02b: CT Diseases Flashcards
Most common subtype of cutaneous lupus erythematosus:
Discoid (70-80%)
Pt with discoid lupus notices hair loss that isn’t growing back with time, despite resolution of inflammed scalp lesions. What is the cause of this and what can be done to treat?
Follicular plugging and scarring alopecia; hair can’t be grown back
T/F: 60% or more of patients with discoid lupus will develop SLE over time.
False - only 10-20% (and with milder systemic disease)
Discoid lupus: histology characterized by which process?
Interface dermatitis
Distinctly photosensitive subset of cutaneous lupus:
Subacute cutaneous lupus eryth (SCLE)
T/F: Subacute lupus (SCLE) and Acute cutaneous lupus (ACLE) lesions heal without scarring.
True
T/F: Subacute lupus (SCLE) lesions most commonly appear on face and extremities.
False - face relatively spared
Presence of anti-(X) Ab is seen in 85% of SCLE patients.
X = Ro
Bilateral malar erythema, especially following (X), is classic for which subset of cutaneous lupus?
X = sun exposure (butterfly rash)
Acute cutaneous lupus (ACLE)
T/F: Acute cutaneous lupus (ACLE) is the subtype that’s least associated with systemic disease.
False - nearly always associated with systemic disease
Rx for Cutaneous Lupus:
- Sun protection and behavioral modification (vit D status, smoking cessation)
- Topical agents (corticosteroids, calcineurin inhibitors)
- Systemics (anti-malarials or immunosuppressives)
Pathognomonic features for dematomyositis:
- Heliotrope rash (around eyelids)
2. Gottron’s papules (flat-topped papules over knuckles, mainly of hands)
Violaceous confluent erythema over knees, cuticular dystrophy, and non-scarring alopecia. These are all features of:
Dermatomyositis
Dermatomyositis typically involves (proximal/distal) (symmetric/asymmetric) muscle weakness.
Proximal; symmetric
Aside from muscle and skin, which organ system(s) are affected by dermatomyositis?
- Joints (arthralgia/arthritis)
- Esophagus (dysphagia, dysphonia)
- Lungs (interstitial lung disease, muscle weakness)
Dermatomyositis has particularly strong association with which malignancies?
- Ovarian
- Lung
- GI (pancreatic, stomach, colon)
- NHL
Dermatomyositis Rx:
- Sun protection and behavior change
- Skin hydration and anti-pruritics
- Topical agents (corticosteroids, calcineurin inhibitors)
- Systemic (anti-malarials or immunosuppressive)
T/F: First manifestations of scleroderma are related to fibrosis and atrophy.
False - edema first (ex: can’t close swollen hands), then fibrosis, then atrophy
The “salt and pepper sign” refers to (X) skin finding and is suggestive of which disease?
X = de-pigmentation except for around hair follicles (esp prominent in dark skin)
Scleroderma
Mat telangiectases are (X)-shaped and can appear on (Y) parts of body. They’re characteristic for which disease?
X = square-ish Y = any (palms, oral mucosa, face)
Scleroderma
Cuticular dystrophy and digital ulcers/pits are characteristic of:
Scleroderma
Calcinosis cutis is a relatively common finding in which disease?
Scleroderma (Ca deposits in skin)
Leading cause of death in scleroderma patients:
Lung disease
Melanocytes are derived from which embryological tissue?
Neuroectoderm
Freckles: increased (pigmentation/proliferation) of melanocytes.
Pigmentation
The common, irregular hyper-pigmented macules seen on dorsal surface of elderly woman’s hands are likely:
Solar lentigo (incidence increases with age and indication of chronic UV exposure)
Histology of solar lentigo would show:
Long rete of epidermis, extending into dermis with increased pigmentation of melanocytes
Acquired nevi can be divided into which subtypes?
- Junctional (flat)
- Compound (dome-shaped)
- Intradermal (pedunculated)
Compound nevi histology: melanocyte proliferation in which layer(s)?
- Junction (epidermis and dermis)
2. Extends into dermis
Intradermal nevi histology: melanocyte proliferation in which layer(s)?
Dermis only (not at junction)
T/F: Congenital melanocytic nevi have no malignancy potential, but acquired nevi do.
False - vice versa
(X) skin finding is blue/black, large flat patches commonly seen in Asian infants. It can be mistaken for (Y).
X = mongolian spot Y = bruising (child abuse)
Mongolian spot: what gives the skin finding the characteristic (X) color?
X = blue-ish
Tyndall effect (melanocytes very deep down and reflection of light gives them blue color)
Familial Atypical Mole Melanoma Syndrome: (X) mutation in about 40% and inherited in which fashion?
X = CDKN2A
AD
ABCDE criteria: cut-off for diameter
6 mm
Most common melanoma subtype:
Superficial spreading melanoma (70%)
20% of melanoma cases are (X) subtype, which primarily grows (radially/vertically).
X = nodular
Vertically (no appreciable radial growth phase; aggressive)
(X)% of melanomas are in (Y) subtype, due to chronic (as opposed to episodic) UV exposure.
X = 5 Y = lentigo maligna melanoma
T/F: Lentigo maligna melanoma more common in head/neck and have long radial growth phase.
True
(X)% of melanomas are in (Y) subtype and non-UV induced.
X = 5 Y = acral lentiginous melanoma
Melanoma on nail-bed is likely to be which subtype?
Acral lentiginous melanoma
(X) melanoma associated with Kit mutation.
X = Acral lentiginous melanoma
Skin biopsy of melanoma: which two characteristics have prognostic value in staging melanoma?
- Breslow depth
2. Ulceration
Sentinel Lymph Node biopsy should be considered for melanomas that have which features?
- Greater than 0.8 mm deep
2. Ulcerated
List the FDA approved drugs for melanoma that target the key (X) pathway.
X = MAPK
- BRAF inhibitors (vemurafenib, dabrafenib)
- MEK inhibitor (Trametinib)
FDA approved “immuno” Rx drugs for melanoma:
- Anti-CTLA4 (ipilimumab)
2. anti-PD1 (nivolumab, pembrolizumab)
T/F: Most effective treatment choice for melanoma is BRAF inhibitors.
False - ONLY given to patients with BRAF mutation (otherwise, melanoma will progress); and combo Rx (BRAFi and MEKi) is preferred
What’s the biggest issue with BRAFi therapy?
Cutaneous squamous cell carcinoma (due to paradoxical activation of MAPK path in normal cells)
Frequency of Cutaneous squamous cell carcinoma that results from BRAFi use can be reduced by:
Adding MEKi
Targeted v immunotherapy for melanoma: which therapy results in higher survival after 3y?
Immunotherapy (but less people respond to it)
