Derm Block 2 Flashcards
What type of light causes most photobiologic skin reactions and dzs
What are the 3 types of this light?
UV light
UVA: 320-400nm, long black light radiation
UVB: 320-390nm, middle wave sun burn
UVC: 100-290nm, short wave germicidal
What time of the day does most of the UVA and UVB light occur?
? is the majority of UV radiation that reaches Earths surface?
70% UVA/80% UVB between 10AM-3PM
UVA
UVA light
What happens if there is chronic exposure?
Constant through out day/year
Long waves penetrate deeply to dermis/SQ fat
CT degeneration
PhotoAging PhotoAllergic
UVB light
Greatest during summer and MOST harmful of waves
High amount of energy to corneum/superficial layers
Sun burn/tan
Pigmentation/inflammation
UV light
This form is only transmissible via ?
Absorbed by ozone
Germicidal lamps
Skin Phototype is based upon ? skin and AKA ?
The phototype characteristic of burn or tan is based on ?
Buttocks, Fitzpatrick scale
30-45min of exposure after winter/no exposure
What are the 6 phenotypes on the Fitzpatrick scale
1: British European, Northern
2: European Scandanavian
3: Southern, Central European
4: Mediterranean Asian Latina
5: Indian African
6: African Aboriginal
? ground surface can reflect UVB light
What barrier absorbs UVC light
Snow, Ice
Ozone layer
Define SPF
Ratio of:
Least amount UVB energy to create erythema reaction through sunscreen compared to-
Amount of UVB required to create same reaction w/out sunscreen
Sunscreen w/ SPF blocks ? radiations
What are steps taken to protect against UV damage
UVA and AVB
Avoid peak exposure times Wear protective clothes Apply 15-30min prior to outdoors Reapply q2hrs, after water Daily SPF 15-30
What is the body’s two natural sun protectors
What is the best protective measure
Stratum corneum
Melanin
Clothing
What are the 3 MOAs of sunscreen
Physical- scatter, reflect light for photosensitizing conditions (titanium dioxide, zinc oxide)
Chemical- absorbs radiation
Water resistant- proof x 80min, resistant x 40min
Define Photoaging
Sun induced damage can cause changes in ? 4 things
Skin changes from chronic sun exposure
Texture Vascular Pigment Papular
What are 3 types of photoaging texture changes
Solar Elastosis- thick skin w/ yellow hue
Atrophy- thinned skin w/ prominent vessels
Wrinkles- don’t disappear w/ stretching
What type of vascular changes can photoaging cause?
Diffuse erythema
Venous lake- ectatic lip vessel
Telangectasis
Stellate Pseudo- scars above attachment points
Why types of pigment change happen w/ photoaging
Reactive hyperplasia of melanocytes
Irregular- deep brown area w/ hypopigment
Poikiloderma of Civatte- reticulated w/ telangectasis, atrophy, prominent hair follicles
Lentigo- large brown macules
Ephelides- freckles
What types of papular changes can occur due to photoaging?
Nevi
Seborrheic Keratosis
Solar Elastosis
Favre Racouchot- open/closed comedome/inclusion cyst
How is photoaging Tx
What s/e needs to be prevented?
Prevention
Topical Retinoids- Tretinoin, Tazarotene
Inc photosensitivity, daily sun screen
Topical Tx for photoaging will work on all changes except for ?
How is resurfacing Tx done?
Coarse wrinkles
Telangiectasis
Chemical peels
Dermabrasion
Lasers
? is the MC light induced skin dz
What is the pathogenesis process causing this?
Polymorphous light eruption from UVB light
Delayed hypersensitivity response of endogenous photo induced Ag
When/who does polymorphous light eruption present?
This condition’s prevalence is inversely related to ?
What phenomenon can occur for Tx?
First 3 decades of fair skin female PTs
Latitude
Harden- gradual UV exposure
What are the two morphologies of Polymorphous Light Eruption?
What are the 6 types of this condition?
LPP: grouped pruritic, erythematous papules
DPP: group of pin-size papule
Papular- MC Plaque- 2nd MC, superficial, urticarial or eczematous Papulovesicular Eczematous Erythema multiforme hemorrhagic
What location of the body is Polymorphous Light Eruption MC to be in?
How does this present in clinic?
What PT education may be beneficial
V of chest
Back of hand
Extensor of forearm
Lower legs of women
30m-hrs after exposure w/ malaise, chills, HA, nausea
No scarring w/ lesion healing
How does Polymorphous Light Eruption presentation distinguish it from SLE
What studies are mandatory to r/o SLE from plaque type PLE?
How is the Dx confirmed
Delayed onset, morphology
Quick resolution
Biopsy
Immunofluorescence
Phototesting- eruption w/ UVA/B= confirm
Do not harden prior to Derm
How is Polymorphous Light Eruption Tx
They can be referred to Derm for ? Tx methods?
Topical CCS group 2-5
PO steroid- wide pruritis
Desensitize w/ photo therapy
Psoralen UVA
Last line- Hydroxychloroquine
What is the name of the hereditary form of Polymorphic Light Eruption and ? population is it seen in?
How does it present
How is it Tx
Actinic Prurigo
Inuit/Native American w/ childhood onset and FamHx
Itching plaques, MC on face,
Actinic cheilitis- may be only feature
Topical CCS group 2-5
PO steroid- wide pruritis
Desensitize w/ photo therapy
Define Phototoxicity
What are the two possible etiologies
What type of phototoxicity reactions are more intense?
Non-allergic skin response to topical/systemic agents
UVA
Phytophotodermatitis- bizarre patterns of sun exposed area
Photo drug eruptions
What are the two types of responses that can occur w/ Phototoxicity
Minimal: erythema then hyperpigmentation
Max: tingling erythema after exposure leading to desquamation
Hyper pigmentation x 12mon
What topical can be phototoxic agents?
What plants can be phototoxic agents?
What meds can be phototoxic?
Perfume
Parsnip Celery Meadow grass
Fig Lime Wild carrot
5 FIFTHS DIA
5-FU FQs Isotretinoin Furosemide TCNs HCTZ Sulfonamides
Diltiazem Ibuprofen Amiodarone
How is Phototoxicity Tx
I SPAS
Identify Sunscreen PUVA
Avoidance Steroids
Define Vitiligo
What are the two etiologies
When does is present in PTs?
Acquired loss of melanocyte/pigment
Autoimmune Abs to melanocytes
Genetics
M>F, half before 20y/o
What are the two types of Vitiligo
How do the different types present?
Type A- MC, generalized
Type B- segmental
A: symmetric pattern of white macules
B: asymmetric, doesn’t cross midline
Type A Vitiligo can have ? phenomenon present?
What is this condition also associated w/?
Koebner phenomenon
Halo Nevi
What are two differentiating facts about Type B Vitiligo
What are the associated concerns of any type?
Follicles depigment
Earlier onset
Psych
Depigmented retinal- uveritis
Depigmented labyrinth- hearing
Leptomeningeal melanocyte destruction- aseptic meningitis
What are the comorbidites assoiciated w/ vitiligo
How is this condition Dx
Graves Addisons Pernicious
DM1 Hypothyroid Alopecia Melanoma
Clinical
Woods lamp accentuates depigmentation
What are the goals of Vitiligo Tx
What meds are used for Vitiligo Tx
Stabilize depigmentation
Stimulate repigmentation
Topical CCS- first line
Vit D3 analog- Calcitriol
Camouflage- dihydroacetone (FDA approved)
Depigment w/ Monobenzone, Hydrquinone)
Define Idiopathic Guttate Hypomelanosis
What would be seen on biopsy results
ASx white spots w/ sharp borders from seborrheic keratoses, lentigines and xerosis in same area
Dec melanocytes
How is Idiopathic Guttate Hypomelanosis prevented?
How is it Tx
Avoid sun
Sunscreen w/ SPF
Tretinoin
Abrasion
Low potency steroids
LN2
Define Solar Lentigo
These may be AKA ?
Tan macules in Caucasian >60y/o from chronic sun exposure
Liver spots
How are cases of Solar Lentigo differentiated from freckles?
Although rarely needed, what Tx is offered?
Freckles darken after light exposure, Solar does not
Topical retinoid
Cryotherapy
Hydroquinone + Retinoid
? is AKA the Mask of Pregnancy
What can cause this
Melasma/Chloasma
Thyroid dysfunction
OCPs
Phenytoin
What are the 3 patterns of melasma?
What is the most important part of Tx?
Centrofacial: FCCL
Malar: cheek nose
Mandibular
Protection from UVA/B
What meds can be used for hypopigmentation of melasma
Hydroquinone- best
Azelaic/Tretinoin- slow
Tri-Luma x 8wks- combo, more effective than single agent
Refer if no improvement
What are the Benign Epidermal Proliferations, Mulitples
DDS FLAPS
Dermatosis papulosa nigra
Disseminated superificial actinic porokeratosis
Seborrheic keratosis
Flegel Dz
Lichenoid keratosis
Acrokeratosis verruciform
Porokeratosis palamris
What are the Benign Epidermal Proliferations, Solitary
CELIAC Cutaneous horn Epidermolytic acanthoma Large cell acanthoma Invertied follicular keratosis Acantholytic acanthoma Clear cell acanthoma
Lichenoid keratosis
Warty dyskeratoma
What are the Benign Epidermal Proliferations, Linear
NMILE Nevous comedonicus Mosaic of Darier dz Inflammatory LVEN Linear porokeratosis Epidermal nevus
? is the MC benign cutaneous neoplasm
What can cause this
How does it present
Seborrheic Keratosis
Proliferation of immature keratinocytes
Evolve from macule
Progress to papule/verrucous
Stuck on/Greasy appearance
in sebaceous areas
How are seborrheic keratosis differentiated from malignancy
How are SKs Tx
Melanoma- smooth surface w/ color variety
SK- uniform appearance
LN2/Curettage
Define Leser Trelat sign
When do SKs need to have malignancy r/o?
Sudden appearance of multiple SKs, rare sign of internal malignancy
Dark lesions
Define Stucco Keratosis
What is the etiology of Stucco Keratosis
Who/what is the classical presentation
Benign proliferation of keratinocytes
Vascular insufficient- Xerosis
Elderly light skin PTs w/ peripheral edema
How is Stucco Keratosis different than SK
Where are these lesions seen on the body?
How is Stucco Keratosis Tx
Stuck on appearance of white warty lesions in non-sebaceous areas
Ankles, Dorsal feet
Curettage
Cryosurgery
Define Dermatosis Papulosa Nigrans
How does it present?
Where does it present?
Smaller SKs in darker skin tone PTs that are completely benign
Dome shaped brown/black papule,
Hereditary in teen female AfAm/Hispanic PTs
Cheeks/Bilateral peri-orbital in photodistribution
What Tx has to be done cautiously in Dermatosis Papulosa Nigra PTs
How can they be Tx
Cryotherapy- hypopigmentation risk
Small: scissor, cautery, curette
Large: anesthetize removal w/ shave/excision
Skin tags are AKA ?
Where are these commonly found?
What PTs are these more commonly seen in?
Acrochordon
Areas of skin rubbing
Obese >25y/o
Define Dermatofibroma
How do they present?
Fibrous reactive process from trauma causing collection of fibroblasts, endothelial and histocytes
Early pruritic/tender leading to ASx
How are Dermatofibromas differentiated during PE?
Where are these likely to be found on the body?
Hard growth that retract down when squeezed- dimpling
Anterior lower leg- MC
Shoulders
Upper back
How are Dermatobfibromas Tx
What form of Tx is avoided?
Punch Biopsy
Excision
Cryosurgery- can cause divot/deformity
Can be used conservatively to reduce color
How are hypertrophic scars and keloids the same?
How are they different
Firm
Raised
Red/hyper pigment
Shiny/smooth
Scar: confined to wound, starts early but regresses
Keloid- abnormal large scar beyond borders, rarely subsides
Where are keloids more commonly seen?
Define Keratoacanthoma
Shoulder/chest
Benign epithelial tumor w/ smooth, dome shaped w/ rapid expansion
Distinct hyperkeratotic core
Where are Keratoacanthoma MC seen on the body?
These are indistinguishable from ? and require ? Tx
Limbs w/ sun exposure
SCC- excision for Path
Recurrent- Tx w/ 5-FU or Methotrexate
How do cutaneous horns present?
Most are benign but ?
How are they Tx
Hard keratonic cone lesion in M on sun exposed sites
In situ/invasive SCC
LN2 Excision Shave
Define Sebaceous Hyperplasia
What is their characteristic appearance on presentation?
What PT populations do these show in?
Small tumors of enlarged sebaceous glands
Dome shape w/ central puncta on face
PTs w/ sun damage and oily skin +30y/o
Sebaceous Hyperplasia presenting w/ ? need to be differentiated from ?
How is this differentiation done?
Telangiectasia, BCC
Dermoscopy-
BCC- vessels on surface
SH- vessels in valley w/ yellow lobule border
Define Syringoma
Who do these present in
If attempted, how are they Tx
Sweat duct tumor under eyes
ASx in F PTs 20-30y/0
Electrodessication
Elevation and Excision
Shaved w/ 11 blade
Define Neurofibroma
How is this unique presentation ID’d
Benign tumor on nerve sheath
Button hole sign- invaginates w/ pressure
What other derm findings may be seen in PTs w/ Neurofibromas
When can these possible be cancerous?
Axillary freckles
Cafe au Lait spot (von Reckling, NF1)
2 or more= Von Reck/NF1 suspicion, malignant potential
? is the MC vascular malformation and almost always in ? PTs
How does this MC look on PE?
Define Telangiectasia and their max size
Cherry Angioma on PTs >30y/o on trunk/extremity
.5-5mm smooth deep red papule
Permanently dilated vessels of 1mm
Spider angiomas are types of ?
What are the two types of angiomas
How are they Tx
Telangiectasia
Arterioles- spider body
Capillaries- spider legs
Electrodessication
Laser ablation
Define Pyogenic Granuloma
What two PT populations may have unique presentations?
What issue do these typically present w/?
Acquired vascular lesion of skin and mucus membrane
Pregnant- gingival lesion
Isotretinoin- cyst acne Tx
Rapidly grow, easily friable, bleeding
How do Pyogenic Granulomas present?
Where are these distributed through the body?
Rapidly growing dome shapes w/ moist to scaly surface
Finger Gingiva Head/neck
How are Pyogenic Granulomas Tx
? is the MC benign soft tissue tumor
Curettage base/border
Electro dissection eradicates lesion
Lipomas
? is the MC skin CA and MC malignant neoplasm in humans
What is the origin of this MC
What is the most important RF?
BCC
Sun induced from intense, intermittent exposure
Inability to tan
What is the MC form of BCC to be seen on presentation
What buzz words may be used to describe it
Nodular
Pearly papule
Ulcerates, elevates w/ rolled border and tangelectasis- rodent ulcer
What is the reassuring part of a BCC Dx
What is the MC presenting complaint?
Almost always doesn’t metastasize
Bleeding/scabbing sore
Zit that won’t go away
Where are most BCCs located on the body
How does this form of Ca lead to death
Nodular MC- nose
Superficial MC- trunk
Direct extension destruction of tissue/organs
How are BCC cases Tx
How long is management done?
Refer to Derm for:
Early: excision
Late: Mohs micrograph
Annual TBSE
D/c after 3yrs tumor free
Define Actinic Keratosis
Who is more likely to develop this type?
What would be seen on micro exam?
SCC confined to epidermis pre-malignancy
Chronic UVB exposure in fair skin PTs
Atypical squamous cells in epidermis
How will actinic keratosis be describe in test questions?
This can present as a ? w/ underlying ?
Hard crusty yellow scale
Erythema w/ scale
Hyperkeratinic lesion on ear/hand dorsum
Cutaneous horn
SCC AK Wart SebK
What Dx is considered for Actinic keratosis seen on the pinna that is tender?
How is it Tx
Chondrodermatitis Nodularis Helicis- degeneration of underlying collagen
Excision w/ special pillow
How is Actinic Keratosis managed
How can the lesions be Tx
Photo protection
TBSE
One/Few: LN2
Multiple: F-FU
Imiquimod (alternative)
What is the prognosis for PTs w/ Actinic Keratosis
How does this type of CA evolve into a new Dx
SCC development <20yrs
*Photo protection dec new lesions and allows small lesions to self resolve
AK= SCC of epidermis
Once invades dermis= SXX
Define Bowen Dz
How is this form different than others
SCC in Situ
Histological Dx
What does In Situ of Bowen Dz mean
How does it appear on PE
Keratinocytic dysplasia involving full thickness of epidermis only
Well define border w/ elevated/red scaly plaque
What are the MC locations for SCC In Situ by gender
How is it Tx
How often are f/us needed?
M: scalp/ear
F: LE
LN2 Curretage Excision
Large- 5-FU or Imiquimod
6mon
Define Erythroplasiz of Queyrat
How does it present
What causes this and who does it present in
SCC In situ of mucus membranes
Moist red raised plaque
HPV-8
Uncircumcised older male
Vulva older female
How is E of Q Tx
? is the 2nd MC skin Ca and how is this MC different
5-FU or Imiquimod
Laser
SCC, high chance of metastases
What are the RFs and MC precursor of SCC
What words may be used to describe it?
UVA/B radiation
Precursor- AKs
Persistent red scale w/ deeper involvement
Hypertrophic lesion w/ ulcer/hyperkeratosis
Lip ulcer w/ induration
How are PTs w/ SCC managed
? part of the body has the highest potential for metastasis?
Small from AK- EDnC
Larger/lips- Excision
F/u q12mon for life
Lips
Define Mole
How are these nevus cells different from melanocytes
Benign growth of nevus cells derived from melanocytes
Larger
Abundant cytoplasms
No dendrites
Contains coarse granule
What are the ABCDEs of assessing moles?
Asymmetry Border irregularity Color variation Diameter >5mm Evolution (size shape color new)
When are melanocytic incidence high?
If PTs have more than ? nevus, they need f/u every ?
Larger during pregnancy/puberty
Peak 4-5th decade
> 100
q6-12mon
What are the 3 types of nevus?
What extrinsic factors affect hem
Junction
Compound
Dermal
Hormone Sun
Junctional nevus
Flat/slight elevated brown/black lesion <0.6cm
MC in childhood, generally after 2y/o
Can develop into Compound Nevi
Compound Nevi
Slightly elevated dome w/ smooth surface possibly w/ hair
White periphery- halo nevus
Dermal Nevus
MC dome shaped
Brown/black that fades w/ age
Common in adults
Nevus cells in dermis and possibly fat cells
Nevus Spilus is AKA ?
When are these MC seen
Benign Juvenile Melanoma is AKA ?
Speckled lentiginous nevus
Adolescence Birth Early infancy
Spitz nevus
Define Congential Melanocytic Nevi
When are these concerning for Ca
Birthmark
> 5% BSA or,
20cm
Size categories for congenital melanocytic nevus
Define Nevus Spilus
What is unique about their prevalence and how are they Tx
Small <1.5cm
Med 1.5-20cm
Large >20cm
Hairless oval brown macule dotted w/ black papules
Not related to sun exposure
None
? is not a true nevus
How does it present
Where do they MC appear
Becker’s nevus
Brown macule w/ or w/out hair in adolescent males
Unilateral upper back
Shoulder/upper arm
Submammary
How are Becker’s Nevus Tx
Halo nevus may signal upcoming Dx of ?
Laser removal of macule and hair
Vitiligo but rarely converts to malignancy
Where are Halo Nevus more commonly and never seen?
Spitz nevus are AKA and named because ?
Where are they commonly found
MC trunk
Never palms/soles
Benign Juvenile Melanoma
Histologic similarity to melanoma
Head Neck LE
How do Spitz Nevus look on exam?
Define Blue Nevus presentation
How is this growth is commonly mistaken for Ca, how is it differentiated from Ca
Hairless red dome w/ sudden appearance
Elevated round nevus w/ large amount of pigment on extremities/hand dorsum
Develops in childhood, never changes
Where are Mongolian Spots MC found where in ? PTs
These appear due to ? effect
Scalp/Presacral
African/Asian
Tyndall effect of melanin deeper in skin
Define Nevus of Ota
Other than the skin what other structures does it affect and in ? PT population
What Tx/f/u is needed
Blue pigmentation of 1st and 2nd branch of trigeminal nerve
Sclera, Conjunctiva
Asian females
Laser lightens lesion
Monitor for glaucoma
Define Labial Melanotic Macule
How is this differentiated from Ca
How is it Tx if desired
Brown macule on lower lip in young women
No change w/ sun exposure
Cryotherapy/laser
Define Nevus Flammeus
Define Dysplastic Nevus
Port Wine Stain- not a nevus
Congenital vascular malformation
Atypical nevus in Caucasians appearing from puberty to 4th decade
How do Dysplastic/Atypical nevus look on exam?
How is this lesion’s presence different
Fried Egg appearance
Appears in sun protected areas- back, UE/LE
What are the Dx criteria needed for Dysplastic Nevus
How often do these PTs need f/u?
3 of: >5mm diameter Ill defined border Irregular margin Varying pigmentation Papular and Macular parts
TBSE q6-12mon w/ base line pictures
Malignant melanoma is _th most common Ca in men and _MC Ca in women
What is the highest relative risk for this
5th in men
6th in women
Hx of atypical moles
FamHx of melanoma
>75moles
Greatly increased risk factors for malignant melanomas
Hx/FamHx/>75moles
Congenital nevus >20cm
Hx/FamHx of melanoma
ImmSupp
Previous non-melanoma Ca
Moderate increased risks for malignant melanoma
Clinically atypical nevi Larger number of nevi 26-100 nevi Chronic tanning w/ UVA >250 PUVA psoriasis Txs
Skin Phototype Chart
1: always, never
2: easy, light
3: some, gradual
4: minimal, always
5: rare, deep tan
6: never, deep pigment
Where are malignant melanomas MC located in men and women
What location is MC for non-white PTs
M: back
W: arm, leg
Mucosal
What are the two parts to a malignant melanoma exam?
What labs are ordered to look for ?
Skin phototype
TBSE
CBC CMP UA
Leukocytosis
Sign of metastases
What test/procedure is not done on PTs w/ malignant melanoma
How often do they need f/u?
What is the most important histological determinant?
Shave biopsy
q3-4mon x 12mon then q6mon
Breslow Mircrostage Depth in mm
In Situ: 95-100% 5yr survivial
>4mm 50% 5yr survival
Define Clark Level for Malignant Melanomas
Depth at anatomic site: Epidermis Papillary dermis Fills papillary dermis Reticular dermis Enters SQ fat
What are the 4 histological types of malignant melanoma
Superficial spreading- MC
Nodular
Lentigo maligna
Acra lentiginous
Superficial Spreading Melanoma
MC type of melanoma
MC in 30-40y/o
Hallmark: haphazard combo of many colors
Nodule appears when lesion >2.5cm
Nodular Melanoma
This one is commonly mis-Dx as ?
Completely vertical growth usually 40-60y/o male
MC dark/red/black brown lesion
Blood blister Hemangioma Dermal necus SK Dermatofibroma
? is a poor prognostic factor of nodular melanoma seen on PE
Lentigo Maligna Melanoma
Ulcer/blister w/ pressure means Breslow depth >4mm
Older PT 60-70y/o MC on face
Slow growth over 5-20yrs
Brown/black macula w/ raised blue/black nodule
Acral Lentiginous
What PE sign may be seen in these PTs?
MC form in dark pigmented PTs on palms, soles, terminal phalanges and mucous membranes
Hutchingson sign- sudden pigment band at proximal nail fold
What is the relation between malignant melanoma in light and dark pigmented PTs
Light- most Ca were on sun exposed area
Dark- most Ca were on sun
COVERED area, more likely on subungual, mucosa, plantar and palm
When doing TBSE on dark pigment PTs, what areas need to be focused on more?
What are the modified ABCDEFs for dark pigment PTs
Palms Fingers Soles Toes Subungual and Mucosal
Age: 5-6th decade Brown/black band Change- recent/rapid Digit MC involved Extension of brown pigment on cuticle Fam/Hx of unusual moles
What phase of malignant melanomas have better prognosis?
What is the most important prognosis factor of malignant melanoma?
Horizontal/radial growth
Sentinal lymph node imvolvement in lesions >1mm thick
80% of malignant melanomas arise in ? areas
Table
Covered by clothes
Slide 82 MM
Why/how do hypertrophic scars/keloids reoccur after Tx removal?
? test/tx step is avoided in keratoacanthomas
Collagen production
Just debride, excise to r/o SCC
Pts w/ FamHx of multiple lipomas need to be referred to ? for Tx
Bowen’s Dz only involves ? layer of skin
MSK Ortho surgeon
Epidermis
? infection is precursor for SCC
Excision of melanocytic nevus can only be done by ? methods
HPV
Shave/Excisional biopsy
? type of nevi has ‘halo nevus’
Where will the 3 different types of nevi have cells on histology results
Compound
Junction: junction
Compound: junction and upper dermis
Dermal: dermis, fat cells
When/how are congenital melanocytic nevi Tx
Halo nevus can be either of ? two nevus types
What age do these typically present but they can fade in ?
Small/Med: elective removal after puberty
Large/Giant: prophylactic removal
Compound Dermal
15y/o, fade over decades due to T-cells attacking
Epidemiology of malignant melanoma
5th MC M/6th MC F Dx age: 57 Age of death: 67 M>F White 10x>others
