Term
cutaneous squamous cell carcinoma
predisposing factors |
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Definition
UV radiation/fair skin
immunosupression
certain toxins
chronic ulcers, scars, thermal damage
ionizing radiation
HPV
genodermatoses (inherited diseases) |
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Term
| role of UV light as a contributor to skin cancer |
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Definition
UV light drive accumulation of mutations contributing to cancer
p53 mutation is common |
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Term
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Definition
inherited disease causing defective DNA repair
predisposes to skin cancer |
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Term
cutaneous SCC
distribution |
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Definition
head, neck, UE
areas that are the most sun-exposed |
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Term
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Definition
pink papule, nodule, or plaque
firm to hard
typical lesions have a thick scale
ulcerated lesions have indurated border |
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Term
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Definition
large masses of epithelioid cells infiltrating into dermis
variable degree of keratinization
horn pearls - concentric layers of keratinized cells
aggressive - nuclear pleomorphism and atypical mitotic figures
well differentiated SCC cells resemble epidermal spinous and cornified cells |
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Term
| infiltration of cutaneous SCC |
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Definition
keratinizing tumor cells infiltrate the dermis
get much thicker epidermis
*epidermal-like structures in the dermis* |
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Term
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Definition
normal appearing keratinocyte
actinic keratosis
proliferative/recurrent actinic keratosis
SCC in situ
invasive SCC |
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Term
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Definition
gritty surface
thin, adherent scale
no substance |
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Term
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Definition
skin = Bowen's disease
genitalia = erythroplasia of Queyrat |
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Term
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Definition
2-4% rate of metastasis
higher risk in: radiation of burn sites, chronic osteomyelitis sinus tracts, lower lip, genitalia |
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Term
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Definition
most: cut it out at it's gone
surgical excision
cryosurgery
radiation therapy
local immunotherapy
chemotherapy |
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Term
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Definition
less that in the past
3-6 months for 2 years, then yearly |
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Term
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Definition
90% of SCCs have p53 mutations
key additional genetic changes not yet identified |
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Term
| predisposing factors to basal cell carcinoma (BCC) |
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Definition
UV radiation/fair skin
immunosuppression
arsenic
scars, ionizing radiation
genodermatoses |
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Term
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Definition
nodular BCC
superficial BCC
morpheaform BCC |
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Term
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Definition
smooth papule with pearly or translucent appearance
prominent superficial vessels (telangiectases)
occasional ulceration
very common on sun-exposed areas
shiny pink-red bumps |
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Term
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Definition
| thin, slightly scaly, pink plaque |
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Term
| morpheaform (sclerosing) BCC |
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Definition
hypopigmented, depressed, scar-like
rare |
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Term
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Definition
tumor cells arranged in nests in dermis or as epithelial downgrowths
tumor cells resemble epidermal basal cells
characteristic retraction space
*palisading* |
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Term
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Definition
thin strands or tumor cells surrounded by dense, fibrotic stroma
clusters of cells
considered high-risk lesions |
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Term
| BCC metastasis and behavior |
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Definition
BCC usually grows slowly
very low incidence of metastasis - 0.1%
may cause extensive local damage
-loss of organ function
-perineural spread
-invasion through bone |
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Term
|
Definition
electodessication and curettage
surgical excision
cryosurgery
radiation therapy |
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Term
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Definition
require Mohs micrographic surgery
large/recurrent lesions
tumors on central face, ear, chin, jaw
morpheaform
lesion with poor borders
incompletely excised tumors |
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Term
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Definition
PATCHED1 gene mutation
PTCH1 is a receptor for hedgehog proteins, involved in embryonic signaling
*~100% of BCCs have abnormalities in the hedgehog pathway*
Hh pathway inhibitor prevents new BCC development - stop tx, tumors come back |
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Term
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Definition
-constitutive Hh signaling appears to be sufficient for BCC development
-turning off Hh signaling in mouse models of BCC leads to tumor regression
-phase I/II Hh inhibitor trials in BCC are promising, but tumors may grow back after drug is stopped
-additional clinical trials in BCC and other cancers are underway |
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Term
merkel cell carcinoma (MCC)
predisposing factors |
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Definition
age
UV radiation
ummunosuppression
rare! |
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Term
merkel cell carcinoma
distribution |
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Definition
| head, neck extremities most common |
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Term
merkel cell carcinoma
appearance |
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Definition
blue to red papule, nodule, or plaque
firm to hard
ulceration is rare
(difficult to make the diagnosis clinically) |
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Term
merkel cell carcinoma
histology |
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Definition
-tumor cells arranged in nodules in dermis and SQ fat
-"small blue cell tumor" (minimal cytoplasm)
-high mitotic rate
-vascular invasion
-perineural invasion
-necrosis
-lots of mitotic cells |
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Term
merkel cell carcinoma
biological behavior |
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Definition
may exhibit very rapid growth
frequently (20-75%) metastasizes
30-64% 5-year survival rate (more deadly than melanoma) |
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Term
merkel cell carcinoma
treatment |
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Definition
surgery
+/- radiation therapy
+/- chemotherapy
poor response to tx in advanced cases |
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