Benign and Malignant Neoplasms of the Skin

Question 1

Nevi?

Answer 1

pigmented skin lesion that is usually benign. Commonly called moles, usually involve epidermis and dermis but rarely may involve the subcutaneous tissue as well.

Question 2

Junctional Melanocytic Nevus

Answer 2

macule, tan to black, round with smooth borders. epidermis. Usually appear in early childhood

Question 3

Compund Melanocytic Nevus

Answer 3

Papule or nodule, light to black but usually dark brown, Surface may be smooth or cobblestone, defined borders, always <1 cm. Involves both dermis and epidermis. Appear in childhood

Question 4

Dermal Melanocytic Nevus

Answer 4

Papule or nodule, smooth, dome shaped. From dermis, possible hairs. Appear in adults

Question 5

Halo Nevus

Answer 5

Halo of depigmentated skin around a junctional or compound nevus. Nevus will regress, leaving white spot which will repigment. May also occur around melanoma

Question 6

Blue Nevus

Answer 6

Papule or nodule, firm, dark blue to black. Very small. Appear in children and young adults, if large biopsy for confirmation

Question 7

Nevus spilus

Answer 7

Many dark brown macules or papules scattered throughout a pigmented background Junctional and compound nevi are scattered in a defined area of increased melanocytes

Question 8

Spitz Nevus

Answer 8

Nodule, dome-shaped, hairless, ,1cm, epidermis only, reddish. Appear in children and adults under 40. Develop relatively abruptly which makes diagnosis confusing

Question 9

Mongolian spot

Answer 9

Macule, gray-blue, usually in lumbosacral area. Congenital, seen in Asians and Native Americans, may fade and disappear

Question 10

Nevus of Ota

Answer 10

Macule, area dusky blue/brown. Distributed around the trigeminal nerve, including mucous memb. and sclera. Not hereditary, but most common in Asians. Will not fade or disappear. Lasers can help

Question 11

Dysplastic Nevi

Answer 11

atypical nevus and potential precursor to melanoma. Irregular border, indistinct margins, mixed coloration. The “ugly duckling” sign

Question 12

Management of Dysplastic Nevi

Answer 12

Excision NOT recommended, only remove if lesion has changed or cant be followed. Follow up with pt every 12 months if family history or large # or every 3-6 months if not

Question 13

Congenital Melanocytic Nevus (CMN)

Answer 13

Precursor to melanoma, present at birth but fades in.
<15 cm= low risk
Surgical excision may be necessary for large lesions
small lesion removal can be delayed

Question 14

What is ABCDE Rule?

Answer 14

Used to detect whether melanoma has developed. 
A= Asymmetry
B=Border
C=Color
D=Diameter
E=Elevation and Enlargement

Question 15

Melanoma

Answer 15

A malignancy of melanocytes that occur in skin, eyes, ear, GI tract, oral and genital mucous membranes. One of the most dangerous tumors. Leading cause of skin disease

Question 16

Risk Factors for Melanoma

Answer 16

Dysplastic nevus >5, congenital nevus, large # of benign moles, family history of DN or melanoma, red hair, fair skin, sever sunburn before 14, previous non melanoma or melanoma skin cancer

Question 17

Management of suspicious lesions

Answer 17

Recognize melanoma at earliest stage
Use ABCDE rule
excise suspicious lesion when possible, document size
A punch biopsy is appropriate when suspicion is low or lesion is too large

Question 18

Management of Melanoma

Answer 18

REFER
Treatment is excision, lesion thickness is most important factor determining prognosis. Entire nodal basin is dissected if spread to lymph. Radiation is not helpful and chemotherapy is limited.

Question 19

Squamous Cell Carcinoma

Answer 19

A slow growing malignant tumor of squamous epithelium that can (rarely) metastasize to other areas

Question 20

Actinic Keratosis

Answer 20

considered pre-cancerous skin lesion to squamous cell carcinoma, dry, hard, scaly papules in sun exposed areas of skin on face, scalp, forearms. Painful and tender to scrape but doesn’t cause bleeding

Question 21

Treatment of Actinic Keratosis

Answer 21

Cryosurgery - single treatment for 10-15 sec freeze time

can use topical preparations but not as effective because pt. doesn’t use them consistently

Question 22

What is Squamous Cell Carcinoma caused by?

Answer 22

UVR or human papilloma virus, begins on skin but can become invasive through lymph node, then organ involvement (Bowen’s cancer)

Question 23

Symptoms of Squamous Cell Carcinoma

Answer 23

Lesions may be thick or thin, adherent scale with erythematous base, may have cutaneous horn

Question 24

Where can Squamous Cell Carcinoma be found?

Answer 24

most common distribution is on scalp, dorsal hands, helix of ear, may also be found on mouth, tongue, soft palate, pharynx, larynx

Question 25

How do you manage Squamous Cell Carcinoma?

Answer 25

Referral is a good option Small lesions with cryosurgery Larger lesions should be excised If advanced disease radiotherapy and chemotherapy are options

Question 26

Basal Cell Carcinoma

Answer 26

malignant epithelial cell tumor that arises from the basal layer of the epidermis and does not metastasize Most common cancer in humans, caused by UVR Is locally invasive

Question 27

Symptoms of Basal Cell Carcinoma

Answer 27

Occurs in many different clinical forms 1. Nodular- peary, firm, dome shaped, most common 2. Ulcerated(cystic)-pearly, firm, bumpy border, ulcer in middle 3. Sclerosing-waxy, firm, flat to slightly raised "scar like" 4. Superficital- think scaling plaque that bleeds when scraped, looks like actinic keratosis 5. Pigmented- similar to nodular form, but with pigment

Question 28

Diagnosis of Basal Cell Carcinoma

Answer 28

Biopsy must be done before management is chosen. Shave biopsy is often preferred, but punch sometimes

Question 29

Management of Basal Cell Carcinoma

Answer 29

``` Non-aggressive lesions <3mm deep and not on scalp are excised or (cryosurgery/electrocautery) Topical creams possible but will have to be a long time so not recommended Mohs surgery(histology at time of surgery) is used for difficult area ```

Question 30

Nevus Sebacious

Answer 30

present at birth(2/3rd) develops in infants (1/3rd), may rarely undergo malignant transformation into basal cell carcinoma in adulthood hairless or linear plaque with orange color and pebbly surface

Question 31

Cutaneous Lymphomas

Answer 31

many types of cutaneous T-cell and B-cell lymphomas, | initially extranodal proliferations of T or B cells, but eventually LN and internal organs are involved

Question 32

What is the most common cutaneous lymphoma?

Answer 32

Mycosis Fungoides T cell involved in older adults treatment is by stage: PUVA, interferon electron beam therapy

Question 33

Kaposi Sarcoma

Answer 33

Human herpes virus type 8, localized or generalized, purple brownish macules. If systemic mainly in GI tract. common in HIV males, diagnose through biopsy, refer, treat with radiation and chemotherapy

Question 34

Merkel Cell Carcinoma

Answer 34

Pts. carry the polyomavirus which mutates from UV nodule that is pink or reddish brown exposure, nodules grow rapidly and metastasize quickly to LN mortality 40% found on white skin only AEIOU rule

Question 35

AEIOU Rule

Answer 35

``` Asymptomatic Expand rapidly Immune compromised pts more common Older than 50 Ultraviolet-exposed areas of skin ```

Question 36

Treatment of Merkel Cell Carcinoma?

Answer 36

Excision or Mohs surgery, sentinel node biopsy, radiation, plus one chemotherapy med (avelumab)

Question 37

Inherited Cancer Susceptibility Syndromes (ICSS)

Answer 37

caused by inherited genetic mutations that place pts at increased risk of cancer autosomal dominant pattern with the ones discussed

Question 38

Neurofibromatosis Type 1

Answer 38

(ICSS) cafe-au-lait macules, nerofibromas, axillary and inguinal freckling tumor type-malignant peripheral nerve sheath tumors

Question 39

Hereditary Multiple Melanoma

Answer 39

5% of pts. diagnosed with melanoma have this, increases pancreatic cancer risk, family members may have large # of benign and dysplastic nevi

Question 40

Peutz-Jeghers Syndrome

Answer 40

associated with various GI cancers and breast cancer risk | dark macules on lips and buccal mucosa during infancy or childhood

Question 41

Seborrheic Keratosis

Answer 41

most common benign cutaneous neoplasm hereditary small papules to plaques that apppear stuck on the skin appear during middle age and then grow with age no treatment required

Question 42

Dermatofibroma

Answer 42

button like dermal nodule, usually solitary lesion on lower legs may develop in response to trauma "dimple sign" no treatment unless cosmetic

Question 43

Keloids

Answer 43

abnormally large scar that extends beyond margins of injury appears soft to firm tuberous papule or nodule that grows slowly may be pruritic or tender, appears more in blacks no treatment is high effective

Question 44

Lipoma

Answer 44

common benign fatty tumors (subcutaneous) that usually are asymptomatic freely mobile, soft mass under skin no treatment is necessary but may be surgically excised if larger than 5 cm cosmetic or symptomatic

Question 45

Sebaceous Cyst (Epidermal/Epidermoid Cyst)

Answer 45

epidermal cells go down into the dermis cyst that forms in dermis and is lined with epithelial cells that produce keratin has sm opening to surface called punctum treatment is excision (pull out pouch)

Question 46

Syringoma

Answer 46

Benign tumors of eccrine glands commonly around eyes very small, flest to light colored papules, usually multiple symmetrically near both eyes no treatment, but may be removed for cosmetic purposes

Question 47

Xanthelasma

Answer 47

asymptomatic, yellow-orange papules near eyelids. develop over months to years usually in pts >50 yrs but if seen in children or young adults associated with familial hyperlipidemia can be excised, elctrodessicated, or removed with TCA

Question 48

Pyogenic Granuloma

Answer 48

common benign vascular lesion that evolves quickly over a period of weeks solitary glistening red papule or nodule that is prone to ulceration occurs in children and young adults at the side of minor trauma treatment is excision with electrodessication