Actinic Keratoses and Skin Cancer Flashcards
Identify lesion and treatment
- childhood onset
- fair skin
- sun exposed skin
- darkens with sun exposure
- tan to light brown macules (1-2 mm)
Freckle (actinic damage)
Bleaching agents, laser/IPL, **sun protection
- childhood onset, fair skin, hereditary, seen on sun exposed skin
- DON’T change in number/color with UV exposure
- tan, light brown, to black
- 2-10 mm oval shaped macules
Juvenile lentigines (actinic damage)
Bleaching agents, laser/IPL, **sun protection
- sun exposed skin, fair skin, onset is ADULTHOOD, especially late
- increase in number and size with age
- 2-20 mm tan to light brown macules/patches
Solar lentigines (actinic damage)
Bleaching agents, laser/IPL, **sun protection
- lentigines
- EKG abnormalities
- ocular disorders
- pulmonary stenosis
- abnormalities of genitalia
- retardation of growth and deafness
LEOPARD syndrome
ddx: macular seborrheic keratosis, pigmented actinic keratosis, lentigo maligna, junctional melanocytic nevus
Bleaching agents, laser/ IPL, **sun protection
- lentigines
- atrial and/or mucocutaneous myxomas
- neurofibromas
- freckles
- blue nevi
LAMB or NAME syndrome
ddx: macular seborrheic keratosis, pigemented actinic keratosis, lentigo maligna, junctional melanocytic nevus
Bleaching agents, Laser/IPL, **sun protection
- face, neck, chest, dorsal hands
- epidermis thins, skin uneven tone
- fine wrinkles around eyes, deep lines on forehead/cheeks
- telangiectasias
- senile pupura (bruising on dorsal hands and arms)
- milia, solar comedones (blackheads around eyes)
- Poikiloderma of Civatte (dark pattern on neck per UVB)
- Actinic Keratoses
Photoaging
ddx: rosacea, discoid lupus, chronic topical steroid use
tx: derm for eval and monitoring
- topical retinoids
- antioxidant serums
- sun protection (prevents and txs)
- premalignant lesion (SCC and BCC)
- common in fair skin, 40+, TRANSPLANT pts
- sun exposure
- face, ears, neck, shoulder girdle, dorsal hands/arms
- 1-6 mm scaly/flakey/rough papule w/out underlying induration (think sandpaper)
- no color to red to tan
Actinic keratosis
ddx: SCC, BCC, lentigo maligna, inflamed seborrheic keratosis
tx: cryotherapy, topical 5-fluorouracil 5% cream (red aftermath)
Most common skin cancer
BCC
- caucasians>asians> africans
- face, scalp, ears, neck
- pearly/shiny papule with telangiectasia
- pink, tan, or skin colored
- can develop into a nodule
- can have rolled/raised/rounded borders with a flat center
- 2 mm to >2 cm
BCC aka Rodent Ulcer
types: nodular BCC (most common), pigemented, superficial, morpheaform, sclerosing, micronodular (determined by microscopic eval)
tx: If superficial: ED&C or photodynamic therapy if not surgical candidate
- all others: excision–>Moh’s micrographic surgery
- skin checks twice yearly
- head, neck, hands
- 2 mm to >2 cm poorly defined scaly papule
- adherent scale/cutaneous horn
- can be dull red, firm nodule with crusted center
SCC
ddx: BCC, malignant melanoma (amelonatic), Merkel cell carcinoma, inflamed seborrheic keratosis
tx: excision per Moh’s micrographic surgery, skin cancer checks twice yearly, lymph node palpation, imaging studies and radiation (high risk tumors)
Risk factors for SCC
- UV radiation, exposure to hydrocarbons, arsenic tobacco
- chronic infections/inflammation (psoriasis, atopic dermatitis)
- burns
- HPV/HIV
- transplant pt
- caucasian
- head, neck, hands
- if HPV induced, will see on genitalia and periungally
- d/t UVR, arsenic, hydrocarbons, chronic heat exposure
- Sun exposed areas: red, sharply demarcated, scaling, hyperkeratotic papule/plaque
- Genitalia: red, sharply demarcated, glistening macule/papule, patch/plaque
- anogenital: tan, brown or black papules
- 6mm–> >10 mm
Bowen’s Disease (variant of SCC)
ddx: superficial BCC, seborrheic keratosis, psoriasis, localized chronic eczematous dermatitis
tx: excision, electrodessication and curettage, cryosurgery, topical 5-fluorouracil, skin cancer checks twice yearly
- face, neck, dorsal hands, UE’s and LE’s
- rapidly growing crateriform nodule
- 0.5-2.0 cm flesh-colored or red, tender
Keratoacanthoma (variant of SCC)
ddx: SCC, giant molluscum contagiosum, warts
tx: excision, electrodessication and curettage, skin eval q6 months
What factors increase the risk of malignant melanoma?
- fair skin/blonds and redheads with blue or green eyes
- atypical nevi
- personal hx melanoma
- fam hx of atypical nevi or melanoma
- hx of blistering sunburn (5 or more betw ages 15-20)
- large congenital nevi
- tanning bed use
Presents in any color: pink, red, any variation of brown or black, and variegated in color (anything blue/red in black background)
- any shape with irregular borders
- any size
- 30% pre-existing melanocytic nevus, 70% de novo
Malignant melanoma
tx: not sure, excise it, refer to derm
At derm: re-excise per guidelines, total body skin checks, check lymph nodes, spleen, liver, CXR, LFTs, watch skin tattoos closely
