VEGF, TGF-B, etc

Front 6

What is melanosis?

In transit metastasis?

Breslow thickness is useful for what?

Back 6

deep pigmentation of skin in disseminated melanoma ("slate gray")

nodules in skin/SQ tissue representing melanoma deposits as it spreads to lymph nodes

melanoma staging

Front 7

Higher risk for lymph node involvement:

Surgical excision of melanomas <1 mm, between 1-4 mm, >4 mm thick:

Melanoma on fingers, toes?

Ear? Face?

Back 7

male, age >50, increased thickness

<1 - 1 cm normal skin
1-4 - 2 cm normal skin
>4 - 4 cm normal skin

usually requires partial amputation

ear - "Van Gogh" procedure - resection, amputation
face - 1 cm excision usually OK

Front 8

Only curative modality for nodal metastatic disease?

Is radiotherapy usually effective for melanoma?

When is A-interferon used?

Back 8

lymph node removal

not effective

>4 mm, in transit metastasis, regional lymph nodes involved

Front 9

Primary cutaneous neuroendocrine carinoma, fair-skinned elderly patients, cells located in basal layer of epidermis, hair follicles, highly malignant:

Treatment?

Back 9

Merkel Cell Carcinoma

Wide local excision, prophylactic regional lymph node dissection - chemo for metastatic disease

Front 10

Tumor from bone marrow derived dendritic cells in upper layer of epidermis:

Seen in children under 2, acute, fulminant, progressive, fatal:

Children 2-6, exopthalmos, diabetes insipidus, skull involvement:

Children, young adults, solitary bone lesions:

Back 10

Langerhans cell - histiocytosis X

Letterer-Siwe disease

Eosinophilic granuloma

Hand-Schuller-Christian diseas

Front 11

Tumor of hair follicle, single/multiple nodules on face/neck resembling warts:

Discrete, skin-colored papules on nose. eyelids, face, onset with puberty:

Arise from hair matrix, "Wicked Witch of the West":

Back 11

Trichilemmoma

Trichoepithelioma

Pilomatricoma

Front 12

Small, often closely set, yellowish papules on vermillion border of lips, oral mucosa:

May be associated with what?

Most commonly occurs in women 60-80, upper eyelid conjunctiva, higher incidence in Asians:

Back 12

Fox-Fordyce anomaly

Reiter's syndrome

sebaceous carcinoma

Front 13

Benign tumor of eccrine gland, seen on palm or sole:

"turban tumor" - intradermal coiled duct of eccrine gland, multiple firm, smooth, dome-shaped papules:

Back 13

Poroma

Cylindroma

Front 14

Solitary tumor of face, hand, foot, widespread metastasis common:

Low grade T-cell lymphoma that originates in skin, associated with IGG, biblical story of Job:

Leakage of lymphoma cells into blood:

Treatment?

Back 14

clear-cell carcinoma

Mycosis fungoides

Sezary syndrome

electron beam radiation, topical nitrogen mustard

Front 15

Small blue-red nodule in SQ tissue or under fingernail - significant pain:

malignant tumor of blood/lymph:

What is Stewart-Treves syndrome?

Cavernous hemangioma that causes localized DIC:

Back 15

Glomus tumor

angiosarcoma

lymphangiosarcoma in extremities classically seen in breast cancer

Kassabach Merritt

Front 16

3 types of Kaposi's sarcoma?

Most common benign neoplasm?

2nd most common malignant soft tissue sarcoma, treat with aggressive surgery:

Back 16

classic - old Mediterranean men, Jewish
African - Bantu men
Immunocompromised - HIV patients

lipoma

liposarcoma