Basal cell carcinoma AND squamous cell cancer

Question 1

incidence and natural hx -4

Answer 1

BCC most common human cancer

Question 2

BCC etiology -3

Answer 2

basal cell layer,

mets rare,

extensive local damage if untreated

Question 3

SCC etiology -4

Answer 3

rapid growth,

local invansion,

mets potential,

perineural involvement associated with increased risk of recurrence post tx and inc risk of mets

Question 4

risk factors -9

Answer 4

UV light, 
age, 
actinic keratoses,
 ionizing radiation, 
chronic immunosuppression, 
viruses, 
chronic arsenic exposure, 
chronic skin inflammation, 
genetic conditions (xeroderma pigmentosum, epidermolysis bullosa, albinism, epidermodysplasia verruciformis)

Question 5

risk factors for recurrence -7

Answer 5

increased size,

poorly differentiated borders,

recurrent dz,

site of prior RT,

immunosuppression,

aggressive growth pattern,

perineural involvement

Question 6

prevention -3

Answer 6

minimize UV,

sunscreen,

treat actinic keratosis (premalignant SCC) with retanoids

Question 7

signs and sx -4

Answer 7

nodularity,

erythema,

scaly plaque,

necrosis

Question 8

primary tx concepts -7

Answer 8

goal: cure of tumor AND maximal preservation of function

Question 9

vismodegib indication

Answer 9

metastatic or locally advanced BCC that has recurred following surgery or who are not candidates for surgery or XRT

CR 21-22%

median response duration: 7.6 mo

Question 10

vismodegib ADR -12

Answer 10

muscle spasms, 
alopecia, 
dysgeusia, ageusia
wt loss, 
fatigue, 
N, D, V
dec appetite, 
constipation, 
arthralgias

Question 11

follow up -3

Answer 11

close follow-up extremely important with pt counseling

BCC - q6mo x5yr (36% develop another primary BCC within 5yrs)

SCC - q3mo x5yr, then q6mo indefinitely

Question 12

prognosis -2

Answer 12

2000 deaths out of 1-2 million new dx

rare met dz <50% 5yr OS