DERM 2 HY Step 2 Flashcards
The assessment of pigmented skin lesions (suspected melanoma) should include the ABCDEs (Asymmetry, Border irregularities, Color variegation, Diameter, Evolving) rule; lesions with __ of the ABCDE criteria warrant an ____ biopsy.
Just one
excisional biopsy
(1-3mm margins)
Excisional biopsy for suspected melanoma is also recommended for lesions with:
⬩itching, crusting, or bleeding
⬩ ____ changes
or + ugly duckling sign
sensory
ugly duckling sign (lesions that are significantly different in appearance from other pigmented spots)
In-situ destruction via ___ or topical ___ is indicated for treatment of actinic keratosis.
cryotherapy
fluorouracil
(Actinic keratosis presents as small, roughened papules in sun-exposed areas (eg, scalp, face, hands) and typically is not pigmented)
In Elderly,
typically presents as a slow-growing nodule with pearly, rolled borders. ± Central ulceration or telangiectatic vessel
BCC
(SCC is FAST growing)
A nonhealing ulcer or a scaly nodule arising from chronic wounds, burns, or scars should undergo skin biopsy due to concern for what?
squamous cell carcinoma (SCC)
Presents as erythematous silvery plaques with scales
The lesions are pruritic and most commonly occur at the extensor surfaces (knees) or hands, scalp, back, & nail plates.
Psoriasis
⬩Topical: high-potency glucocorticoids, vitamin D analogs, calcineurin inhibitors)
⬩Ultraviolet light/phototherapy
⬩Systemic: methotrexate, calcineurin inhibitors, retinoids,biologics
a benign pigmented lesion with a well-demarcated border and a velvety or greasy surface. It can be nearly flat or be a thickened lesion often described as having a rough surface & stuck-on appearance.
Seborrheic keratosis
(no treatment & no biopsy- it is keratin cyst)
nonpigmented cutaneous tumors that usually present as dome-shaped nodules with a central keratinous plug or crater.
Keratoacanthomas
(Surgical excision/Mohs surgery for concerns of cSCC)
Pulsed dye ___ therapy is first-line management for port-wine stains
laser
Topical __ is used to treat rosacea, which presents in adults with localized facial (nose/cheeks) erythema ± pustules and papules.
Topical Metronidazole (papulopustular type)
⎯
Laser or topical Brimonidine an α-2 agonist (erythematotelangiectatic type)
the most common skin malignancy in patients on chronic immunosuppressive therapy for a history of organ transplant.
Squamous cell carcinoma (SCC)
in infants is characterized by yellow, greasy scales of the face (eyebrows, nose) and scalp, as well as glistening, confluent erythema of intertriginous areas (neck folds, axillae, diaper area).
Rash typically self-resolves.
Seborrheic dermatitis
First-line
emollients, unscented shampoo
Second-line
Topical antifungals (selenium sulfide, ketoconazole)
Topical glucocorticoids
Topical calcineurin inhibitors (Pimecrolimus)
Dx?
cauliflower-like lesions located in the anogenital region.
Caused by HPV 6/11 are associated with _____ of the anus, genitals, and throat.
Condylomata acuminata (anogenital warts)
Squamous cell carcinoma
Bx if immunocomp
Molluscum contagiosum is a self-limited, skin infection caused by ____.
It is characterized by small pink or skin-colored papules with indented centers it spares the palms and soles
poxvirus
(can be sexually transmitted or self-innoculated)
A manifestation of secondary syphilis characterized by flattened pink or gray velvety papules. These are seen most commonly at the mucous membranes and moist skin of the genital organs, perineum, and mouth.
Condyloma lata
(Look up appearance)
nontender, firm, hyperpigmented nodules that are usually <1 cm. most commonly occur on the lower extremities.
Lesions have a fibrous component that causes the central area to dimple when pinched
some patients may develop lesions after trauma or insect bites.
Dermatofibromas
(s/t fibroblast proliferation)
If Asymptomatic, no treatment (cryo or shave off)
Patients who are on high-dose immunosuppressive therapy after organ transplantation are at high risk for developing ____, an endothelial tumor associated with reactivation of HHV-8.
Lesions typically arise within the first year of therapy and appear as multiple violaceous, red, or brown papules that are non-tender & non-pruritic.
Kaposi sarcoma
(red spots that are otherwise asymptomatic)
In the setting of behavioral/cognitive disorders (eg, attention-deficit hyperactivity disorder, intellectual disability) or family/personal history of seizures, this disease can present with Angiofibromas (red or flesh-colored, fibrous papules that are most commonly located in the malar region). Other common skin findings include ash-leaf spots (hypopigmented macules) and shagreen patches (thickened, leathery skin).
Tuberous sclerosis
An autosomal dominant neurocutaneous disorder characterized by axillary freckling hyperpigmented café-au-lait macules and multiple soft, skin colored papules/nodules.
Neurofibromatosis type 1
(Neurofibroma nodules)
an inflammatory reaction to drugs or certain infections (Mycoplasma pneumoniae) characterized by
⬩Acute flu-like prodrome
⬩Rapid-onset erythematous macules, vesicles, bullae
desquamation, and mucositis (mouth, eyes).
⬩Necrosis & sloughing of epidermis
Systemic signs include fever, hemodynamic instability, and altered level of consciousness.
Stevens-Johnson syndrome
Treatment for fatal Stevens-Johnson syndrome?
Treatment is supportive:
aggressive IVFs and wound care.
(Secondary infections are common)
Causes of Stevens-Johnson syndrome include:
⬩infection with Mycoplasms
⬩Vaccination
⬩ GVHD
⬩NSAID (Piroxicam)
and (5 more meds)
⬩ sulfonamides (TMP/SMX, acetazolamide, sulfamethoxazole)
⬩ aminopenicillins (Amoxicillin/clavulanate, Ampicillin)
⬩ Antiepileptics (LAMOTRIGINE, levetiracetam, Valproate, carbamazepine, phenytoin,)
⬩ Allopurinol (Gout)
⬩ Sulfasalazine (DMARD for RA)
Staphylococcal scalded skin syndrome is usually seen in children age <6. It is a syndrome of acute exfoliation caused by what?
toxins produced by Staphylococcus aureus
Presents with fever, rash, hypotension, and multi-organ injury.
The rash is characterized by diffuse erythema resembling sunburn, with desquamation involving the palms and soles
Toxic shock syndrome
(an inflammatory response caused by a staphylococcal exotoxin)
benign, painless subcutaneous masses with normal overlying epidermis. They are usually soft to rubbery and irregular, and do not typically regress and recur.
Lipomas
Presents as a dome-shaped, firm, freely movable cyst or nodule with a small central black punctum The lesion can remain stable or increase in size & may produce a cheesy white discharge; Usually resolves spontaneously.
Epidermal inclusion cyst
(benign: contains squamous epithelium that produces keratin)
a benign proliferation of melanocyte cells that presents within the first few months of life and are usually solitary, hyperpigmented (black/brown) lesions with an increased density of overlying dark, coarse hairs
Initially flat, homogenous hyperpigmentation, they can grow during infancy and become heterogeneously pigmented and raised.
If growing larger what is the NBSIM?
congenital melanocytic nevus (CMN)
surgical removal (risk of melanoma if too big)
Presents as flat, gray-blue patches that are poorly circumscribed and will fade with time. They are classically located on the lower back and sacrum, and are more common in Asian and African American populations.
Congenital dermal melanocytosis (Mongolian spots)
flat, hyperpigmented macules that can be isolated or associated with McCune-Albright syndrome or neurofibromatosis.
Café au lait spots
A vascular birthmark seen on infants face or body. Red to purple, blanchable patches that do not regress. respect the midline.
Association?
Nevus Flammeus
(Port-Wine-Stain)
Sturge Weber → seizures
A vascular birthmark seen on infant’s eyelids and nape of neck. Blanching pink patches that fade with time.
Nevus Simplex
Treatment of Plaque psoriasis includes:
⬩topical high-potency glucocorticoids, betamethasone, fluocinonide
⬩Vitamin D derivatives, calcipotriene
⬩topical retinoids
⬩calcineurin inhibitors tacrolimus (chosen for the face and other sensitive areas)
A skin infection most frequently due to Pseudomonas aeruginosa. It presents as hemorrhagic pustules with surrounding erythema that rapidly progress to form necrotic ulcers. Patients typically have systemic symptoms (eg, fever), but focal pain is less prominent.
High Risk: DM2
Ecthyma gangrenosum
(picture looks like black dry dead wound)
characterized by pain and ulceration in the distal extremities, primarily the digits. Seen in smokers and patients are typically age <45.
Thromboangiitis obliterans
An inherited disorders characterized by epithelial fragility (bullae, erosions, ulcers) triggered by minor trauma.
⬩ friction-induced blisters
⬩ oral blisters with bottle-feeding
⬩ patients may have chronic thickening of the skin of the feet.
Treatment is supportive.
Epidermolysis bullosa
Hidradenitis suppurativa is a chronic, relapsing condition characterized by inflammatory occlusion of folliculopilosebaceous units. There is a strong association with what?
tobacco use (smoking)
*also obesity & diabetes
Chronic & recurrent lesions in intertriginous areas (axilla, thighs, groin)
Mild: painful nodules, draining abscesses (foul smelling)
Moderate: sinus tracts & scarring
Severe: extensive sinus tracts
Diagnosis?
Hidradenitis suppurativa
