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👩🏼‍⚕️ ANDREWS' DISEASES OF THE SKIN 13TH EDITION > 29- Epidermal Nevi to SCC/Merkel > Flashcards

29- Epidermal Nevi to SCC/Merkel Flashcards

1
Q

Most common type of epidermal nevus

A

Keratinocytic epidermal nevi

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2
Q

Most common pattern of keratinocytic epidermal nevus

A

Linear epidermal nevus

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3
Q

Verrucous, skin colored, dirty gray or brown papules that coalesce to form serpiginous plaque

Onset at birth or within 10 years old
Follow lines of Blaschko

A

Keratinocytic epidermal nevus

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4
Q

Most common internal manifestations in keratinocytic epidermal nevus

A

Skeletal

CNS

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5
Q

Management of keratinocytic epidermal nevus

A

Can be difficult -recurs

5% 5-FU plus 0.1% tretinoin cream OD
Cryotherapy
CO2 or Er:YAG laser
Excision- small lesion

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6
Q

Closely arranged, grouped often linear papules that have dilated folliculr openings with keratinous plugs that resemble comedones

Unilateral, mostly on trunk, develop from birth to 15 years old

A

Nevus comedonicus

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7
Q

Treatment of nevus comedonicus

A

Uncomplicated- primarily cosmetic (pore strips, topical tretinoin)

Inflamed- oral isotretinoin 0.5mg/kg/day (most fail to respond)

Excision- limited area affected

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8
Q

Erythematous papules and plaques with fine scale; characteristically pruritic

Follow lines of Blaschko, onset before 5 yo
Usually occurs only on one side

A

Inflammatory linear verrucous epidermal nevus (ILVEN)

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9
Q

Treatment for ILVEN

A

Topical vitamin D
Topical anthralin

Steroids, retinoids- limited benefit

Surgical- excision, cryotherapy, laser

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10
Q

Circumscribed, red, moist, shiny nodule with some crusting and peripheral scale

Usually on shin, calf, thigh
Asymptomatic, slow growing, occurs after age 40

A

Clear cell acanthoma

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11
Q

Treatment for clear cell acanthoma

A

Cryotherapy, CO2 laser or excision

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12
Q

Sharply demarcated papules or plaques, “stuck on appearance”

Palms and soles spared, usually on chest and back

Crumbly surface, when removed, raw moist base revealed, common in sun exposed areas

A

Seborrheic keratosis

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13
Q

Treatment for seborrheic keratosis

A

Liquid nitrogen, curretage

Others: light fulguration and shave removal

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14
Q

Sudden appearance of numerous seborrheic keratoses in an adult thay may be a sign of cutaneous malignancy

Rapid onset, develops at the same time as the cancer, often pruritic

A

Sign of Leser-Trélat

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15
Q

Most common neoplasms associated with Leser-Trélat sign

A

Adenocarcinoma (GIT)

Other: lymphoma, breast, SCC of lung

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16
Q

Minute, round, skin colored or hyperpigmented macules or papules that develop on malar/cheeks below eyes, May also involve neck, upper chest

Asymptomatic
Usually begins in adolescence
Common in black/asians

A

Dermatosis papulosa nigra

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17
Q

Treatment for dermatosis papulosa nigra

A

Light curretage
Liquid nitrogen
Electrodessication

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18
Q

Risk factors for developing skin cancer

A

Fair skinned who tan poorly
Significant chronic or intermittent sun exposure

Other: history of skin cancer
Prior radiation, PUVA, systemic immunosuppression, arsenic exposure

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19
Q

Major cause of nongenital non melanoma skin cancer (NMSC) and actinic keratoses

A

Ultraviolet radiation (UVR)

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20
Q

In situ dysplasia from sun exposure

Found on sun exposed surface- multiple, red pigmented or skin colored, flat or elevated verrucous or keratotic

Surface covered with adherent scale, rough like sandpaper, usually 3 to 1cm

A

Actinic keratosis

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21
Q

Most common epithelial precancerous lesions

A

Actinic keratosis

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22
Q

Actinic keratosis can be prevented by

A

Sunscreen

Low fat diet

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23
Q

What are the six types of actinic keratosis

HABA PiLa

A 
Hypertrophic 
Atrophic
Bowenoid
Acantholytic 
Pigmented
Lichenoid
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24
Q

Treatment of actinic keratosis

A

Cryotherapy with liquid nitrogen
Topical chemotherapy- extensive, broad or numerous lesions

Surgical- chemical peel, laser, photodynamic therapy

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25
Q

Two agents most often used in topical chemotherapy of actinic keratosis

A

5-FU cream

  • 0.5-5% OD
  • 0.5% x 2-3 weeks
  • 5% x 3-6 weeks

Imiquimod
-5% cream 3x a week

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26
Q

4 types of keratoacanthoma

A

Solitary
Multiple
Eruptive
Keratoacanthoma centrifugum marginatum

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27
Q 
Rapidly growing papule, dome shaped skin colored, smooth crater with central keratin plug
Unique feature: 
rapid growth x 2-6 weeks
Stationary x 2-6 weeks
Spontaneous involution x 2-6 weeks

Occurs on sun exposed skin

A

Solitary keratoacanthoma

28
Q

Treatment for keratoacanthoma

A

Excisional biopsy- <2cm

  • exclude SCC
  • excision recommended 50% involution after 3 weeks

Intralesional 5-FU, bleomycin, methotrexate

Low dose systemic MTX- multiple lesions

29
Q

Type of keratoacanthoma that usually has a family history

A

Multiple (Ferguson Smith type)

30
Q

Risk factors for BCC

A 
intermittent sun exposure
(+) family hx
Immunosuppresion
Skin types I and II
Blistering sunburns in childhood
31
Q

Most common form of BCC

A

Nodular BCC (50-80%)

32
Q

Waxy semi translucent nodules around a central depression

Edge has characteristic rolled border
Bleeding on slight injury is common
Ulcer occurs over time

Lesions usually on face and nose

A

Nodular BCC

33
Q

BCC that favors the trunk and distal extremities

Dry psoriasiform scaly lesion, superficial flat growth, enlarge very slowly

A

Superficial BCC

34
Q

Most common pattern of BCC seen in HIV patients

A

Superficial BCC

35
Q

BCC that usually occurs in Latinos or Asians

A

Pigmented BCC

36
Q

Neglected BCC that had formed an ulceration

A

Rodent ulcer

37
Q

Though metastasis is extremely rare, this is the usual site of metastasis in BCC

A

Regional lymph nodes

38
Q

Increases the risk of developing BCC by 10 fold

A

Immunosuppresion from organ transplantation

39
Q

Topical therapy with 5-FU BID x 6 weeks or imiquimod 3x a week with occlusion for 6 weeks has an 80% cure rate in this type of BCC

A

Superficial

40
Q

Surgical management of BCC

A

Excision- preferred due to higher cure rates

Cryosurgery

41
Q

Autosomal dominant disorder that presents with multiple BCC before 30 years old along with:

Jaw cysts-painless swelling
Pitting of palms and soles
Skeletal defects

A

Nevoid BCC syndrome (Gorlin syndrome)

42
Q

Second most common form of skin cancer

A

SCC

43
Q

Major risk factor in the development of SCC

A

Chronic long term sun exposure

44
Q

Immunosuppresion also enhances the risk of developing SCC

Exposure to this drug is associated with greater risk

A

Azathioprine

45
Q

SCC that develops in the genitalia may be due to

A

HPV 16 18 31 35

46
Q

SCC usually occurs at these sites

A

Face

Back of hands

47
Q

Important risk factors for metastasis in SCC

A

Thickness

Others: immunosuppresion, ear location, increased horizontal size

48
Q

Treatment of SCC

A

surgical excision

49
Q

Cause of Bowen disease (SCC in situ)

A

HPV
Arsenic
Sun exposure

50
Q

Erythematous, Slightly scaly and crusted, noninfiltrated patch, sharply defined

May be pigmented if on genital area
Invasion- devt of exophytic, endophytic or ulcerative component

A

Bowen’s disease (in situ SCC)

51
Q

More aggressive than SCC arising in actinic keratosis

A

Bowen disease

52
Q

BD may be misdiagnosed as

A 
Psoriasis
Tinea corporis
Nummular eczema
Seborrheic or actinic keratosis 
Pagets disease
53
Q

Treatment for Bowen disease

A

Imiquimod 5% cream OD X16 weeks or in combination with 5% 5-FU cream BID

Excision, Mohs surgery

54
Q

SCC in situ of the glans penis or prepuce

A

Erythroplasia of Queyrat

55
Q

Erythroplasia of Queyrat is caused by

A

High risk HPV (16,18,31,35)

56
Q

Fixed, well circumscribed, erythematous moist red surface plaques on the glans penis

Mostly occurs in uncircumcised men over 40

A

Erythroplasia of Queyrat

57
Q

Treatment for erythroplasia of Queyrat

A

Patient’s sex partner referred for evaluation

Topical: 5-FU or Imiquimod
Surgical

58
Q

Benign inflammatory lesion of the glans penis: red patch, erythematous moist and shiny, does not produce adenopathy

Histo-plasma cell rich infiltrate

Uncircumcised men affected 24-85 years old

A

Zoon Balanitis

59
Q

Treatment for Zoon Balanitis

A

Topical corticosteroids
With or without candidal treatment

Circumcision

60
Q

Unilateral sharply marginated erythematous patch or plaque in the nipple or areola

May become eroded, may have axillary adenopathy

5% without evidence of CA

A

Paget disease of the breast

61
Q

Presence of this symptom should lead to suspicion of Paget disease

A

Unilateral eczema of the nipple resistant to treatment

62
Q

Most common location of extramammary Paget disease

A

Vulva

63
Q

Tumor that usually occurs in elderly white men

Strong evidence of sun exposure, also with PUVA and immunosuppresion

Rapidly growing nontender red to violaceous nodule with shiny surface and telangiectasia

A

Merkel cell carcinoma

64
Q

Acronym AEIOU for Merkel cell CA

A 
Asymptomatic
Expanding rapidly 
Immunosuppresion 
Older than 50
UVR exposed in fair skin
65
Q

Cause of Merkel Cell CA 80% in North America and 25% in Australia

A

Merkel cell polyomavirus (MCPyV)

66
Q

Treatment for Merkel cell carcinoma

A

Staging- sentinel lymph node biopsy

Surgery and radiation

👩🏼‍⚕️ ANDREWS' DISEASES OF THE SKIN 13TH EDITION (32 decks)

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