SKIN CANCER: QUESTIONS

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SKIN CANCERQUESTIONS

• William A. Curry, MD
• Medicine Resident Block Lectures 2007 2008

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• Non-melanomatous skin cancer is most clearly
  associated with exposure to
• UV B wavelengths
• UV A-1 wavelengths
• UV A-2 wavelengths
• All of the above

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• Non-melanomatous skin cancer is most clearly
  associated with exposure to
• UV B wavelengths
• UV A-1 wavelengths
• UV A-2 wavelengths
• All of the above

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• Which of the following have increased risk for
  non-melanoma skin CA (SCC/BCC)?
• Ionizing radiation
• Post-transplant immunosuppression
• Thermal burns
• a and b
• All of the above

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• Which of the following have increased risk for
  non-melanoma skin CA (SCC/BCC)?
• Ionizing radiation
• Post-transplant immunosuppression
• Thermal burns
• a and b
• All of the above

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• 57 yo pale-skinned red-headed male has nodular
  lesion on his neck that is flesh-colored,
  dome-shaped and has adjacent telangiectasias.
  Most likely this is
• Lentigo maligna
• Squamous cell CA
• Basal cell CA
• Actinic keratosis

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• 57 yo pale-skinned red-headed male has nodular
  lesion on his neck that is flesh-colored,
  dome-shaped and has adjacent telangiectasias.
  Most likely this is
• Lentigo maligna
• Squamous cell CA
• Basal cell CA
• Actinic keratosis

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Nodular Basal Cell Carcinoma
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Lentigo maligna melanoma
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Actinic Keratosis
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• TRUE or FALSE
• Basal cell carcinomas almost never metastasize
  but can cause extensive local destruction if left
  untreated.

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• TRUE or FALSE
• Basal cell carcinomas almost never metastasize
  but can cause extensive local destruction if left
  untreated.
• TRUE

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Sclerosing Basal Cell Carcinoma
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• The risk of metastasis in squamous cell carcinoma
  is
• 10-20
• 2-6
• Less than 1
• Unknown

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• The risk of metastasis in squamous cell carcinoma
  is
• 10-20
• 2-6
• Less than 1
• Unknown

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Well-differentiated SCC
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• Which of the following is true concerning
  metastasis in squamous cell CA of the skin?
• Lesions larger than 2 cm have threefold increased
  risk
• Lesions growing noticeably in a 3 month period
  have increased risk
• Lesions of face and vertex of the scalp have
  increased risk
• All of the above
• None of the above

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• Which of the following is true concerning
  metastasis in squamous cell CA of the skin?
• Lesions larger than 2 cm have threefold increased
  risk
• Lesions growing noticeably in a 3 month period
  have increased risk
• Lesions of face and vertex of the scalp have
  increased risk
• All of the above
• None of the above

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• What do you recommend for these scaly lesions?
• Shave biopsy
• Excisional (deep) biopsy
• Topical 5-flurouracil
• Mohs micrographic surgery

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• What do you recommend for these scaly lesions?
• Shave biopsy
• Excisional (deep) biopsy
• Topical 5-flurouracil
• Mohs micrographic surgery

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8. This 28 yo AAM thinks he bruised his foot
playing basketball. What do you
recommend?

• Ice, elevation, and observation
• Immediate referral for excisional biopsy
• Cryotherapy
• Recheck in one month

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8. This 28 yo AAM thinks he bruised his foot
playing basketball. What do you
recommend?

• Ice, elevation, and observation
• Immediate referral for excisional biopsy
• Cryotherapy
• Recheck in one month

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9. A B C D E of M e l a n o m a

• A
• B
• C
• D
• E

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9. A B C D E of M e l a n o m a

• Asymmetry
• Border ill-defined
• Color very dark, black, or variegated with
  multiple colors in a single lesion
• Diameter greater than 6 mm (pencil eraser)
• Enlargement

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Nodular melanoma

• Superficial spreading
• melanoma

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Melanoma of heel masquerading as a pressure sore
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10. 64 yo w lesion that appeared 3 wks ago

• BCC
• SCC
• Melanoma
• Actinic Keratosis
• None of the above

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10. 64 yo w/ lesion that appeared 3 wks ago

• BCC
• SCC
• Melanoma
• Actinic Keratosis
• None of the above (Merkel cell CA)

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11. On the way out the door, she says, Doctor,
what is this?
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11. On the way out the door, she says, Doctor,
what is this?

• Cutaneous horn

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48 YO with 6 week fast-growing lesion of forearm.
BX keratoacanthomaAcceptable therapyincludes

• Excision
• Wide excision with
• sentinel node biopsy
• Watchful waiting
• a and b but not c
• a and c but not b

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48 YO with 6 week fast-growing lesion of forearm.
BX keratoacanthomaAcceptable therapyincludes

• Excision
• Wide excision with
• sentinel node biopsy
• Watchful waiting
• a and b but not c
• a and c but not b

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60 YO male with peri-anallesion for several
months.BX SCC in situ(Bowens disease).

• Options include
• Excision
• Wide excision with sentinel lymph node biopsy
• Topical imiquimod
• Watchful waiting
• a and c

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60 YO male with peri-anallesion for several
months.BX SCC in situ(Bowens disease).

• Options include
• Excision
• Wide excision with sentinel lymph node biopsy
• Topical imiquimod (Mechanism of action is
  unknown however, induces cytokines, including
  interferon-alpha and others)
• Watchful waiting
• a and c