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What is the most common kind of skin cancer? How would you describe its appearnace?
Basal cell carcinoma
Associated with intense intermittent UVR
Waxy, pink, pearly nodules. Commonly with telangiectasias & rolled borders.
What mutation is basal cell carcinoma associated with?
Mutation in hedgehog signalling pathway (leads to upregulation of p53) which differentiates the cell lines during embryogenesis
How do basal cell carcinomas appear histologically?
"Palisading (aligned) nuclei"
What genes are associated with squamous cell carcinoma?
Silencing of p53 (tumor suppressor gene)
BRAF mutation
Cumulative UV exposure leads to SCC (UVB damages p53), not intense epidoses
What is Marjolin's ulcer?
Squamous cell carcinoma ulceration overlying chronic osteomyelitis or burn scar
What is the preferred treatment for BCC/SCC?
Surgical excision with margins
Treatment with vismodegib
What is a cutaneous angiosarcoma? What can it be associated with?
A cutaneous angiosarcoma is a highly malignant vascular tumor
Stewart-treves syndrome is cutaneous angiosarcoma associated with lymphedema after lymph node dissection of axilla in breast cancer
What are some virally associated skin cancers?
HPV → SCC
HHV8 → kaposi sarcoma
Causes spindle cell formation of lymphatic endothelium forming vascular spaces
What is merkle cell carcinoma?
Aggressive cancer of neural crest cells within the dermis
What is mycosis fungoides?
Cutaneous T-cell lymphoma that can resemble eczematoid or psoriasis
Might have cerebriform nuclei → sezary syndrome
What mutations is melanoma associated with? What are the cells of origin for melanocytes?
BRAF mutations (specifically V600E) →
Can treat with vemurafenib
Also associated with NRAS, KIT, CDNK2A, and PTEN mutations
Neural crest cells are cells of origin for melanocytes
What types of melanoma have a poor prognosis? What types have a better prognosis?
Poor: Acral lentiginous & nodular
Better: superficial spreading & lentigo maligna
How do you biopsy melanoma?
Shave biopsy not indicated
Punch biopsy for diagnosis
Excisional with wide margins for treatment
How can you treat melanoma?
Vemurafenib (targets BRAF)
Prognosis is dependent on Breslow depth
What gene is mutated in dysplastic nevi syndrome?
CDKN2A
Seen in familial atypical mole melanoma syndrome (FAMM)
