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Derm Block 2 Flashcards

1
Q

What type of light causes most photobiologic skin reactions and dzs

What are the 3 types of this light?

A

UV light

UVA: 320-400nm, long black light radiation
UVB: 320-390nm, middle wave sun burn
UVC: 100-290nm, short wave germicidal

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2
Q

What time of the day does most of the UVA and UVB light occur?

? is the majority of UV radiation that reaches Earths surface?

A

70% UVA/80% UVB between 10AM-3PM

UVA

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3
Q

UVA light

What happens if there is chronic exposure?

A

Constant through out day/year
Long waves penetrate deeply to dermis/SQ fat

CT degeneration
PhotoAging PhotoAllergic

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4
Q

UVB light

A

Greatest during summer and MOST harmful of waves

High amount of energy to corneum/superficial layers

Sun burn/tan
Pigmentation/inflammation

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5
Q

UV light

This form is only transmissible via ?

A

Absorbed by ozone

Germicidal lamps

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6
Q

Skin Phototype is based upon ? skin and AKA ?

The phototype characteristic of burn or tan is based on ?

A

Buttocks, Fitzpatrick scale

30-45min of exposure after winter/no exposure

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7
Q

What are the 6 phenotypes on the Fitzpatrick scale

A

1: British European, Northern
2: European Scandanavian
3: Southern, Central European
4: Mediterranean Asian Latina
5: Indian African
6: African Aboriginal

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8
Q

? ground surface can reflect UVB light

What barrier absorbs UVC light

A

Snow, Ice

Ozone layer

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9
Q

Define SPF

A

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

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10
Q

Sunscreen w/ SPF blocks ? radiations

What are steps taken to protect against UV damage

A

UVA and AVB

Avoid peak exposure times
Wear protective clothes
Apply 15-30min prior to outdoors
Reapply q2hrs, after water
Daily SPF 15-30
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11
Q

What is the body’s two natural sun protectors

What is the best protective measure

A

Stratum corneum
Melanin

Clothing

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12
Q

What are the 3 MOAs of sunscreen

A

Physical- scatter, reflect light for photosensitizing conditions (titanium dioxide, zinc oxide)

Chemical- absorbs radiation

Water resistant- proof x 80min, resistant x 40min

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13
Q

Define Photoaging

Sun induced damage can cause changes in ? 4 things

A

Skin changes from chronic sun exposure

Texture Vascular Pigment Papular

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14
Q

What are 3 types of photoaging texture changes

A

Solar Elastosis- thick skin w/ yellow hue

Atrophy- thinned skin w/ prominent vessels

Wrinkles- don’t disappear w/ stretching

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15
Q

What type of vascular changes can photoaging cause?

A

Diffuse erythema

Venous lake- ectatic lip vessel

Telangectasis

Stellate Pseudo- scars above attachment points

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16
Q

Why types of pigment change happen w/ photoaging

A

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

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17
Q

What types of papular changes can occur due to photoaging?

A

Nevi

Seborrheic Keratosis

Solar Elastosis

Favre Racouchot- open/closed comedome/inclusion cyst

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18
Q

How is photoaging Tx

What s/e needs to be prevented?

A

Prevention
Topical Retinoids- Tretinoin, Tazarotene

Inc photosensitivity, daily sun screen

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19
Q

Topical Tx for photoaging will work on all changes except for ?

How is resurfacing Tx done?

A

Coarse wrinkles
Telangiectasis

Chemical peels
Dermabrasion
Lasers

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20
Q

? is the MC light induced skin dz

What is the pathogenesis process causing this?

A

Polymorphous light eruption from UVB light

Delayed hypersensitivity response of endogenous photo induced Ag

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21
Q

When/who does polymorphous light eruption present?

This condition’s prevalence is inversely related to ?

What phenomenon can occur for Tx?

A

First 3 decades of fair skin female PTs

Latitude

Harden- gradual UV exposure

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22
Q

What are the two morphologies of Polymorphous Light Eruption?

What are the 6 types of this condition?

A

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
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23
Q

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

A

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

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24
Q

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

A

Delayed onset, morphology
Quick resolution

Biopsy
Immunofluorescence

Phototesting- eruption w/ UVA/B= confirm
Do not harden prior to Derm

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25
Q

How is Polymorphous Light Eruption Tx

They can be referred to Derm for ? Tx methods?

A

Topical CCS group 2-5
PO steroid- wide pruritis
Desensitize w/ photo therapy

Psoralen UVA
Last line- Hydroxychloroquine

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26
Q

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

A

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

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27
Q

Define Phototoxicity

What are the two possible etiologies

What type of phototoxicity reactions are more intense?

A

Non-allergic skin response to topical/systemic agents

UVA
Phytophotodermatitis- bizarre patterns of sun exposed area

Photo drug eruptions

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28
Q

What are the two types of responses that can occur w/ Phototoxicity

A

Minimal: erythema then hyperpigmentation

Max: tingling erythema after exposure leading to desquamation
Hyper pigmentation x 12mon

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29
Q

What topical can be phototoxic agents?

What plants can be phototoxic agents?

What meds can be phototoxic?

A

Perfume

Parsnip Celery Meadow grass
Fig Lime Wild carrot

5 FIFTHS DIA
5-FU FQs Isotretinoin Furosemide TCNs HCTZ Sulfonamides
Diltiazem Ibuprofen Amiodarone

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30
Q

How is Phototoxicity Tx

A

I SPAS
Identify Sunscreen PUVA
Avoidance Steroids

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31
Q

Define Vitiligo

What are the two etiologies

When does is present in PTs?

A

Acquired loss of melanocyte/pigment

Autoimmune Abs to melanocytes
Genetics

M>F, half before 20y/o

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32
Q

What are the two types of Vitiligo

How do the different types present?

A

Type A- MC, generalized
Type B- segmental

A: symmetric pattern of white macules
B: asymmetric, doesn’t cross midline

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33
Q

Type A Vitiligo can have ? phenomenon present?

What is this condition also associated w/?

A

Koebner phenomenon

Halo Nevi

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34
Q

What are two differentiating facts about Type B Vitiligo

What are the associated concerns of any type?

A

Follicles depigment
Earlier onset

Psych
Depigmented retinal- uveritis
Depigmented labyrinth- hearing
Leptomeningeal melanocyte destruction- aseptic meningitis

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35
Q

What are the comorbidites assoiciated w/ vitiligo

How is this condition Dx

A

Graves Addisons Pernicious
DM1 Hypothyroid Alopecia Melanoma

Clinical
Woods lamp accentuates depigmentation

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36
Q

What are the goals of Vitiligo Tx

What meds are used for Vitiligo Tx

A

Stabilize depigmentation
Stimulate repigmentation

Topical CCS- first line
Vit D3 analog- Calcitriol
Camouflage- dihydroacetone (FDA approved)
Depigment w/ Monobenzone, Hydrquinone)

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37
Q

Define Idiopathic Guttate Hypomelanosis

What would be seen on biopsy results

A

ASx white spots w/ sharp borders from seborrheic keratoses, lentigines and xerosis in same area

Dec melanocytes

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38
Q

How is Idiopathic Guttate Hypomelanosis prevented?

How is it Tx

A

Avoid sun
Sunscreen w/ SPF

Tretinoin
Abrasion
Low potency steroids
LN2

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39
Q

Define Solar Lentigo

These may be AKA ?

A

Tan macules in Caucasian >60y/o from chronic sun exposure

Liver spots

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40
Q

How are cases of Solar Lentigo differentiated from freckles?

Although rarely needed, what Tx is offered?

A

Freckles darken after light exposure, Solar does not

Topical retinoid
Cryotherapy
Hydroquinone + Retinoid

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41
Q

? is AKA the Mask of Pregnancy

What can cause this

A

Melasma/Chloasma

Thyroid dysfunction
OCPs
Phenytoin

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42
Q

What are the 3 patterns of melasma?

What is the most important part of Tx?

A

Centrofacial: FCCL
Malar: cheek nose
Mandibular

Protection from UVA/B

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43
Q

What meds can be used for hypopigmentation of melasma

A

Hydroquinone- best
Azelaic/Tretinoin- slow
Tri-Luma x 8wks- combo, more effective than single agent
Refer if no improvement

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44
Q

What are the Benign Epidermal Proliferations, Mulitples

A

DDS FLAPS
Dermatosis papulosa nigra
Disseminated superificial actinic porokeratosis
Seborrheic keratosis

Flegel Dz
Lichenoid keratosis
Acrokeratosis verruciform
Porokeratosis palamris

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45
Q

What are the Benign Epidermal Proliferations, Solitary

A 
CELIAC
Cutaneous horn
Epidermolytic acanthoma
Large cell acanthoma
Invertied follicular keratosis
Acantholytic acanthoma
Clear cell acanthoma

Lichenoid keratosis
Warty dyskeratoma

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46
Q

What are the Benign Epidermal Proliferations, Linear

A 
NMILE
Nevous comedonicus
Mosaic of Darier dz
Inflammatory LVEN
Linear porokeratosis
Epidermal nevus
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47
Q

? is the MC benign cutaneous neoplasm

What can cause this

How does it present

A

Seborrheic Keratosis

Proliferation of immature keratinocytes
Evolve from macule
Progress to papule/verrucous

Stuck on/Greasy appearance
in sebaceous areas

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48
Q

How are seborrheic keratosis differentiated from malignancy

How are SKs Tx

A

Melanoma- smooth surface w/ color variety
SK- uniform appearance

LN2/Curettage

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49
Q

Define Leser Trelat sign

When do SKs need to have malignancy r/o?

A

Sudden appearance of multiple SKs, rare sign of internal malignancy

Dark lesions

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50
Q

Define Stucco Keratosis

What is the etiology of Stucco Keratosis

Who/what is the classical presentation

A

Benign proliferation of keratinocytes

Vascular insufficient- Xerosis

Elderly light skin PTs w/ peripheral edema

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51
Q

How is Stucco Keratosis different than SK

Where are these lesions seen on the body?

How is Stucco Keratosis Tx

A

Stuck on appearance of white warty lesions in non-sebaceous areas

Ankles, Dorsal feet

Curettage
Cryosurgery

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52
Q

Define Dermatosis Papulosa Nigrans

How does it present?

Where does it present?

A

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

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53
Q

What Tx has to be done cautiously in Dermatosis Papulosa Nigra PTs

How can they be Tx

A

Cryotherapy- hypopigmentation risk

Small: scissor, cautery, curette
Large: anesthetize removal w/ shave/excision

54
Q

Skin tags are AKA ?

Where are these commonly found?

What PTs are these more commonly seen in?

A

Acrochordon

Areas of skin rubbing

Obese >25y/o

55
Q

Define Dermatofibroma

How do they present?

A

Fibrous reactive process from trauma causing collection of fibroblasts, endothelial and histocytes

Early pruritic/tender leading to ASx

56
Q

How are Dermatofibromas differentiated during PE?

Where are these likely to be found on the body?

A

Hard growth that retract down when squeezed- dimpling

Anterior lower leg- MC
Shoulders
Upper back

57
Q

How are Dermatobfibromas Tx

What form of Tx is avoided?

A

Punch Biopsy
Excision

Cryosurgery- can cause divot/deformity
Can be used conservatively to reduce color

58
Q

How are hypertrophic scars and keloids the same?

How are they different

A

Firm
Raised
Red/hyper pigment
Shiny/smooth

Scar: confined to wound, starts early but regresses

Keloid- abnormal large scar beyond borders, rarely subsides

59
Q

Where are keloids more commonly seen?

Define Keratoacanthoma

A

Shoulder/chest

Benign epithelial tumor w/ smooth, dome shaped w/ rapid expansion
Distinct hyperkeratotic core

60
Q

Where are Keratoacanthoma MC seen on the body?

These are indistinguishable from ? and require ? Tx

A

Limbs w/ sun exposure

SCC- excision for Path
Recurrent- Tx w/ 5-FU or Methotrexate

61
Q

How do cutaneous horns present?

Most are benign but ?

How are they Tx

A

Hard keratonic cone lesion in M on sun exposed sites

In situ/invasive SCC

LN2 Excision Shave

62
Q

Define Sebaceous Hyperplasia

What is their characteristic appearance on presentation?

What PT populations do these show in?

A

Small tumors of enlarged sebaceous glands

Dome shape w/ central puncta on face

PTs w/ sun damage and oily skin +30y/o

63
Q

Sebaceous Hyperplasia presenting w/ ? need to be differentiated from ?

How is this differentiation done?

A

Telangiectasia, BCC

Dermoscopy-
BCC- vessels on surface
SH- vessels in valley w/ yellow lobule border

64
Q

Define Syringoma

Who do these present in

If attempted, how are they Tx

A

Sweat duct tumor under eyes

ASx in F PTs 20-30y/0

Electrodessication
Elevation and Excision
Shaved w/ 11 blade

65
Q

Define Neurofibroma

How is this unique presentation ID’d

A

Benign tumor on nerve sheath

Button hole sign- invaginates w/ pressure

66
Q

What other derm findings may be seen in PTs w/ Neurofibromas

When can these possible be cancerous?

A

Axillary freckles
Cafe au Lait spot (von Reckling, NF1)

2 or more= Von Reck/NF1 suspicion, malignant potential

67
Q

? is the MC vascular malformation and almost always in ? PTs

How does this MC look on PE?

Define Telangiectasia and their max size

A

Cherry Angioma on PTs >30y/o on trunk/extremity

.5-5mm smooth deep red papule

Permanently dilated vessels of 1mm

68
Q

Spider angiomas are types of ?

What are the two types of angiomas

How are they Tx

A

Telangiectasia

Arterioles- spider body
Capillaries- spider legs

Electrodessication
Laser ablation

69
Q

Define Pyogenic Granuloma

What two PT populations may have unique presentations?

What issue do these typically present w/?

A

Acquired vascular lesion of skin and mucus membrane

Pregnant- gingival lesion
Isotretinoin- cyst acne Tx

Rapidly grow, easily friable, bleeding

70
Q

How do Pyogenic Granulomas present?

Where are these distributed through the body?

A

Rapidly growing dome shapes w/ moist to scaly surface

Finger Gingiva Head/neck

71
Q

How are Pyogenic Granulomas Tx

? is the MC benign soft tissue tumor

A

Curettage base/border
Electro dissection eradicates lesion

Lipomas

72
Q

? is the MC skin CA and MC malignant neoplasm in humans

What is the origin of this MC

What is the most important RF?

A

BCC

Sun induced from intense, intermittent exposure

Inability to tan

73
Q

What is the MC form of BCC to be seen on presentation

What buzz words may be used to describe it

A

Nodular

Pearly papule
Ulcerates, elevates w/ rolled border and tangelectasis- rodent ulcer

74
Q

What is the reassuring part of a BCC Dx

What is the MC presenting complaint?

A

Almost always doesn’t metastasize

Bleeding/scabbing sore
Zit that won’t go away

75
Q

Where are most BCCs located on the body

How does this form of Ca lead to death

A

Nodular MC- nose
Superficial MC- trunk

Direct extension destruction of tissue/organs

76
Q

How are BCC cases Tx

How long is management done?

A

Refer to Derm for:
Early: excision
Late: Mohs micrograph

Annual TBSE
D/c after 3yrs tumor free

77
Q

Define Actinic Keratosis

Who is more likely to develop this type?

What would be seen on micro exam?

A

SCC confined to epidermis pre-malignancy

Chronic UVB exposure in fair skin PTs

Atypical squamous cells in epidermis

78
Q

How will actinic keratosis be describe in test questions?

This can present as a ? w/ underlying ?

A

Hard crusty yellow scale
Erythema w/ scale
Hyperkeratinic lesion on ear/hand dorsum

Cutaneous horn
SCC AK Wart SebK

79
Q

What Dx is considered for Actinic keratosis seen on the pinna that is tender?

How is it Tx

A

Chondrodermatitis Nodularis Helicis- degeneration of underlying collagen

Excision w/ special pillow

80
Q

How is Actinic Keratosis managed

How can the lesions be Tx

A

Photo protection
TBSE

One/Few: LN2
Multiple: F-FU
Imiquimod (alternative)

81
Q

What is the prognosis for PTs w/ Actinic Keratosis

How does this type of CA evolve into a new Dx

A

SCC development <20yrs
*Photo protection dec new lesions and allows small lesions to self resolve

AK= SCC of epidermis
Once invades dermis= SXX

82
Q

Define Bowen Dz

How is this form different than others

A

SCC in Situ

Histological Dx

83
Q

What does In Situ of Bowen Dz mean

How does it appear on PE

A

Keratinocytic dysplasia involving full thickness of epidermis only

Well define border w/ elevated/red scaly plaque

84
Q

What are the MC locations for SCC In Situ by gender

How is it Tx

How often are f/us needed?

A

M: scalp/ear
F: LE

LN2 Curretage Excision
Large- 5-FU or Imiquimod

6mon

85
Q

Define Erythroplasiz of Queyrat

How does it present

What causes this and who does it present in

A

SCC In situ of mucus membranes

Moist red raised plaque

HPV-8
Uncircumcised older male
Vulva older female

86
Q

How is E of Q Tx

? is the 2nd MC skin Ca and how is this MC different

A

5-FU or Imiquimod
Laser

SCC, high chance of metastases

87
Q

What are the RFs and MC precursor of SCC

What words may be used to describe it?

A

UVA/B radiation
Precursor- AKs

Persistent red scale w/ deeper involvement
Hypertrophic lesion w/ ulcer/hyperkeratosis
Lip ulcer w/ induration

88
Q

How are PTs w/ SCC managed

? part of the body has the highest potential for metastasis?

A

Small from AK- EDnC
Larger/lips- Excision
F/u q12mon for life

Lips

89
Q

Define Mole

How are these nevus cells different from melanocytes

A

Benign growth of nevus cells derived from melanocytes

Larger
Abundant cytoplasms
No dendrites
Contains coarse granule

90
Q

What are the ABCDEs of assessing moles?

A 
Asymmetry
Border irregularity
Color variation
Diameter >5mm
Evolution (size shape color new)
91
Q

When are melanocytic incidence high?

If PTs have more than ? nevus, they need f/u every ?

A

Larger during pregnancy/puberty
Peak 4-5th decade

> 100
q6-12mon

92
Q

What are the 3 types of nevus?

What extrinsic factors affect hem

A

Junction
Compound
Dermal

Hormone Sun

93
Q

Junctional nevus

A

Flat/slight elevated brown/black lesion <0.6cm

MC in childhood, generally after 2y/o

Can develop into Compound Nevi

94
Q

Compound Nevi

A

Slightly elevated dome w/ smooth surface possibly w/ hair

White periphery- halo nevus

95
Q

Dermal Nevus

A

MC dome shaped
Brown/black that fades w/ age

Common in adults

Nevus cells in dermis and possibly fat cells

96
Q

Nevus Spilus is AKA ?

When are these MC seen

Benign Juvenile Melanoma is AKA ?

A

Speckled lentiginous nevus

Adolescence Birth Early infancy

Spitz nevus

97
Q

Define Congential Melanocytic Nevi

When are these concerning for Ca

A

Birthmark

> 5% BSA or,
20cm

98
Q

Size categories for congenital melanocytic nevus

Define Nevus Spilus

What is unique about their prevalence and how are they Tx

A

Small <1.5cm
Med 1.5-20cm
Large >20cm

Hairless oval brown macule dotted w/ black papules

Not related to sun exposure
None

99
Q

? is not a true nevus

How does it present

Where do they MC appear

A

Becker’s nevus

Brown macule w/ or w/out hair in adolescent males

Unilateral upper back
Shoulder/upper arm
Submammary

100
Q

How are Becker’s Nevus Tx

Halo nevus may signal upcoming Dx of ?

A

Laser removal of macule and hair

Vitiligo but rarely converts to malignancy

101
Q

Where are Halo Nevus more commonly and never seen?

Spitz nevus are AKA and named because ?

Where are they commonly found

A

MC trunk
Never palms/soles

Benign Juvenile Melanoma
Histologic similarity to melanoma

Head Neck LE

102
Q

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

A

Hairless red dome w/ sudden appearance

Elevated round nevus w/ large amount of pigment on extremities/hand dorsum

Develops in childhood, never changes

103
Q

Where are Mongolian Spots MC found where in ? PTs

These appear due to ? effect

A

Scalp/Presacral
African/Asian

Tyndall effect of melanin deeper in skin

104
Q

Define Nevus of Ota

Other than the skin what other structures does it affect and in ? PT population

What Tx/f/u is needed

A

Blue pigmentation of 1st and 2nd branch of trigeminal nerve

Sclera, Conjunctiva
Asian females

Laser lightens lesion
Monitor for glaucoma

105
Q

Define Labial Melanotic Macule

How is this differentiated from Ca

How is it Tx if desired

A

Brown macule on lower lip in young women

No change w/ sun exposure

Cryotherapy/laser

106
Q

Define Nevus Flammeus

Define Dysplastic Nevus

A

Port Wine Stain- not a nevus
Congenital vascular malformation

Atypical nevus in Caucasians appearing from puberty to 4th decade

107
Q

How do Dysplastic/Atypical nevus look on exam?

How is this lesion’s presence different

A

Fried Egg appearance

Appears in sun protected areas- back, UE/LE

108
Q

What are the Dx criteria needed for Dysplastic Nevus

How often do these PTs need f/u?

A 
3 of:
>5mm diameter
Ill defined border
Irregular margin
Varying pigmentation
Papular and Macular parts

TBSE q6-12mon w/ base line pictures

109
Q

Malignant melanoma is _th most common Ca in men and _MC Ca in women

What is the highest relative risk for this

A

5th in men
6th in women

Hx of atypical moles
FamHx of melanoma
>75moles

110
Q

Greatly increased risk factors for malignant melanomas

A

Hx/FamHx/>75moles

Congenital nevus >20cm
Hx/FamHx of melanoma
ImmSupp
Previous non-melanoma Ca

111
Q

Moderate increased risks for malignant melanoma

A 
Clinically atypical nevi
Larger number of nevi
26-100 nevi
Chronic tanning w/ UVA
>250 PUVA psoriasis Txs
112
Q

Skin Phototype Chart

A

1: always, never
2: easy, light
3: some, gradual
4: minimal, always
5: rare, deep tan
6: never, deep pigment

113
Q

Where are malignant melanomas MC located in men and women

What location is MC for non-white PTs

A

M: back
W: arm, leg

Mucosal

114
Q

What are the two parts to a malignant melanoma exam?

What labs are ordered to look for ?

A

Skin phototype
TBSE

CBC CMP UA
Leukocytosis
Sign of metastases

115
Q

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?

A

Shave biopsy

q3-4mon x 12mon then q6mon

Breslow Mircrostage Depth in mm
In Situ: 95-100% 5yr survivial
>4mm 50% 5yr survival

116
Q

Define Clark Level for Malignant Melanomas

A 
Depth at anatomic site:
Epidermis
Papillary dermis
Fills papillary dermis
Reticular dermis
Enters SQ fat
117
Q

What are the 4 histological types of malignant melanoma

A

Superficial spreading- MC
Nodular
Lentigo maligna
Acra lentiginous

118
Q

Superficial Spreading Melanoma

A

MC type of melanoma

MC in 30-40y/o

Hallmark: haphazard combo of many colors

Nodule appears when lesion >2.5cm

119
Q

Nodular Melanoma

This one is commonly mis-Dx as ?

A

Completely vertical growth usually 40-60y/o male

MC dark/red/black brown lesion

Blood blister
Hemangioma
Dermal necus
SK
Dermatofibroma
120
Q

? is a poor prognostic factor of nodular melanoma seen on PE

Lentigo Maligna Melanoma

A

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

121
Q

Acral Lentiginous

What PE sign may be seen in these PTs?

A

MC form in dark pigmented PTs on palms, soles, terminal phalanges and mucous membranes

Hutchingson sign- sudden pigment band at proximal nail fold

122
Q

What is the relation between malignant melanoma in light and dark pigmented PTs

A

Light- most Ca were on sun exposed area

Dark- most Ca were on sun
COVERED area, more likely on subungual, mucosa, plantar and palm

123
Q

When doing TBSE on dark pigment PTs, what areas need to be focused on more?

What are the modified ABCDEFs for dark pigment PTs

A

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
124
Q

What phase of malignant melanomas have better prognosis?

What is the most important prognosis factor of malignant melanoma?

A

Horizontal/radial growth

Sentinal lymph node imvolvement in lesions >1mm thick

125
Q

80% of malignant melanomas arise in ? areas

Table

A

Covered by clothes

Slide 82 MM

126
Q

Why/how do hypertrophic scars/keloids reoccur after Tx removal?

? test/tx step is avoided in keratoacanthomas

A

Collagen production

Just debride, excise to r/o SCC

127
Q

Pts w/ FamHx of multiple lipomas need to be referred to ? for Tx

Bowen’s Dz only involves ? layer of skin

A

MSK Ortho surgeon

Epidermis

128
Q

? infection is precursor for SCC

Excision of melanocytic nevus can only be done by ? methods

A

HPV

Shave/Excisional biopsy

129
Q

? type of nevi has ‘halo nevus’

Where will the 3 different types of nevi have cells on histology results

A

Compound

Junction: junction
Compound: junction and upper dermis
Dermal: dermis, fat cells

130
Q

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 ?

A

Small/Med: elective removal after puberty
Large/Giant: prophylactic removal

Compound Dermal

15y/o, fade over decades due to T-cells attacking

131
Q

Epidemiology of malignant melanoma

A 
5th MC M/6th MC F
Dx age: 57
Age of death: 67
M>F
White 10x>others

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