Snapshot A 42-year-old fair-skinned woman is concerned about a “pink pearly mole” on her cheek. She has no significant past medical history, but reveals that she regularly goes to tanning salons and beaches. She admits that she occasionally forgets to apply sunscreen and does not re-apply when she is outside all day. Introduction Most common skin malignancy that rarely, if ever, metastasizes Epidemiology risk factors sun exposure prior ionizing radiation xeroderma pigmentosum common in fair-skinned individuals Commonly affects upper lip (squamous cell carcinoma typically affects lower lip ) Presentation Symptoms typically asymptomatic, but may be tender if ulcerated slow-growing Physical exam pink, pearly-white, almost translucent dome-shaped nodule or papule overlying telangiectasias commonly develop raised or rolled border commonly ulcerate, bleed, and crust in the center (a non-healing ulcer) frequently on sun-exposed areas Evaluation Diagnosis by skin biopsy basophilic palisading cells on histology nests of basaloid cells in dermis Differential Squamous cell carcinoma Actinic keratosis Treatment Determined by size location histology cosmetic considerations Options electrodesiccation and curettage (typically for non-facial tumors that are small or superficial – not used for aggressive tumors) cure rate up to 92% wide local surgical excision cure rate up to 90% Mohs micrographic surgery (especially if on high-risk and/or cosmetically sensitive areas like the face or if a recurrence) cure rate up to 99% Prognosis, Prevention, and Complications Prognosis if treated, typically very good risk of developing another basal cell carcinoma is 5-8% per year Prevention use sunscreen avoid sun exposure High Yield
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.ON.15.4694) A 47-year-old woman presents to your clinic with complaints of a lesion on her nose. She first noticed it more than a year ago, and it seems to have gotten larger in the past 6 months. The patient is otherwise healthy and works as a tennis coach. Physical exam is notable for the lesion in Figure A. What is the most appropriate treatment for this patient? QID: 107871 FIGURES: A Type & Select Correct Answer 1 Broad surgical excision 0% (0/0) 2 Chemotherapy 0% (0/0) 3 Cryotherapy 0% (0/0) 4 Curettage 0% (0/0) 5 Mohs surgery 0% (0/0) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept (M2.ON.15.62) A 68-year-old male presents to your office for his annual physical exam. He has no complaints at this time and his chronic hypertension is well controlled. You notice a .5cm papule on the patient's eyelid that has a pink pearly appearance, rolled borders, and overlying telangiectasias. On further questioning, you find out the patient was a door-to-door salesman and spent a lot of time outdoors, and he did not wear sunscreen. He has fair skin and blonde hair. The patient states that he first noticed the lesion about 6 months prior, and it has grown slightly since then. What is the most likely diagnosis? QID: 104273 Type & Select Correct Answer 1 Squamous cell carcinoma 6% (1/17) 2 Keratoacanthoma 0% (0/17) 3 Verrucous carcinoma 0% (0/17) 4 Basal cell carcinoma 76% (13/17) 5 Actinic keratosis 12% (2/17) M 6 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept (M2.ON.15.8) A 65-year-old male presents to his dermatologist to discuss treatment options. He was recently diagnosed with basal cell carcinoma located on his nose. It is currently 1 cm in diameter with a central depression (Figure A). Previous pathology findings demonstrate that it is an infiltrative sub-type. What is the most appropriate course of treatment for this individual? QID: 104648 FIGURES: A Type & Select Correct Answer 1 Electrodesiccation and curettage 4% (3/78) 2 Surgical excision 36% (28/78) 3 Mohs surgery 56% (44/78) 4 Topical 5-fluorouracil 3% (2/78) 5 Imiquimod 0% (0/78) M 7 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept