CC Sept 2015 Actinic keratosis

echoecho's version from 2015-10-15 02:14


Question Answer
What is the most common premalignant skin lesion?actinic keratosis
AK's occur only on what type of damaged skin?sun damaged
What is the cause of AKs?a UV-light induced gene mutation results in clones of abnormal squamous cells
List 2 patient types at highest risk?fair-skinned patients and those with extensive skin sun exposure
Describe AKs when they first begin as to appearance?increased vascularity with slight roughening of the skin surface
Later there may be an adherent, what color crust?yellow
Removal of the crust may result in?bleeding
Lesions may be single or multiple and vary in size from ____ to ____ mm?3-6
List 2 other possible symptoms? pruritis, burning sensation
AK's increase in prevalence with advancing ____?age
AK's are more common in what gender?men
AKs can undergo futher mutation and become what type of skin cancer?SCC (squamous cell cancer)
The risk of malignant transformation of an AK within 1 year is about 1 in 1000, however, most do not progress to SCC and ___% regress spontaneously?26%
Do AKs progress to malignant melanoma?no
Management of AKs may be what 2 options?med or surg
*** Although treatment may be done for cosmetic purposes and symptom relief, what is the primary goal of tresatment?prevention of SCC
List medical management options?photodynamic therapy or topical therapies
List surgical managment options?cryosurgery, curettage, electrosurgery
For large lesions or diagnostic uncertainty, what should be performed to r/o underlying occult malignancy?biopsy
When are topical therapies useful?for patients with 15 or more AKs
What determines time of response to topical treatment?depends on area of body treated
Lesions on what part of the body are the quickest to respond? take the most time to respond?face; arms
Can lesions recur after topical treatment?yes
List a topical cream with 3 brand names that may cause pain and edema? what is the treatment duration?1) Fluouracil cream 5% (Brand: Carac, Efudex, Allergan) 2) 2-4 weeks
Fluorouracil can also be used as ____ therapy before cryosurgery?adjuvant
What category is Imiquimod (Aldara) cream in?it is an immunostimulant
What side effects can Imiquimod (Aldara) cause? Length of treatment?1)erythema, scabbing; ulceration, systemic reactions like fatigue, flu-like s/s, angioedema 2) 16 weeks
What is treatment duration for diclofenac gel (Solaraze)?9-12 weeks
Can chemical peels be a rx option?yes
Explain how photodynamic therapy (PDT) works?a photosensitizing agent (topical aminolevulinic acid (Levulan Kerastick) is applied to each AK. After incubation period,, the treated area is exposed to a specific wavelength of light that leads to cell death
*** A recent meta-analysis and systematic review comparing photodynamic therapy (PDT) to cryrotherapy found that PDT had a 14% higher likelihood of complete lesion clearance at ____ months for thin AKs on the face and scalp? 3
Is Naproxen an effective therapy for AKS?no
A new FDA-approved rx gel for AK was approved in 2012. Give the name and brand name? What is the dosage? What is the mechanism of action1) Ingenol mebutate gel (Brand: Picato) 2) 2-3 day duration dosage. Dependent on area of treatment (0.15% gel = face and scalp), 0.05% gel on trunk / extremities 3) mechanism of action: mitochondrial swelling and membrane disruption and B-cell antibody cellular toxicity
*** 4 multicenter, randomized controlled trials showed 2-3 days of gel was effective for AK rx with only mild adverse effects. True or false?true
What is the most common method of treating AKs?cryrosurgery
Explain how cryrosurgery is performed?1)performed usually with liquid nitrogen (but nitrous oxide or carbon dioxide can be also used) 2) longer treatments are more effective
Is cryosurgery effective on hyperkeratotic lesions? Why or why not? What can be done?1) no 2) because they must be debrided before rx 3) curretage is done by scraping the AK wiht a sharp curette (useful but requires local anesthesia)
What procedure may be required as an adjuvant to curretage to destroy the remaining abnormal tissue and provide hemostasis?electrosurgery
Although the application of a sunscreen is not treatment for AKs, regular use has been demonstrated to decrease what?development of new AKs
In a study involving about 500 adults > 40 years of age, the regular use of sunscreen over one summer reduced what?the number of new AKs by about 40%
Have sunscreens been proven to increase the likelihood of spontaneous resolution of preexisting AKs?no
*** Summary: Fair-skinned individuals and those with extensive ____ exposure are at highest risk for AKs?sun
*** Summary: AKs may undergo further mutation and become what type of skin cancer?squamous cell carcinomas
*** Summary: What are the two options of treatment for AKs?medical and surgical
*** Summary: Application of sunscreen is not treatment, although regular use has been demonstrated to decreased what?the development of new AKs