Bafl Exam 2: Ak, Ka, And Scc

Front 1

What are the UV exposure risks for BCC vs SCC?

Back 1

BCC- intermittent intense episodes, sunburns at any age

SCC- cumulative long term exposure, childhood sunburns

Front 2

How does ionizing radiation increase risk of SCC?

Back 2

3 fold increased risk

Larger, fractionated doses (>12-15Gy) are more tumorigenic than smaller, spaced out doses despite the same cumulative dose

always ask about history of XRT

Front 3

Healthy skin cancer incidence v organ transplant cancer incidence?

Back 3

Normal: BCC > SCC > melanoma

Transplant: SCC > BCC > melanoma

Front 4

What transplants are associated with the greatest number of SCC?

Back 4

small bowel/cardiac/lung > pancreas/liver > kidney

hematopoietic cancers have no markedly increased risk likely d/t shorter immunosuppression

Front 5

Which HPV viruses are associated with common warts? Epidermodysplasia verruciformis? High risk oncogenic warts? Low risk oncogenic warts?

Back 5

COMMON- 1&2

EV- 5

HIGH RISK- 16&18

LOW RISK- 6&11

Front 6

What is sirolimus?

Back 6

Sirolimus (Rapamycin) is an immunosuppressive agent which is protective against cutaneous malignancies and should be considered in transplant patients with SCC

Front 7

Xeroderma pigmentosum increases risk of SCC by how much?

Back 7

4800X

Front 8

MCC death with dystrophic epidermolysis bullosa?

Back 8

SCC

Front 9

Likelihood of SCC evolving from AK?

Back 9

10% in 10 years

Front 10

4 subtypes of AK?

Back 10

1. hypertrophic/hyperkeratotic

2. pigmented

3. lichenoid

4. atrophic

Front 11

Actinic chelitis risk of progression to SCC? Treatment?

Back 11

Risk of progression to SCC is 2.5x higher than cutaneous AK

Treatment includes solaraze, CO2

Front 12

DDX for cutaneous horn?

Back 12

SWATS!!

SCC, warts, AK, trichilemomma, SK

Front 13

15% of cutaneous horns are caused by?

Back 13

AK

Front 14

Risk of SCCIS progressing to invasive SCC?

Back 14

3-5%

Front 15

What are the 3 major subtypes of verrucous carcinoma?

Back 15

Buschke-Lowenstein (giant condyloma acuminatum of genitalia)

Epithelioma cuniculatum (plantar foot)

Oral florid papillomatosis

**these are associated with HPV!!!

Front 16

How do we treat KAs?

Back 16

They are known to spontaneously regress, but are also known to progress to SCC and metastasize

bottom line: can't reliably predict, so most regard these as SCC subtype and treat accordingly

Front 17

What is keratoacanthoma centrifugum marginatum?

Back 17

very large (up to 30cm plaques) of KA, progressive, commonly on LE, persist several months before resolution, heals with prominent scarring

Front 18

What is Ferguson-Smith syndrome?

Back 18

INHERITED autosomal dominant mutation in TGFB-R1 that leads to multiple KA's in sun exposed areas that begins in the 2nd and 3rd decades, can be scarring

Front 19

What is Grzybowski syndrome?

Back 19

NOT INHERITED- Eruptive KA's in middle aged adults, can appear anywhere (incl. face, scalp, trunk, extremities, lips, tongue)

Scarring! ectropion, nodules on larynx can lead to hoarseness

Front 20

Differences between Ferguson Smith and Grzybowski syndromes?

Back 20

FS- AD mutation in TGFB-R1, in kids! can be scarring, NOT pruritic

Grzy- not inherited, erupt suddenly in middle aged adults, severely pruritic, scarring, ectropion, hoarsness

Front 21

What is Muir Torre?

Back 21

Muir–Torre syndrome (MTS) is a rare hereditary, AD cancer syndrome that is thought to be a subtype of HNPCC. Individuals are prone to develop cancers of the colon, breast, and genitourinary tract, and skin lesions, such as KAs and sebaceous tumors. The genes affected are MLH1, MSH2, MSH6, and PMS-2 (involved in DNA mismatch repair)

KM- dominant (AD) female (breast ca), a-hole (colon cancer), always cranky (PMS), tons of KAs, sebaceous tumors

Front 22

Invasive squam that can arise in site of prior trauma or scars?

Back 22

Marjolin's ulcer

Front 23

Which tumor features/anatomic sites are the highest risk for SCC metastasis?

Back 23

>2mm thick, perineural invasion, Ear/LIP worst

Front 24

increased risk of SCC metastasis with lesion on normal skin vs ear vs lip vs scar

Back 24

5% chance of metastasis on normal skin

10% chance if on ear

15% chance if on lip

up to 38% for SCC arising in a scar or non sun exposed skin

Front 25

MOA of 5-fluorouracil? Imiquimod? What are these used for?

Back 25

5-FU is a thymine analog blocks thymidylate synthetase --> inhibits DNA formation and leads to cell death

Imiquimod activated TLR-7 --> induces IFNa

can be used for a ton of stuff.... but for us... AK

Front 26

Recommended treatment time of AK's with Picato? MOA?

Back 26

INGENOL MEBUTATE

0.015% x 3 days on face

0.05% x 2 days on trunk/extremities

Induces death by being taken up in cells --> calcium spike --> mitochondrial swelling and cell death; produces localized neutrophil rich infiltrate within hours to prevent tumor relapse

fast acting! thats why the time is so short.

Front 27

Margins for low risk SCC?

Back 27

<2mm thick, well circumscribed are reassuring for low risk

4mm

Front 28

Margins for high risk SCC?

Back 28

deemed high risk if depth is >2mm, perineural invasion, on ear or lip, poorly differentiated

6-10mm

Front 29

This term is used when there are histopath changes of SCCIS found in a genital wart? What virus is it associated with?

Back 29

Bowenoid papulosis, associated with HPV 16 & 18

Front 30

What is Erythroplasia of Queyrat? What is is malignant potential?

Back 30

SCCIS of glans/prepuce, can also occur on conjunctiva, vulva, oral mucosa

10% malignant transformation to invasive SCC

note- circumcision is not associated with a reduced risk

Front 31

What is xeroderma pigmentosa, briefly?

Back 31

AR disorder in DNA repair after UV exposure (MC nucleotide excision repair)

skin cancers common

Front 32

AKs can be treated with...

Back 32

LN (69-83% clearance), PDT (69-83% clearance), chemical peel, laser

Front 33

What is solaraze?

Back 33

Diclofenac for actinic chelitis!

TOPICAL NSAID

inhibits metabolism of arachidonic acid and impedes tumorigenic effects of its metabolites