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21 Cards in this Set
- Front
- Back
Basal Cell Carcinoma Epidemiology
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Epidemiology
Most common cancer in the United States Approximately 900,000 cases annually occur in the United States Incidence has continued to rise over the last decade |
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Basal Cell Carcinoma Clinical Features –Risk Factors
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Clinical Features –Risk Factors
fair skin sun (i.e., ultraviolet) exposure family history radiation therapy arsenic |
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Basal Cell Carcinoma Appearance of lesions
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Appearance of lesions
Classically, the lesions are pink dome-shaped papules which have pearly, rolled borders and telangiectasias; the lesions are normally found on sun-exposed areas such as the face and arms. However, it is important to remember that not all BCC’s will share all of these characteristics. |
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Basal Cell Carcinoma Diagnosis
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Diagnosis
Skin biopsy is the only way to definitively diagnose a BCC (or almost any skin disease). Although biopsies of lesions which are suspicious for BCC are routinely performed, one can often accurately diagnose a BCC by physical examination alone. |
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Basal Cell Carcinoma Course/Prognosis
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Course/Prognosis
BCC’s very rarely metastasize (<1 per 4000 cases), thus they rarely cause death. BCC’s which do metastasize are normally related to very large primary tumors that remain untreated for years. Untreated BCC’s will become very large and disfiguring, so their early detection and removal is of great importance. |
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Actinic Keratosis Epidemiology
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Epidemiology
Very common, affects over 50% of elderly, fair-skinned persons in hot, sunny climates |
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Actinic Keratosis Clinical Features
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Clinical Features
Risk factors -fair skin -history of significant UV exposure -family history -immunocompromised individuals |
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Actinic Keratosis Appearance of lesions
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Appearance of lesions
dry, red, scaly, hyperkeratotic papules and macules which are most commonly found on the face, scalp,and arms |
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Actinic Keratosis Diagnosis
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Diagnosis
Biopsy is definitive. In practice, actinic keratoses are generally diagnosed by physical examination alone. However, if one suspects evolution into a SCC, then biopsy is indicated |
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Actinic Keratosis Pathology
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Pathology
Actinic keratoses are benign epidermal tumors which are best thought of as pre-cancerous lesions (a slight oversimplification). The percentage of AK’s which will become squamous cell carcinomas if untreated is somewhat controversial, but the actual figure is almost certainly less than 10% . |
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Squamous Cell Carcinoma Epidemiology
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Epidemiology
Approximately 200,000 new cases every year incidence continues to rise |
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Squamous Cell Carcinoma Clinical Features
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Clinical Features
Risk Factors fair skin Sun (i.e., ultraviolet) exposure family history Arsenic Hydrocarbons Heat Radiation Scars Uncircumcised Males (penile SCC) Alcohol and Tobacco – together they have a synergistic effect (oral SCC) HPV |
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Squamous Cell Carcinoma Appearance of lesions
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Appearance of lesions
There is much variation in the appearance of SCC’s,but classically they are described as small, red, hard, scaly papules and plaques. |
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Squamous Cell Carcinoma Diagnosis
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Diagnosis
Skin biopsy is definitive, but many SCC’s can be reliably diagnosed by physical exam alone. |
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Squamous Cell Carcinoma Prognosis/Course
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Prognosis/Course
Metastasis of SCC is uncommon, but not as rare as metastasis of BCC. Approximately 5% of cutaneous SCC’s metastasize. As is the case with BCC, tumors which are large and untreated for long periods of time are the most likely to metastasize. |
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Squamous cell carcinoma in situ
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Squamous cell carcinoma in situ (i.e., entire tumor is confined to the epidermis without invasion into the dermis) is called Bowen’s Disease.This form of SCC appears as a characteristic red, slightly scaly patch or plaque. Bowen’s disease (not unexpectedly) has a much better prognosis than invasive SCC.
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Melanoma Epidemiology
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Epidemiology
Approximately 60,000 new cases a year in the United States Accounts for about 4% of skin cancer cases, but 79% of skin cancer deaths incidence is rising faster than any other cancer |
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Melanoma Risk Factors
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Risk Factors
intermittent sun exposure appears to be more predisposing to melanoma than chronic sun exposure fair-skinned patients who sunburn easily genetic factors (defective p16 tumor suppressor gene increases risk of melanoma) family history congenital nevi (risk increases with size) dysplastic nevi immunosuppression |
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Melanoma Appearance
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Like all skin cancers, melanomas have many different appearances.
Characteristics which might suggest that a pigmented lesion is a melanoma include Asymmetry Border Irregularity Color Variegation Diameter > 5 mm Enlargement Lesions which itch, burn, are tender, bleed or ulcerate should also raise a clinician’s index of suspicion for melanoma. |
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Melanoma Diagnosis
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Diagnosis
Skin biopsy is only way to make a diagnosis of melanoma.. The diagnosis of melanoma is sometimes difficult to make on physical exam alone (for early lesions). This is because the high mortality rate of melanoma mandates early detection in order to increase the chances of a cure. At their earliest stages, melanomas probably will not exhibit all of the above classical features. Sometimes dermatologists will employ a magnifying device known as a dermatoscope to increase their diagnostic accuracy. Any lesion that is even minimally suspicious for melanoma should be biopsied. The need to increase diagnostic accuracy has also fostered the development of new modalities such as ultrasound, mole mapping, and digital image analysis to aid in the detection of melanoma. To date, none of them are widely used. |
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Melanoma Prognosis
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Prognosis
Unlike, BCC’s and SCC’s, the prognosis of melanoma is relatively poor. This is because of its much greater potential for metastasis, and the lack of effective treatment for metastatic disease. The prognosis of melanoma is strongly correlated with the depth of the tumor (i.e., the deeper the tumor, the poorer the prognosis). The presence of ulceration and nodal disease are also poor prognostic indicators. |