Morphology and Skin Cancers

morphology refers to _

structure of a lesion

a circumscribed change of skin color w/o elevation or depression in the skin, up to 1 cm in diameter

macule

a large macule greater than 1 cm in diamter

patch

a raised, solid lesion less than 1 cm in diameter

papule

a large papule is referred to as a _

plaque

a solid, palpable lesion originating in the dermis or subdermis that may not be elevated above the level of the surrounding skin

nodule

a large nodule that is greater than 1 cm

tumor

a circumscribed, elevated lesion containing fluid less than 1 cm

vesicle

a large vesicle

bulla

groups of morphology

macule/patch

papule/plaque

nodule/tumor

vesicle/bulla

a circumscribed lesion containing pus

pustule

non-blanching, violaceous discoloration of the skin that may or may not be palpable

purpura

purpura that are less than 1 cm

petechiae

purpura that are greater than or equal to 1 cm

ecchymosis

evanescent, edematous, erythematous papule or plaque that is usually pruritic

wheal

wheals are usually _

pruritic

wheals are also known as _

hives

telangiectasia

small superficial blood vessels

dilated capillaries

blanchable

telangiectasia: blanchable or nonblanchable?

blanchable

a superficial denudation of the epidermis

erosion

denudation of the skin involving the dermis

ulcer

types of skin cancers (3)

basal cell carcinoma

squamous cell carcinoma

malignant melanoma

the most common skin cancer is _

basal cell carcinoma

general characteristics of basal cell carcinoma (5)

locally invasive

slow growing

rarely metastasizes

may be pruritic

friable

location of basal cell carcinoma

sun-exposed areas

head / chest / shoulders / back

nodular BCC appearance

pearly, white, translucent papule/plaque

central ulceration

rolled borders

haphazardly organized telangeiectasis

central ulceration of basal cell carcinoma

rodent tumor

superficial BCC appearance

well-circumscribed, erythematous macule/patch

OR

slightly raised, flat papule/plaque

white, waxy, scar-like papule or plaque with indistinct borders. Usually appears on the face. Can have sub-clinical wide and deep extension of tumor

sclerosing BCC

basosquamous carcinoma tend to have _ growth pattern

infiltrative

BCCs may present with variable amounts of _

melanin (pigmented BCC)

BCC risk factors

UV exposure

male

50+

fair skin

PMHx of skin cancer

chronic inflammation of skin

arsenic exposure

trauma

family history

superficial BCC DDx

actinic keratosis

SCC

psoriasis

nummular dermatitis

cutaneous T-cell lymphoma

nodular BCC differential diagnoses

SCC

amelanotic melanoma

dermal nevus

sebaceous hyperplasia

angiofibroma

trichoepithelioma

seborrheic keratosis

types of basal cell carcinoma

superficial

nodular

pigmented

sclerosing

what is mohs surgery used to treat

facial lesions

cosmetically sensitive areas

sclerosiing BCC

infiltrative/recurrent BCC

superficial BCC treatment

excision

electrodessication + curettage

topical treatment

photodynamic therapy

cryotherapy

radiotherapy

nodular BCC treatment

excision

electrodessication and curettage

radiotherapy

when to refer for BCC

BCC on the face or sensitive area

biopsy confirms BCC

recurrent BCC

basosquamous carcinoma

lack experience treating BCC

actinic keratosis appearance

hyperkeratotic

rough

skin-colored to tan/brown

irregularly shaped, ill defined papules and plaques

where does actinic keratosis occur

sun-exposed skin

actinic keratosis risk factors

fair skin

history of prolonged sun exposure

compromised immune system

etiology of actinic keratosis

abnormal keratinocyte development due to DNA damage from UVB

actinic keratosis cancer status

pre-cancerous, may develop into squamous cell

actinic keratosis treatment

cryotherapy

topical medications

PDT

ED+C

chemical peels

laser surgery

squamous cell carcinoma appearance

erythematous, scaly, indurated papules or plaques

SCC may arise within existing _

actinic keratoses

SCC location

sun-exposed sites

potential causes of SCC

mutations in keratinocyte DNA caused by UVB (main cause)

tobacco use

HPV

which SCC lesions tend to be more aggressive?

head and neck lesions

poorly differentiated lesions

SCC risk factors

elderly males

previous history of skin cancer

history of actinic keratoses

sun exposure

fair skin

smoking

inherited syndromes

immunosupression

trauma

ionizing radiation and arsenic exposure

workup for SCC

biopsy

imaging for advanced stages

biopsies for SCC

shave

punch

excisional

imaging for SCC

CT or MRI

ED&C treatment for SCC is used for:

low risk, in-situ SCC of the torso and extremities

Mohs surgery for SCC is used for what lesions?

head and neck

invasive SCCs

when is standard excision used for SCC

low-risk and primary SCC lesions in non-cosmetically sensitive areas

when is radiation therapy used for SCC

used as an adjunctive therapy

patients who are poor surgical candidates

treatment for very high risk or advanced cases of SCC

chemotherapy and immunotherapy

treatment for low-risk SCC

ED&C

standard excision

when to refer for SCC

biopsy-proven SCC

invasive SCC

SCC of face, neck, sensitive areas

personal history of skin cancer

history of excessive sun exposure

non-dendritic, pigment producing, melanocyte derived cells

nevus cells

a nevus is a _ occurring in the skin

nest of nevus cells

nevi are typically described by _

where in the skin they're located

junctional nevi location

nests of nevus cells at the dermal-epidermal junction

junctional nevi appearance

round

well circumscribed

brown to black macule

very slightly raised papule

nevus cells located within the dermis

intradermal nevi

intradermal nevi appearance

round

dome-shaped / warty

skin-colored

possibly pedunculated papule

compound nevi consist of _

nevus cells at the dermal-epidermal junction AND within the dermis

compound nevi appearance

central, round, raised pigmented papule

surrounded by well-defined, pigmented, macular component

a nevus with an appearance different from common nevi

dysplastic nevus (atypical nevus)

dysplastic nevi cancer status

benign

greater risk for developing melanoma

characteristics of dysplastic nevus syndrome

100+ nevi

nevi > 8 mm in diameter

one or more atypical nevi

FAMM syndrome stands for

familial atypical multiple mole melanoma

FAMM syndrome characteristics

multiple melanocytic nevi (>50)

family history of melanoma

the predominant group of nevi in a person with multiple nevi is known as _

signature nevus

ugly duckling sign

the one nevus among many that appears differnt from the others

a neoplasm of melanocytes is referred to as _

malignant neoplasm

malignant melanoma can mestasize via

direct extension

lymphatic system

hematogenously

morphology of malignant melanoma

irregularly shaped and pigmented macule, nodule, papule, or plaque

melanoma types (5)

superficial spreading

nodular

lentigo maligna

acral lentiginous

amelanotic

most common form of melanoma

superficial spreading melanoma

superficial spreading melanoma characteristic

lesion confined to epidermis

horizontal growth phase

nodular melanoma characteristics

invasive melanoma

lesion grows downward, penetrates basement membrane

vertical growth phase

lentigo maligna melanoma characteristic

changing "freckle"

in-situ

melanoma occurring on the acral surfaces

acral lentiginous melanoma

acral surfaces

palms of hands

soles of feet

nail beds

melanoma that does not produce pigment

amelantic melanoma

ABCDEs of melanoma

assymetry

borders

color

diameter

evolution

_ is helpful when considering whether to biopsy a suspicious lesion

dermatoscopic criteria

diagnostic criteria of malignant melanoma

breslow depth

clark's level

thickness of MM lesion correlates with

prognosis

prognostic indicators of malignant melanoma

thickness

ulceration

regression

miotic rate

clark level 1

melanoma confined to the epidermis

clark level 2

melanoma has invaded the papillary dermis

clark level 3

melanoma has invaded through the papillary dermis

now touching reticular dermis

clark level 4

melanoma has invaded the reticular dermis

clark level 5

melanoma has penetrated the subcutaneous fat

malignant melanoma risk factors

increased age

history of MM

history of skin cancer

50+ melanocytic nevi

UV radiation

Parkinson's

malignant melanoma treatment

wide local excision with appropriate margins

possible sentinel lymph node biopsy