Which of the following statements is correct relative to solar cheilosis (SC)? A. The major etiologic factor associated with SC is ultraviolet radiation, principally UV-B. B. Factors predisposing to SC include skin phenotype, age, male sex, outdoor occupation, rural living, and host immune status. C. AK and SC serve as clinical dose-meters for chronic UVR exposure. D. All of the above. Which of the following statements is correct relative to the carcinogenic effects of UV-B? A. UV-B damages DNA at adjacent pyrimidines resulting in double cytosine to double thymidine transition mutations. B. UV-B induced mutations are so specific that they are frequently referred to as the “UV signature” or “UV fingerprint.” C. UV-B mutations target tumor suppressor genes (impair tumor suppressor activity), the most notable being p53. D. All of the above. Which of the following statements is correct relative to the relationship between actinic cheilosis, gender, and skin phenotype? A. SC occurs more frequently in light-complected than dark-complected individuals. B. Susceptible individuals whose sun exposure habits began early in life are at increased risk of developing SC. C. It has been postulated that women are at lesser risk of developing SC because they experience less chronic exposure to sun than men and they are more likely to use some form of lip protection. D. All of the above. Which of the following statements related to SC is correct? A. While the association between tobacco use and SC is unclear, the habit of leaving a cigarette on the lip has been reported to increase the risk of labial SCC. B. The likelihood that SC will progress to SCC of the lip vermilion is 2.5 times higher than the risk of AK progressing to cutaneous SCC. C. It is estimated that in the United States there are 3500 new cases of SCC of the lip diagnosed annually. D. All of the above are correct. All of the following statements are correct relative to the various stages of SC associated with chronic exposure to UVR EXCEPT which one? A. Chronic exposure to UVR results in sunburn, blistering, and peeling of the lip vermilion. B. Chronic exposure to UVR initially leads to SC characterized by dry, scaly unobtrusive “chapped lips.” C. Palpation provides a sense of rubbing the fingers over sandpaper. D. At later stages, chronic exposure to UVR progressively leads to small nodules, marked parallel fissuring. E. SC may appear mottled, opalescent, with white or gray slightly elevated plaques. Which of the following statements is correct relative to the relationship between actinic cheilosis and squamous cell carcinoma? A. The clinical appearance of actinic cheilosis does not correlate directly with the underlying histological changes and is not predictive when a given actinic cheilosis evolves into squamous cell carcinoma. B. Waxing and waning of erythematous or hemorrhagic area and ulcerations of relatively long duration are ominous signs. C. Induration, redness, ulcerations, and the onset of pain are generally suggestive of malignant transformation. D. All of the above. Which of the following statements is correct relative to the diagnosis of SC? A. The working diagnosis of actinic cheilosis is usually derived by correlating history with clinical findings. B. The presence of concurrent AK on sun-exposed areas (face, neck, bald scalp, ears) reinforces the clinical impressions. C. The progressive nature of SC to squamous cell carcinoma emphasizes the importance of biopsy to establish a definitive diagnosis. D. All of the above. General protection guidelines published by the American Cancer Society to minimize actinic damage include all of the following EXCEPT which one? A. Avoid sun-exposure when UV rays are the strongest, i.e., before 10 AM and after 4 PM. B. Covering-up exposed skin. C. Wearing a hat that shades the neck, face, and ears; wearing sunglasses. D. Using a sunscreen with a sun protection factor (SPF) of 30 or higher. Which of the following statements is correct with respect to sunscreens? A. Sunscreens can be divided into two types based on their ingredients, i.e., inorganic or organic. B. Sunscreens that contain zinc or titanium oxide act to physically block, reflect, or scatter UVR. C. Organic agents have variable absorptive spectra and sunscreen manufacturers typically combine several agents to produce a broad spectrum product capable of blocking both UV-A and UV-B. D. All of the above are correct. All of the following statements are correct relative to lip balms EXCEPT which one? A. For the prevention of SC, the product should be formulated for use on the lip B. The lip balm should provide broad-spectrum protection against both UV-A and UV-B. C. If a lip balm is not available, a board-spectrum crème-formulation sunscreen is preferred. D. Regardless of the sunscreen chosen, it should be applied 15-30 minutes prior to exposure UVR and reapplied after any activity that may wash or rub it away. All of the following statements are correct with respect to SC, which presents as a well-circumscribed nodule or papule less than 5 mm in diameter except which one? mm in diameter except which mm in diameter except which one? A. It is amenable to an excisional biopsy. B. Serial sections of the surgical specimen and histologic evaluation are not necessary. C. Mohs micrographic surgery (MMS), because of its excellent cosmetic yield, may be considered. D. If the histologic diagnosis confirms mild to moderate dysplasia no further treatment is indicated, but the patient should be placed in a closely monitored follow-up program. All of the following statements are correct with respect to SC, which presents as a nodule, papule, area of atrophy, erosion or prolonged ulceration >5 mm in diameter EXCEPT which one? A. An incisional biopsy is indicated. B. Serial sections of the specimen must be evaluated histologically. C. If the histologic diagnosis is mild to moderate dysplasia the area may be treated with 5% topical 5-fluorouracil or imiquimod. D. Treatment with topical agents has been shown to result in excellent clinical remission of SC and to completely eradicate dysplasia at the microscopic level. All of the following statements are correct with respect to cryotherapy (liquid nitrogen applied with a cryoprobe) or electrosurgery in the treatment of SC EXCEPT which one? A. Ablation with cryotherapy (liquid nitrogen applied with a cryoprobe) or electrosurgery can be useful for the treatment of focal SC. B. A major advantage of both of these techniques is that they yield specimens for histologic evaluation of serial sections. C. Cryotherapy requires no local anesthesia and five-year cure rates as high as 99% have been reported. D. Electrosurgery requires local anesthesia and may lead to damage to adjacent tissues and scar formation. Which of the following statements is correct with respect to SC characterized by diffuse leukoplakia or atrophy of the lip vermilion EXCEPT which one? A. Such lesions should have a single incisional biopsy of the most suspicious area, which has generally been shown to correspond to a greater degree of dysplasia. B. If the histologic diagnosis is mild to moderate dysplasia, field therapy with 5% topical 5-fluorouracil or imiquimod may be an option. C. CO 2 laser ablation has been shown to more predictably resolve both the clinical and histological manifestations of SC than topical chemotherapy. D. All of the above are correct. Which of the following statements is correct with respect to SC associated with severe dysplasia? A. SC with severe dysplasia is considered equivalent to or indistinguishable from squamous cell carcinoma-in-situ (SCIS). B. Vermilionectomy or lip-shave is the most prudent and effective approach to the treatment of diffuse SC, as it provides specimens for histologic evaluation of serial sections. C. Scalpel vermilionectomy can be combined with a wedge procedure to simultaneously eliminate SCIS or a small SCC. D. All of the above are correct. Which of the following statements is correct with respect to clinically highly suspicious lesions thought to be SCIS or SCC? A. Clinically highly suspicious lesions thought to be SCIS or SCC must promptly be referred to a head-and-neck surgeon to maximize prognostic outcome. B. The risk of local metastasis increases in direct proportion to tumor size. C. The most commonly involved nodes associated with SCIS or SCC are the submandibular, followed by the submental groups. D. All of the above are correct.