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This Concept Map, created with IHMC CmapTools, has information related to: Head and Neck Cutaneous Neoplasms, Cutaneous Malignancies SQUAMOUS CELL CARCINOMA Tx: Surgery-4-6mm margins if early 1-2 cm margins if advanced Radiation-for cosmesis or non- operative Mohs Neck dissection + Superficial parotid -for clinically positive nodes ONLY Postop XRT-for close or (+) margins, multiple neck nodes or extracapsular extension, perineurla/intravasc invasion, recurrent, or bone or cartilage involvement F/U: qMONTH x 6mos, then q4-6mos, BASAL CELL CARCINOMA-60% OF SKIN CA -common, indolent, rare mets/invasion -sun-exposed in light skin-unrepaired DNA dmg -esp immunosupp, XERO PIGMENTOSUM -AK-damaged skin -worse in embryonic fusion plates -nasolabial folds, nasal floor, columella, preauric regions -40-60% w/ p53 mutations -30% w/ PTCH mutations -pearly papules w/ telangiectasias -some w/ melanin-mimic nevi, melanoma -can ulcerate, invade bone-"rodent ulcers" MORPH-resemble NL basal cells -no mucosa -grow, ulcerate, NO METS Multifocal growths or Nodular lesions -palisading at periphery of tumor islands -separated by stroma by clefts Px: 90% cure rate in H&N -F/U 4-6 mos for recurrence, 2nd primaries NEVOID BASAL CELL CA SYNDROME =GORLIN SYNDROME- AD Many BCCs ងyo Also abnl bone, nervous, eyes, reproductive organs -cleft lip/palate -palm/sole pits -bifid ribs, scoliosis -frontal bossing -odontogenic karatocyst Mutated t-supp PATCHED (PTCH) -ligand is Sonic hedgehog -2-hit hypothesis, Cutaneous Malignancies BASAL CELL CARCINOMA Tx: Excisional Curettage w/ Electrodessication -ɚcm solid-type lesions, NOT morphea Cryosurgery-cold->tissue necrosis -need 5mm margin əcm lesions Scalpel excision-need 4mm margin -may need frozen sections Radiation-if cosmesis imp't Mohs Micrographic Surgery (Chemosurgery) -96% success -for recurrence, morphea-type, cosmesis, Cutaneous Malignancies BASAL CELL CARCINOMA BASAL CELL CARCINOMA-60% OF SKIN CA -common, indolent, rare mets/invasion -sun-exposed in light skin-unrepaired DNA dmg -esp immunosupp, XERO PIGMENTOSUM -AK-damaged skin -worse in embryonic fusion plates -nasolabial folds, nasal floor, columella, preauric regions -40-60% w/ p53 mutations -30% w/ PTCH mutations -pearly papules w/ telangiectasias -some w/ melanin-mimic nevi, melanoma -can ulcerate, invade bone-"rodent ulcers" MORPH-resemble NL basal cells -no mucosa -grow, ulcerate, NO METS Multifocal growths or Nodular lesions -palisading at periphery of tumor islands -separated by stroma by clefts Px: 90% cure rate in H&N -F/U 4-6 mos for recurrence, 2nd primaries, Cutaneous Malignancies BASAL CELL CARCINOMA Marjolin Ulcer -BCCa on previous burn, Cutaneous Malignancies BASAL CELL CARCINOMA Types 1. *Nodular (Noduloulcerative) -pearly, telangiectasias, "rolled" base, central ulceration 2. Superficial-trunk, extremities -scaly, waxy, indurated 3. Morphea (sclerosing or fibrosing) -common on face, flat, depressed -looks like scar or scleroderma -AGGRESSIVE-WORST PX 4. Pigmented-resembles melanoma, behaves like nodular type 5. Fibroepitheliomas-raised, firm, pedunculated or sessile, red w/ smooth skin surface, Cutaneous Malignancies SQUAMOUS CELL CARCINOMA SQUAMOUS CELL CARCINOMA-30% -1-4% Mets -older yo, sun-drenched -MEN>WOMEN, except lower leg Risk-sun, tars/oils, chronic ulcers, draining osteomyelitis, burn scars, arsenicals, ion radiation, tobacco, betel nut chewing -immunosupp or XP, HPV 36 -DNA dmg by UV light -ACTINIC KERATOSIS MORPH-keratin pearls/eddies -in situ CA-red scaling plaques -hyperkeratosis-mimic keratoacan -can be leukoplakia if oral -enlarged, hyperchrom nuc at ALL levels of epid -invasive-diff'd or anaplastic CLINICAL ɝ% mets by discovery time EPIDERMODYSPLASIA VERRUCIFORMIS -many cutaneous SqCC -via HPV 5, 8, Cutaneous Malignancies SQUAMOUS CELL CARCINOMA Variants 1. Solar Keratosis-extend into pap dermis -may not have keratin pearls 2. Spindle Cell-at scar, trauma, burn -swirling, aggressive form 3. Adenoid-pseudoglandular -preauricular in elderly 4. Verrucous-warty 5. Bowen's Dz -CA in situ