DERM - Basal Cell Carcinoma & Squamous Cell Carcinoma

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Etiology Basal Cell Carcinoma/Squamous Cell Carcinoma Risk Factors Clinical Types and Features Diagnosis Management

What is the best "type" of skin cancer?

Basal Cell Carcinoma

What CA does not have the capacity to metastasize?

Basal Cell Carcinoma

What is the most common invasive malignant cutaneous neoplasm found in humans >40 years old?

Basal Cell Carcinoma

What kind of CA is most commonly found on the the nose but is rarely found on the dorsal hands?

Basal Cell Carcinoma

A rare, genetic trait, w/ multiple BCCs beginning in childhood is known as?

Basal Cell Nevus Syndrome

Fair skin, blonde or red hair, light eye color, poor tanning ability and sun-damaged skin [inability to tan and burn easily], childhood and adolescent sun exposure and
transplant patients are all at greater risk of developing which skin CA?

Basal Cell Carcinoma

Which kind of BCC has well-defined, firm, pink, papule with smooth, "pearly" surface with telangiectasias and "rolled-over edges"?

Nodular Basal Cell Carcinoma

This kind of BCC is often referred to as a Rodent Ulcer.

Nodular Basal Cell Carcinoma

A BCCs that contain melanin imparting a brown, black, or blue color is called?

Pigmented Basal Cell Carcinoma

BCC that has a waxy, firm, slightly elevated, pale white or yellowish papule/plaque with indistinct borders that blend into the skin is called?

Sclerosing Basal Cell Carcinoma

Which is the "best kind" of BCC to have b/c it is the least aggressive?

Superficial Basal Cell Carcinoma

What BCC has well-marginated, round-to-oval, red, scaling plaque with a thin, raised pearly white border (looks like eczema)?

Superficial Basal Cell Carcinoma

If you see Superficial Basal Cell Carcinoma it will often appear red and scabby, but they are NOT from____.

excoriations

With BCC you must always obtain 'what' to differentiate?

biopsy

What kind of biopsy is recommend for pigmented basal cell carcinoma unless malignant melanoma can be ruled out with confidence?

elliptical excision

Low risk histological subtypes of BCC include these 2 types:

nodular and superficial.

High risk histological subtypes of BCC include these 3 types:

morpheaform, basosquamous and micronodular.

Which type of surgery has the highest cure rate and most conservation of tissue?

Moh's

The best treatment modality depends upon the basal cell:

type, tumor size, and location

Best Tx of Nodular and Superficial BCCs commonly includes:

surgical excision with 5mm margins followed by primary closure, skin flaps or grafts (usually graft from skin behind ear)

Best Tx of Scerlosing BCCs:

Mohs micrographic surgery

Best Tx of Basal cells on central face (around eyes) especially > 6mm:

Mohs micrographic surgery

How often is follow-up on surgical procedures recommended?

at least yearly for the next 5 years

Actinic Keratosis is aka -

Solar Keratosis

Actinic Keratosis is confined to where?

epidermis

When a tumor extends into the papillary dermis it is termed?

squamous cell carcinoma

Actinic Keratosis most often affects whom?

Skin types I-II, those with high cumulative sun exposure, occupations that involve being outdoors, people living in sunny climates and being a "sun-lover" and the elderly.

What country has the highest prevalence of Actinic Keratosis?

Australia

What kind of skin condition is better recognized by palpation than inspection due to their pink, rough, scaly papules?

Actinic Keratosis

What is actinic keratosis occurring on the lower lips called?

actinic cheilitis

SCCs of the lip have approximately an 11% metastatic rate (oropharynx, larynx, and lungs), whereas _____ SCCs rarely metastasize

cutaneous

An actinic keratosis that does not completely resolve with treatment may be?

SCC

What is the Tx of choice for Actinic Keratosis?

Topical chemotherapy with 5-fluorouracil 5% cream (5-FU)

What happens if 5-fluorouracil 5% cream (5-FU) is applied to unaffected skin?

nothing

Malignant tumor of skin and mucous membranes, arises from squamous cells of the epidermis and skin appendages is called?

SCC

Greatest predisposing factor for developing SCC is?

cumulative sun exposure starting with childhood and adolescent exposure

Human papillomavirus (types 16,18,31, and 33) is a predisposing factor for developing what CA?

SCC

What is this pathway called? Actinic keratosis-->Squamous cell in-situ (Bowen's Disease) -->Invasive Squamous Cell Carcinoma

The Clinical Spectrum

It is difficult to clinically differentiate where an AK ends and where a SCC begins which is why we need what?

biopsy

Squamous Cell In-Situ (SCCIS) is aka?

Bowen's disease

Where does Squamous Cell In-Situ (SCCIS) commonly affect?

Females on lower legs and men on scalp, ears, dorsal hands

What is SCCIS presenting on the mucous membranes of the vulva and penis called? erythroplasia of Queyrat

erythroplasia of Queyrat

Kind of general but what presents as well-marginated, pink scaly or hyperkeratotic macule, papule, or plaque?

Squamous Cell In-Situ (SCCIS)

With Squamous Cell In-Situ (SCCIS) what is the Tx of choice?

surgical excision

Any isolated keratotic or eroded papule/plaque persisting for over a month is considered carcinoma until proven otherwise!

Invasive Squamous Cell Carcinoma

Pink or red indurated papule, plaque, or nodule with thick adherent keratotic scale AND/OR... ulcerative lesion with firm margins that is asymptomatic but may bleed is known as?

Invasive Squamous Cell Carcinoma

Tumors that have higher risk for metastasis include:

Tumors on the ears, nose, and lips

Tumors that have higher risk for metastasis include:

Tumors greater than 2 cm with poor differentiation on histology

Tumors that have higher risk for metastasis include:

Tumors developing at sites of chronic inflammation such as ulcers, scar tissue, and previous radiation sites also have higher rates of metastasis

Tumors that have higher risk for metastasis include:

Tumors on patients who are immunosuppressed especially patients who are transplant recipients

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