Chapter 17. Recognition and Treatment of skin lesions Flashcards
Subcutaneous lesion characterized by a central punctum that may drain a foul-smelling, cheesy substance. Histologically, characterized by columnar epithelial cells lining a keratin-filled sac
a. Keratin cyst
b. Sebaceous cyst
c. Epidermal inclusion cyst
d. AOTA
Ans. D (EIC aka Keratin cyst aka Sebaceous cyst)
Most common location of dermoid cyst
a. Postauricular area
b. Lateral brow
c. Forehead
d. Cheek
Ans. B
Macular hyperpigmented lesions that are photo induced and darken upon sun exposure. They are characterized by a proliferation of benign melanocytes at the dermoepidermal junction
a. Ephelis
b. Lentigenes
c. Benign nevus
d. Milia
Ans. B
Unlike lentigenes, ephelides (freckles) are not caused by an increase in the number of melanocytes, but by increased melanogenesis within normal epidermis.
Pedunculated fibrous papules that frequent areas of friction, such as the axillae or beneath abdominal pannus
a. Nevus sebaceous
b. Keloid
c. Acrochordon
d. Xanthelasma
Ans. C (aka skintag)
Condition characterized by the accumulation of cholesterol within the dermis of periorbital skin, forming yellow plaques. Typically present in the 3rd or 4th decade of life and are asymptomatic.
a. Sebaceous hyperplasia
b. Xanthelasma
c. Vitiligo
d. Acrochordon
Ans. B
Severe cutaneous reaction to a drug or infectious trigger, characterized by erythema and blistering of the skin and mucous membranes of less than 10% body surface area
a. Stevens-Johnson syndrome
b. Toxic epidermal necrolysis
c. Overlap syndrome
d. None of the above
Ans. A (<10%)
B - >30% body surface area
C - 10-30%
A melanoma growth phase that begins with a superficial, noninvasive tumor that resides entirely in the epidermis
a. Radial growth phase
b. Microinvasive radial growth phase
c. Vertical growth phase
d. Circular growth phase
Ans. A
B - contained in the superficial dermis
C - past the granular cell layer of the epidermid, potentially metastatic
Type of melanoma that has no identifiable radial growth phase and immediately begin invading the dermis
a. Superficial spreading
b. Lentigo maligna
c. Acral lentiginous
d. Nodular melanoma
Ans. D
Melanoma skin or subcutaneous metastases that are more than 2cm from the primary lesion, but not beyond the regional nodal basin
a. Satellite lesions
b. In-transit metastases
c. Locoregional metastases
d. Distant metastases
Ans. B
Intermittent and intense recreational sun exposure early in life is a risk factor for ____, whereas cumulative UV radiation dose is important for ____, while multiple sunburns are associated with ____.
a. SCC, BCC, Melanoma
b. Melanoma, SCC, BCC
c. BCC, SCC, Melanoma
d. Melanoma, BCC, SCC
Ans. C
Most common type of BCC and presents as a pearly, trlangiectatic, dome-shaped nodule with central ulceration
a. Nodular BCC
b. Superficial multifocal
c. Sclerosing BCC
d. Infiltrative BCC
e. Morpheaform BCC
Ans. A
Type of BCC that presents as a scaly bred-brown patch with a subtle pearly border that is typically found on the trunk
a. Nodular BCC
b. Superficial multifocal
c. Sclerosing BCC
d. Infiltrative BCC
e. Morpheaform BCC
Ans. B
Type of BCC that presents as an atrophic plaque with telangiectasus and ulceration but no other stigmata of BCC. Usually arises in the embryonic fusion planes around the ears and nose.
a. Nodular BCC
b. Superficial multifocal
c. Sclerosing BCC
d. Infiltrative BCC
e. Morpheaform BCC
Ans. C
BCC type wherein only the “tip of the iceberg” is clinically apparent
a. Nodular BCC
b. Superficial multifocal
c. Sclerosing BCC
d. Infiltrative BCC
e. Morpheaform BCC
Ans. D
Type of BCC that is insidious and presents as a yellow, scarlike plaque with telangiectasias and indistinct margins. This subtype extend widely intradermally, and complete excision typically requires radical surgery.
a. Nodular BCC
b. Superficial multifocal
c. Sclerosing BCC
d. Infiltrative BCC
e. Morpheaform BCC
Ans. E
An aggressive form of BCC that will invade underlying structures such as large vessels, bones, and even meninges. This is frequently fatal from hemorrhage or infection.
Ulcus terebrans
Characteristics associated with more aggressive behavior in BCC, except
a. >6mm in face
b. >10mm in forehead, scalp and neck
c. Perineural invasion
d. Nodular BCC subtype
Ans. D
First systemic medication approved by US FDA for metastatic and locally advanced BCC. Taken as a
150 mg capsule daily until disease progression, the drug is ideal for patients who are not candidates for surgery or radiation.
a. Vismodegib
b. Sonidegib
c. Imidegib
d. Remidegib
Ans. A
B- approved in 2015
HPV subtypes that are most comminly carcinogenic and are specific factors related to SCC
a. HPV 6, 11
b. HPV 16, 18
c. HPV 31, 33
d. HPV 35, 38
Ans. B
Traits associated with more aggressive behavior in SCC except
a. >2cm in diameter
b. Depth of invasion >4mm
c. Location near the parotid gland/ear
d. Solitary lesions
Ans. D
Worst prognostic indicator in SCC
a. Nodal involvement
b. Tumor size
c. Depth of invasion
d. Perineural invasion
Ans. D
Other term for squamous cell carcinoma in situ (full thickness epidermal high grade squamous dysplasia)
Bowen disease
Hallmarks of transformation of SCC in situ to SCC
a. Erythema or pain
b. Ulceration or induration
c. Pigmentation or scaling
d. Freckling or plaque formation
Ans. B
Rapid growth with involution within 2 to 6 months is the hallmark of this lesion.
a. Keratoacanthoma
b. Actinic keratosis
c. Dermatofibrosarcoma protuberans
d. Merkel cell carcinoma
Ans. A
rapidly growing tumor that can grow from a 1 mm flesh-colored papule to a 2.5 cm nodule with a keratin filled central crater in 3 to 8 weeks.
Initial management of keratoacanthoma
a. Punch biopsy
b. Excision of tumor with adequate depth
c. Intralesional 5-fluoruracil x 6 weeks
d. Methotrexate
Ans. B
Punch biopsy is not recommended, as it is usualy nondiagnostic
Hyperkeratotic premalignant lesions resulting from chronic sun exposure. May be pigmented, erythematous or skin colored and commonly occur on the face and ears.
a. Keratocanthoma
b. Bowen disease
c. Actinic keratoses
d. Squamous cell carcinoma
Ans. C
