04- dermatology cutaneous malignancies

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cutaneous malingancies
updated 8 years ago by bolip888
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1

3 most common skin cancers (ordered by rate in which they occur)

1. basal cell carninoma
2. squamous cell carcinoma
3. melanoma

2

Actinic keratosis is the precursor to which cancer?

Precursor to squamous cell carcinoma

3

Where is actinic keratosis found on the body, and what does it look like?

found on sun-exposed skin: face, posterior neck, bald scalp, arms, hands, ears

with thin pink or red papules with adherent scale

often can be noticed by palpitation before visual inspection

4

actinic keratosis

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actinic keratosis

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actinic keratosis

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7

Actinic Cheilitis (form of AK)

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8

Actinic Keratosis: what is the prognosis?

The risk of SCC evolving from an AK has been estimated to be around 1% per lesion per year
Rates similar to intraepithelial neoplasia of other sites (cervix, etc)
Some lesions remit spontaneously
Improved with sun protection

9

Actinic Keratosis: What is the Treatment?

Liquid nitrogen
5 to 8 second spray
Topical therapies
5-fluorouracil (Efudex, Carac)
Applied BID for 3-4 weeks
imiquimod (Aldara)
Applied daily 3 days per week for 4 weeks
Photodynamic therapy
5-ALA and blue light

10

Where on the body does squamous cell carcinoma occur?

Typically arises on sun-damaged skin
Most common on head and neck
Can occur on lips, genitals, and non-exposed skin

11

What does squamous cell carcinoma look like?

Hyperkeratotic, scaly, flesh-colored to pink papules
can have crusting and ulceration

12

What are the squamous cell carcinoma risk factors?

UV exposure
Cumulative sun exposure more than intermittent
Tanning beds
Fair skin/freckling, blue eyes, red hair
Chronic, non-healing wounds
Human papilloma virus (HPV 16, 18)
Immunosuppression
Ionizing radiation
Arsenic exposure
Hydrocarbon exposure

13

squamous cell carcinoma

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14

squamous cell carcinoma

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15

squamous cell carcinoma

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16

squamous cell carcinoma

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17

Squamous Cell Carcinoma: what is the Treatment (in situ)?

Liquid nitrogen (2 cycles of 30 second freeze thaw)
Electrodessication and Curettage
Topical imiquimod (Aldara) cream

18

squamous cell carcinoma

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19

Squamous Cell Carcinoma: what are the Metastasis Rates?

All sites – 0.5 - 5.2%
Scars – 38%
Lip – ~14%
External ear – ~14%
SCC with perineural invasion
47% recurrence
35% metastasis

20

Squamous Cell Carcinoma: Treatment (general)

SCC:
Liquid nitrogen or ED&C (destruction)
Surgery (standard excision vs. Mohs Micrographic Surgery)
Radiation therapy

21

Where is basal cell carcinoma generally located?

Usually arises on the head and neck
Becoming more common on the trunk and limbs

22

Basal Cell Carcinoma (BCC)- males vs females.
How common is it?

Most common skin cancer and most common malignancy in humans
Slightly more common in males
Incidence is increasing
Disproportionate increase in young women
Rarely ever metastasize

23

Basal Cell Carcinoma: Risk Factors

UV exposure
Intermittent sun exposure more than cumulative
Tanning beds
Fair skin/freckling, blue eyes, red hair
Immunosuppression
Ionizing radiation

24

Basal Cell Carcinoma: Variants

Nodular:
Most common
Can be pigmented
Superficial:
Common on chest and back
Morpheaform:
Scar-like; poorly defined margins; aggressive
Recurrent:
Tend to be more aggressive

25

Basal Cell Carcinoma (BCC)

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Basal Cell Carcinoma (BCC)

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Basal Cell Carcinoma (BCC)

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Basal Cell Carcinoma (BCC)

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Basal Cell Carcinoma (BCC)

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30

Basal Cell Carcinoma: Treatment for superficial

Liquid nitrogen (2 cycles of 30 second freeze/thaw)
Electrodessication and Curettage
Topical Imiquimod cream

31

Basal Cell Carcinoma: Treatment for other types

Liquid nitrogen or ED&C (destruction)
Surgery (standard excision vs. Mohs Micrographic Surgery)
Radiation therapy

32

Describe Mohs Micrographic Surgery

Tissue-sparing surgical technique
Serial sections with histologic evaluation of 100% of specimen borders
Allows higher probability of clearing cancer while preserving healthy tissue

33

Indications for Mohs Micrographic Surgery

Recurrent tumor
Aggressive histology (e.g. morpheaform BCC)
Tumor size greater than 2 cm
Ill-defined clinical margins
High risk areas (perioral, periorbital, nasolabial, nasal ala)
Tissue conservation (face, fingers, genitalia)

34

Mohs Micrographic Surgery

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35

Melanoma- in which part of the skin does the malignancy arise?
How many patients develop metastatic disease?
Early detection can cure what %?

Malignancy arising from melanocytes (found normally at dermal-epidermal junction)
1/5 of patients develop metastatic disease, usually associated with death
Early detection and treatment leads to a cure rate of over 90%

36

What are the risks for melanoma? (age and race)

Among the most common cancers in young adults
Lifetime Risk
1 in 50 Caucasians
1 in 250 Hispanics
1 in 800 Asians
1 in 1,100 Blacks

37

What are other risks for melanoma besides age and race?

UV exposure
Intermittent, high intensity exposure of unacclimatized skin more than cumulative
Tanning beds
Fair skin/freckling, blue eyes, red hair
Family history
Melantocytic nevi (moles), particularly atypical
Ephelides (freckles) – marker of sun exposure/damage

38

What kind of growth does superficial spreading melanoma show?

Slow horizontal growth phase followed by rapid vertical growth phase

39

What are the ABC’s of Melanoma?

asymmetry
borders
color
diameter > 5mm
evolution

40

What's the age of onset for superficial spreading melanoma?

Onset between ages of 30 to 50 years

41

What is the most common type of melanoma?

Most common type (70%)- superficial spreading melanoma

42

What are the different common areas of superficial spreading melanoma in male vs female?

Men: trunk Women: legs
About 50% arise in pre-existing nevus (mole)

43

superficial spreading melanoma

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superficial spreading melanoma

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45

superficial spreading melanoma

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46

nodular

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47

How common is nodular melanoma vs other types of melanoma?

Second most common type (15 to 30%)

48

What age group and sex is Nodular melanoma primarily diagnosed in?

Usually diagnosed in the 6th decade
More common in men

49

What is the appearance of a Nodular Melanoma, and where does it frequently occur on the body?

Blue to black nodule that grows rapidly over months
Arises de novo, usually more advanced at diagnosis, with poorer prognosis

Commonly on the trunk, head, neck

50

nodular melanoma

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51

How common is lentigo maligna melanoma?

15% of melanomas

52

What decade is lentigo maligna melanoma diagnosed most often?

Usually diagnosed in the in 7th decade

53

Where is lentigo maligna melanoma most commonly found?
What is its appearance?
How fast does it grow?

Occurs on chronically sun-damaged skin
Most common on face (nose and cheek)
Slowly growing, asymmetric black macule/patch
Slow evolution over many years

54

lentigo maligna melanoma

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lentigo maligna melanoma

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lentigo maligna melanoma

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57

How common is acral lentiginous melanoma?

"relatively uncommon"
ALTHOUGH...
Represents 70% of melanomas in darkly pigmented skins types, given lower incidence of other MM types

58

Where does acral lentiginous melanoma occur on the body?
How fast does it grow?

Occurs on palms and soles or around nails

Faster progression than other types

59

acral lentiginous melanoma

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acral lentiginous melanoma

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61

acral lentiginous melanoma

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acral lentiginous melanoma

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63

Melanoma Variants- Describe:
Amelanotic melanoma

Melanomas lacking clinically evident pigment
Can be seen as a variant of any of the types discussed
Often mistaken for BCC, SCC, or warts
No differences in prognosis or therapy

64

How rare is Ocular melanoma?

rare (5% of melanomas)

65

How rare is mucosal melanoma, and where is it most commonly found on the body?

rare (<4% of melanomas)
Can occur in the mouth, nasopharynx, larynx, vagina, and anus

66

Mucosal melanoma

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amelanotic melanoma

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68

When is Sentinel Lymph Node Biopsy performed?

Typically performed when tumor thickness > 1mm
About 20% have microscopic metastasis despite lack of clinical or radiological findings

69

How is Sentinel Lymph Node Biopsy performed? What are you looking for?

Injection of technetium sulfur colloids around tumor site or scar
isotope is transported in lymphatics
concentrated in sentinel lymph node
Radioactive node is identified and resected
If node is positive for melanoma, then regional lymph node dissection is performed
Can carry significant morbidity (lymphedema, etc.)

70

What are the benefits of performing Sentinel Lymph Node Biopsy (for a diagnostic tool)?

Staging tool for prognosis
Serves as a stratification criterion to enter more homogenous patients into adjuvant clinical trials
THERAPEUTIC BENEFIT (PROLONGING SURVIVAL) HAS NOT BEEN DEMONSTRATED

71

What is the treatment for melanoma?

Excision
Interferon alpha
Melanoma vaccines
Palliative surgery
Chemotherapy