Skin Cancer Overview and Types

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Questions and Answers

Which of the following is a characteristic of basal cell carcinoma?

It appears as an irregular, flaky lesion.

It usually arises from melanocytes in the epidermis.

It primarily affects cells in the stratum corneum.

It can present as a well-circumscribed, pearly elevation. (correct)

What is the purpose of dermoscopy in the evaluation of skin lesions?

To visualize subsurface structures not visible to the naked eye. (correct)

To completely remove lesions without further procedures.

To provide a definitive diagnosis of skin cancer.

To assess the efficacy of skin cancer treatments over time.

Which of the following dermoscopic criteria would suggest malignancy in a pigmented lesion?

Homogeneous color distribution.

Well-defined borders.

Presence of ulceration.

Asymmetric distribution of colors and structures. (correct)

What distinguishes excisional biopsies from other types of skin biopsies?

They involve the complete removal of the lesion and surrounding healthy skin. Signup and view all the answers

What type of skin cancer is primarily associated with cells in the stratum basale?

Basal cell carcinoma. Signup and view all the answers

What is the recommended surgical margin for excising an in situ melanoma?

0.5 centimeter Signup and view all the answers

Which type of therapy is suggested for individuals with a single microscopic lymph node involvement in melanoma?

Adjuvant immunotherapy with a PD-1 agent Signup and view all the answers

What size of melanoma should warrant lymphatic mapping and sentinel lymph node biopsy?

0.8 millimeters thick or greater Signup and view all the answers

Which mutation analysis should be performed if the BRAF V600 mutation is negative?

Assessment for mutations in KIT Signup and view all the answers

Which of the following features of a melanoma lesion does NOT represent a worrisome sign according to the ABCDE mnemonic?

Uniform coloration Signup and view all the answers

What is the primary disadvantage of surgical excision when treating basal cell carcinoma?

It is invasive and sacrifices healthy tissue. Signup and view all the answers

Which treatment method involves the immediate examination of excised tumor margins under a microscope?

Mohs micrographic surgery Signup and view all the answers

What is the most accurate statement about Bowen’s disease in relation to squamous cell carcinoma?

It remains within the epidermis without breaking the basement membrane. Signup and view all the answers

Which treatment option is least likely to be used for basal cell carcinoma due to its high recurrence risk?

Photodynamic therapy Signup and view all the answers

In the management of actinic keratosis, which treatment method is typically used?

Topical therapies with fluorouracil or imiquimod Signup and view all the answers

Study Notes

Skin Cancer

Skin cancer types determined by the type of skin cell involved
- Basal cell carcinoma: Cells in the stratum basale, slow-growing, rarely metastasize, but locally invasive.
- Squamous cell carcinoma: Squamous keratinocytes, can metastasize to lymph nodes or distant areas.
- Melanoma: Melanocytes, most aggressive type, metastasizes quickly.
Diagnosis:
- Begins with visual examination and patient history
- Dermoscopy: non-invasive technique to visualize subsurface skin structures
- Biopsy: Definitive diagnosis, shows cell type
  - Shave biopsy: superficial skin removal
  - Punch biopsy: core-shaped tissue removal
  - Excisional biopsy: entire lesion and surrounding skin removal
Basal cell carcinoma:
- Appearance: Well-circumscribed, pearly, waxy, or shiny elevation with small blood vessels.
- Biopsy: Palisading pattern of tumor cells.
- Treatment:
  - Surgery: Excisional surgery, Mohs Micrographic Surgery
  - Other: Cryotherapy, Curettage and electrodesiccation, Photodynamic therapy
  - Medications: Fluorouracil, Imiquimod
Squamous cell carcinoma:
- Stages: Actinic keratosis (precancerous), Bowen's disease (early stage), Invasive squamous cell carcinoma
- Treatment:
  - Actinic keratosis: Cryotherapy, topical fluorouracil or imiquimod, photodynamic therapy
  - Bowen's disease and Invasive SCC: Surgical excision, Mohs surgery
  - Adjuvant radiotherapy: Extensive perineural involvement, positive surgical margins, single positive lymph node.
  - Second line: Curettage and electrodesiccation, cryotherapy, photodynamic therapy, radiotherapy.
  - Medications: Fluorouracil, imiquimod, Systemic chemotherapeutic agents (cisplatin, capecitabine, methotrexate, cetuximab, bleomycin, doxorubicin, cemiplimab)
Melanoma:
- Precancerous: Melanocytic nevus (mole)
- Growth: Horizontal (within epidermis) and vertical (invading dermis)
- Signs: ABCDE (Asymmetry, Borders irregular, Color varies, Diameter > 6mm, Evolution rapid)
- Biopsy: Full-thickness excisional biopsy to determine thickness and cell characteristics.
- Treatment:
  - Surgical excision: Width dependent on tumor thickness (0.5 - 2 cm)
  - Adjuvant radiotherapy: For high-risk recurrence (tumors > 4 mm, ulceration)
  - Lymphatic mapping and sentinel lymph node biopsy: For tumors ≥ 0.8 mm or smaller tumors with ulceration.
  - Adjuvant immunotherapy: Microscopic involvement of a single lymph node (nivolumab, pembrolizumab)
  - Targeted therapy: BRAF V600 mutation (dabrafenib + trametinib)
  - Palliative treatment for metastatic melanoma: Surgical metastasectomy, radiotherapy, or systemic medications (immunotherapy, targeted therapy, chemotherapy)

Follow up for all skin cancer patients:

At least once a year

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Description

This quiz covers the different types of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma. It discusses their characteristics, diagnosis methods such as dermoscopy and biopsy, and treatment options. Test your knowledge on skin cancer and its various aspects.