Derma. - Precancerous lesions and cutaneous carcinomas

What does MT3 CLOTH stand for?

Moisture, Temperature, Texture, Tenderness, Color, Lesions, Odor, Turgor, Hair

When evaluating lesions, what does SEV COMETS PD stand for?

SEV COMETS PD

• Size

• Elevated (depressed/flat)

• Vascular (red/purple/blue lesion)

• Color

• Odor

• Margins (well delineated or not)

• Exudates

• Texture

• Shape

• Pattern (does it follow a dermatome)

• Distribution (where on body)

What is the most common cancer in the US?

Skin cancer

What demographic is most at risk for skin cancer?

Fair-skinned people

What is the most common type of skin cancer?

Basal cell carinoma

What is the most lethal type of skin cancer?

Melanoma

What is the most common skin cancer type for Black people?

Squamous cell carcinoma

What differentiates basal cell carcinoma from squamous cell carcinoma?

Basal cell is slow growing, squamous cell rapidly grows

What is the primary distribution of basal cell carcinoma?

Face and head, anterior of face around nose and eyes, behind the ear.

Does basal cell carcinoma usually travel?

No

What should we worry about with basal cell carcinoma?

Ulceration of the cancer that can affect the dura mater

Who is most commonly affected by basal cell carcinoma?

Middle-aged and older people

How does basal cell carcinoma usually present?

Starts as a pearly papule/lesion with a firm, slightly rolled up edge

What kind of ulcer should we be particularly worried about with basal cell carcinoma?

Rodent ulcer- has a necrotic center

You want to catch basal cell carcinoma before it becomes what?

Rodent ulcer

What is actinic keratoses?

A subtle, precancerous lesion

What is actinic keratoses a precursor to?

Squamous cell carcinoma

What is the presentation of actinic keratoses?

Rough texture feel, often better felt than seen

How do you distinguish between actinic keratoses and squamous cell carcinoma?

Squamous cell is more obvious with color and is scaly and crusty.

Common cause of actinic keratoses?

Radiation from rays of sun

AKA for Actinic keratoses

“Solar keratoses”

Where is squamous cell carcinoma most commonly seen?

Lower lip (think sun exposure)

What is a precursor to squamous cell carcinoma that is characterized by pale, thickened/keratinized lips, specifically with a lower lip eversion?

Actinic cheilitis

What type of surgery is used to remove dermal cancers and what is specific to it?

Mohs Surgery - thin layers of skin are removed and examined under microscope for cancer cells. The benefit is reduced scarring and lower risk of recurrence.

What are the early stages of squamous cell carcinoma often confused with?

Dermatitis

What is characteristic of squamous cell carcinoma that delineates it from dermatitis?

It will grow and does not regress the way dermatitis usually does.

What is the distribution pattern of squamous cell carcinoma?

Broader than basal cell carcinoma, extensor surfaces, particularly calves and forearms, chest and back.

When a painful nodule is found on the ear, it can be confused for basal cell carcinoma, what is it?

Chondrodermatitis nodularis helicis

What is chondrodermatitis nodularis helicis? Cause? Who gets it most commonly?

Slight upraised painful nodules that are benign.

Potentially triggered by sun exposure

More common in light skinned people, older ppl, and ppl with lots of sun exposure

If painful, it is likely NOT cancer.

Bowen’s disease —> what is it?

Squamous cell carcinoma in situ

Attributes of Bowen’s disease phase?

1) between cancerous and precancerous

2) Looks like eczema

3) slow growing, could transform into squamous

4) 60+ yo most likely to develop it, more common in lower extremity of women

What is Keratoacanthoma?

Small, dome shaped tumor on the face

What percent of keratoacanthomas turn cancerous?

2%

Common placement? Demographic?

Face is common placement

Ppl middle-aged or older

Growth pattern and resolution timeframe?

Can grow 1-2 cm over 1-2 weeks

Around 4-6 months is will likely spontaneously regress

Where is melanoma more likely to show up on POC?

Plantar surface of foot or nail bed

Melanoma ABCDE (EFG) Rule

Asymmetry

Border irregularity (not good if it looks like melted chocolate)

Color variations- more than two, especially blue/black

Diameter > 6mm (size of pencil eraser)

Evolving- rapidly changing size, symptoms or morphology, becomes pruritic.

[EFG]

Elevated

Firm to palpation

Growing progressively over several weeks

What is the aka for mole?

Nevus

Melanoma acronym and what does it stand for?

MM RISK

Moles: atypical, (dysplastic nevus), >5

Moles: common moles (numerous, >50)

Red hair and freckling

Inability to tan: skin phototypes I and II

Sunburn: severe sunburn especially before age 14

Kindred: family history of melanoma

Most common subtype of melanoma that effects fair skinned people and Hispanics?

Superficial spreading melanoma

Most common subtype of melanoma that effects POC?

Acral lentiginous melanoma

Common distribution pattern of melanoma for white people?

Back and Chest (and lower legs for females)

Common distribution pattern of melanoma for POC? MOST common?

Palms of hands, soles of feet, under the nail

MOST common: plantar portion of the foot