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Senoir 21-2 > DERM BLOCK II > Flashcards

DERM BLOCK II Flashcards

1
Q

3 groups of Light

A

UVA (320-400nm)
UVB (290-320nm)
UVC (100-290nm)

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2
Q

UVA light

A

Constant throughout the day/year

Long waves penetrate deeply - dermis, subcutaneous fat

Chronic exposure = connective tissue degeneration

PhotoAging & photoAllergic

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3
Q

UVB light

A

Greatest during the summer - most harmful of waves

High amt of energy to corneum/superficial layers

SunBurn/tan, erythema, pigmentation and inflammation

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4
Q

UVC light

A

Absorbed by ozone layer

Transmitted only by artificial sources – germicidal lamps

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5
Q

SLide 6 chart of skin photo types

Lecture 10

A
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6
Q

What does the SPF mean

A

The least amount of UVB energy req’d to produce a min. erythema reaction
(minimum erythema dose, MED) through sunscreen, compared to
-The amt of energy req’d to produce the same erythema w/out any sunscreen application

SPF 30 = 30x longer exposure before sunburn
Beyond SPF 30 – marginally better

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7
Q

Texture change that Develops in chronically sun-exposed areas and presents as thickened skin with a yellow hue.

A

Solar elastosis

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8
Q

Texture change that is Thinned skin, prominent blood vessels, easy bruising, etc.

A

Atrophy

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9
Q

What is sun-induced wrinkling on back of neck that forms a rhomboidal pattern

A

Cutis Rhomboidalis Nuchae

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10
Q

Lentigo is

A

Large brown macules from the sun

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11
Q

What is. Red-brown reticulated pigmentation with telangiectasias, atrophy, prominent hair follicles on the
Chest and neck

A

Poikiloderma of Civatte

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12
Q

Open and closed comedones and epidermal inclusion cysts around the eyes 2/2 sun damage/ photoaging

A

Favre Racouchot

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13
Q

Retinoids for photoaging need what approach

A

Maintenance requires continued use

Increased photosensitivity during txt = need daily sunscreen use

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14
Q

What is the most common light induced skin dz

A

Polymorphous light eruption

Delayed-type hypersensitivity response endogenous cutaneous photoinduced antigens

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15
Q

What is the phenomenon known as “hardening” in pts wtih polymorphous light erutopon

A

Sun exposure leads to incremental doses of UV radiation based on tolerance & resolution

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16
Q

What are the two types of polymorphous light eruption

A

Papular and Plaque type

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17
Q

A pt presents in the spring/early summer with Malaise, chills, HA, nausea x 1-2 hrs preceding rash
With Mildly to markedly pruritic, grouped, erythematous or skin-colored papules of varying sizes

Most common to sun exposed areas

Think

A

Polymorphous light eruption

R/o lupus with Hx, Bx and Immunofluorescense

Tx: corticosteroids and limit sun exposure (group II-V)
Short course oral steroids if wide spread

SUN PROTECTION AND LIMIT EXPOSURE

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18
Q

A Native American female presents with early onset of intensely itchy papules, plaques, and nodules MC to the face
With a hemorrhagic crust with lichenification

Think

A

Actinic Prurigo

Corticosteroids
(Group II-V)
Short course Oral steroids with widespread

SUN PROTECTION and LIMIT exposure

PUVA

Last line tx: is hydroxychlorquine

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19
Q

A pt presents with non allergic skin response from a topical or systemic agent
Then Skin is exposed to certain wavelengths of light (UVA) inducing the reaction.

Think

A

Phototoxicity

Most severe resopnse: Tingling, erythema shortly after exposure -> burning edema & vesicles within hours ->bullae, linear streaking -> desquamation

Residual hyperpigmentation lasts up to 1 yr

MC Rx RXN: TCNS (Doxy)

Tx: Dc causative agent
Generous use of sunscreen
Topical steroids for S/s relief

Don’t do PUVA

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20
Q

A pt presents with symmetric pattern of white macules on the dorasal Hands, face, body folds, genitalia, or body openings
+Koebner phenomenon on the elbows or sunburned areas
+Halo Nevi

Think

A

Vitiligo type A

Dx with a woods lamp

Tx only if pt desires
With Topical corticosteroids (typically 1st line)
Vitamin D3 analogues (calcitriol)
Topical calcineurin inhibitors (tacrolimus/pimecrolimus)
Phototherapy with NB-UVB
Excimer laser
Camouflage

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21
Q

A pt presents with skin whitening that is in a asymmetric pattern and early early onset

Think

A

Type B segmental vitiligo

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22
Q

A pt presents with 2-5 mm white spots with sharply demarcated borders Located on exposed areas of hands, forearms, and lower legs of middle aged and older people

Think

A

Idiopathic Guttate Hypomelanosis

Prevent with Sun/UV light avoidance
SPF therapy

Tx: is elective 
Tretinoin cream 
Low potency steroids
Liquid nitrogen (LN2)
Hypopigmentation risk
Dermabrasion
Cosmetics/Make-up cover up
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23
Q

A pt presents with Tan to brown macules due to localized proliferation of melanocytes from acute or chronic exposure to sunlight

Aka liver spots

Multiple lesions usually arise in sun-exposed sites
Lesions may be round, oval, with slightly irregular, ill defined border
Scattered, discrete lesions, stellate, sharply defined, and roughly the same size

Think

A

Solar Lentigo

MC to the sun exposed areas

Chronic sun exposure ->hyperplasia of melanocytes ->increased pigmentation

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24
Q

What does ABCDE mean

A 
Asymmetry 
Border Irregularity 
Color 
Diameter 
Evolving
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25
Q

A pregnant pt presents with symmetric brown hyperpigmentation of the face and neck without signs of inflammation

Think

A

Melasma

(Can be 2/2 preg. Or OCP)
Rx cause: phenytoin

Prevent with sun Protection

Tx: Hydroquinone 
(Most effective) 
Azalaic acid or tretinoin 
To Triluma cream 
(Hydro, tretinoin, flucinoloine) x 8 weeks QD
 (EVEN MORE EFFECTIVE)
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26
Q

What is the most common Benign cutaneous neoplasm

A

Seborrheic Keratosis

-Proliferation of immature keratinocytes

Usually pigmented as melanin transfers into keratinocytes

Possible relation to sun exposure

Typically evolve from a macule and may progress to become papular or verrucous

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27
Q

A pt presetns with a “stuck on” “greasy” macule of brown or black verrucous

Think

A

Seborrheic Keratosis

Cut it out even though its not malignant (dont take the chance of miss dx)

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28
Q

What separates SK from Melanoma

A

Melanomas have a smooth surface that varies in elevation and in color, density, and shade.

SKs preserve a uniform appearance over their entire surface

When in doubt Bx

“Leser-Trelat” Sign – sudden appearance of multiple SKs:
Rare sign of internal malignancy

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29
Q

What is Lesner-Trelat sign

A

In SKs R/O malignant melanoma in dark lesions
“Leser-Trelat” Sign – sudden appearance of multiple SKs:
—Rare sign of internal malignancy

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30
Q

A pt presents with 1 - 10 mm, round, dry White or skin colored Hyperkeratotic papules, warty lesions
“Stuck on” appearance

MC on the Ankles, or dorsal feet

Think

A

Stucco Keratosis

2/2 Vascular insufficiency, xerosis,
Benign proliferation of keratinocytes

Completely benign

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31
Q

A pt presents with small SKs that are darker on dark skin tones

2-3mm dome shaped papules
Brown to black
Hyperkeratotic, pedunculated or verrucous papules
Female predominance

MC in Cheeks and around eyes bilaterally

Think

A

Dermatosis papulosa Nigra

Common in African Americans

Completely Benign

Tx directed at cosemtics

  • freezing (can cause hypopigmentation)
  • scissor snip, or removal
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32
Q

A pt presents Skin colored to brown
Soft Pedunculated 1mm - 1cm raised lesions
Located in areas with lots of rubbing

Think

A

Skin Tags, Aka Acrochordon

MC in obese pts

Smaller lesions may not require anesthesia

  • Scissor excision
  • Electrodessication
  • Cryosurgery

Larger lesions
Anesthetize and excise

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33
Q

A pt presents with 3-10mm, slightly raised, pink-brown, sometimes scaly, hard growths, 1-10 lesions
That Retract beneath skin surface w/ compression -“ dimpling”

MC to the extremities and trunk

Think

A

Dermatofibromas

  • Fibrous reactive process to trauma
  • Bug bite, viral infection lesion, shaving, etc.

Dimpling is the clinical presentation

Tx: Removal with punch Bx or regular excision

  • Biopsy dark lesions - r/o MM
  • Conservative cryosurgery to decrease color

Completely benign

34
Q

A pt presents with raised, red or hyper pigmented, firm or shiny, smooth surface,-a hypertrophic scar

Think

A

Keloid

Tx options:

  • Intralesional steroids – effective, but painful
  • Atrophic effect on scar tissue
  • Combo surgery and intralesional steroids
  • Cryotherapy
  • Silicone gel sheeting
  • Intralesional 5-FU
  • Lasers
35
Q

A pt presents with a solitary, discrete, smooth, dome shaped, red papule/ tumor
With a distinctive central hyperkeratotic core

MC to the limbs/ Sun exposed surfaces

Think

A

Keratoacanthoma

Will resolve on its own but dont wait!

Often indistinguishable from squamous cell carcinoma – clinically and histologically

MGMT: excision, do not just Debride!

If recurrent use Intralesion 5-FU or Methotrexate

36
Q

A pt presents with a white to yellow, hard, keratosis conical lesion

On sun exposed sites
MC in men and elderly

Think

A

Cutaneous Horn

up to 20% of cutaneous horns arise in an in situ or invasive SCC

Treatment:

  • Excision
  • May shave or use LN2 if small, narrow base
37
Q

A por presents with small tumors of enlarges sebaceous glands
That begin as small yellow papules, that become dome chapped with a central puncture

With a sebaceous gland like appearance

Mc location is the face And in pts over 30

Think

A

Sebaceous Hyperplasia

No Txt required
-Curette, shave bx, electrosurgery

Take care to prevent scarring

Lesion can extend into dermis

If many lesions, may refer for isotretinoin (very low dose)

Rule of BCC

38
Q

What is the DDX of BCC and Sebnaceous Hyperpplasia

A

BCC – haphazard arrangement of vessels on surface

SH – vessels occur only within the valleys bordered with small yellow lobules

39
Q

What is the differnce between hypertrophic scars and keloids

A

HS usually regress over time

And Keloids do not

40
Q

A pt presents with a “sweat duct tumor” that is 1-3 mm, small, firm flesh colored dermal papules

Lasted under the eyes/ lower lid

Common in young women

Think

A

Syringoma

MGMT:
None, risk of scaring young skin

Cosmetically: can remove shave with an 11 blade

Completely benign

41
Q

A pt presents with a segmented, firm, waxy Nevus that appears after adolescence,

Think

A

Neurofibroma

Nerve sheath tumor, with a button hole sign
“Invaginated through skin with digital pressure”

MGMT: if 2 or more suspect Von Recklinghousen (NF1) – can become cancerous

Followed by Neuro

42
Q

What is the most common vascular malformation

A

Cherry Angioma

43
Q

A pt presents with 0.5- to 5-mm, smooth, firm, deep red papules

MC to the trunk or proximal extremities

Think

A

Cherry Angioma

no tx necessary

May shave or exisce as desired

44
Q

A pt presents with permanently dilated small blood vessels
That are less than 1mm, that appear as single strands, in groups as small as macules

Think

A

Telangiectasia

Treatment with electrodessication or laser ablation

45
Q

A pt presents with small, rapidly growing, yellow to bright red dome shapes glistening lesions

MC to the Head and Neck, fingers or Gingivia

Extremely friable

A

Pyogenic Granuloma

Treatment:

  • Thorough curettage of the base and border
  • Electrodessication often necessary to eradicate the lesions completely and to control bleeding
  • Recurs if the smallest piece of abnormal tissue remains
46
Q

What is the most benign soft tissue tumor

A

Lipoma

47
Q

A pt presents with soft pillowy, mobile, lesion

On the truck or extremities

Think

A

Lipoma,

Management
Excision or no Txt

Prognosis
Once removed normally don’t recur

If fast growing consider malignant transformation

48
Q

What is the most common skin cancer and most common malignant neoplasm in humans

A

Basal Cell Carcinoma

49
Q

What is the highest risk fx for BCC

A

Highest risk: Intense, intermittent exposure vs. equal dose of continuous exposure

And the inability to tan
(light light skin)

50
Q

Define: Malignant proliferation in basal layer of epidermis

A

BCC

51
Q

What is the standard appearance for BCC

A

There isnt one

it varies

Think about this if there is a weird lesion on skin exposed areas

52
Q

Most common form of BCC

A

Nodular

Pink/skin colored, “pearly” !!(opalescence)

Firm, dome shaped papule

Evolves - ulcerates and has elevated, rolled borders and telangiectasias
—“rodent ulcer”

53
Q

A pt presents with a bleeding/scab/sore that heals and recurs
“A zit that wont go away”

Think

A

Classical presentation for a BCC

54
Q

What is the most common location for a BCC

A

NOSE (nodular)

Trunk (superficial)

55
Q

What is the approach to BCC

A

Deferral to derm

With an annual TBSE (total body examination)
May stop if tumor free x 3 years

56
Q 
Define SCC (Squamous Cell Carcinoma) confined to the epidermis
-Premalignant
A

Actinic Keratosis

57
Q

A pt presents with persistent localized rough feeling to the skin, erythema with a scale
-hyperkeratotic lesion on the ears or hand , with sharp adherent yellow scale

Think

A

Actinic Keratosis

On any sun exposed area,
If on lower lip - actinic cheilitis
If on ear- Chondrodermatitis Nodularis Helicis

Tx: Excise or remove it
(LN2/ cryotherapy)
(5-FU-standard)
TBSE

58
Q

What is the difference between actinic keratosis and SCC

A

SCC invades the invades the dermis

59
Q

What are the standard and alternate treatment for Actinic Keratosis

A

5-fluoruracil (5-FU, Efudex cream) - standard

Imiquimod (Aldara cream) – alternative

60
Q

What is Bowen Dz

A

Squamous Cell Carcinoma In Situ

Slightly elevated, red, scaly plaques

Extends DOWNWARD into the follicle

Low grade for malignancy, can progeress to SCC

F/u q 6 months!! Required!!

61
Q

What is Bowens Disease of the Mucosa called

A

Erythroplasia of Queyrat – SCC in situ of mucous membranes

Assoc with HPV-8

Uncircumcised, elderly males, vulva of elderly females and/or oral mucosa

Presents with moist, red, smooth, slightly raised plaque

Treat with 5-FU or Imiquimod or Laser

62
Q

A pt presents with a red, scaly, persistent, deep, hypertrophic lesion with ulcer/ induration

Most commonly to sun exposed areas

Think

A

Bowens dz -> SCC

High risk of Metz

From UVA/UVB exposure
Preceded by Actinic Keratosis

Associated with HPV infections

Treat with excision + lymph nodes
F/u q 12 months indefinitely

63
Q

SCC on what location has the greatest chance to Metz

A

on the lips

So excision + margins

64
Q

What is the approach to Nevus evaluation

A

ABCDE!

Asymmetry 
Borders 
Color 
Diameter (>5mm) 
Evolution (changes)
65
Q

Any lesion that changes in appearance should get what

A

Bx!

66
Q

What is the F.u for a pt with more than 100 Nevi

A

If >100 nevi, follow at 6-12 month intervals

67
Q

What are the three types of Melanocytic Nevi

A

-Junction nevi
(flat, brown, common in childhood)

-Compound nevi
(slightly elevated, smooth or warty, +halo Nevus)

-Dermal nevi
(Dome snapped, verrucous, pedunculated, sessile, arising from the dermis)

68
Q
A

Dermal Nervus

Dome shaped most common

69
Q

What is a “birth mark”

A

Congenital Melanocytic Nevi

Grows proportionally with child growth

Prophylactic removal only if LARGE
-malignancy risk

70
Q

What is Nevus Spilus

A

Speckled Lentiginous Nevus

Rare malignancy risk

Hairless, oval or irregularly shaped brown macule
Dotted w/ darker brown to black papular spots

71
Q
A

Beckers Nevus

Common in adolescent men,
MC tot he upper back, shoulder, upper arm

No cancer risk

Tx; Usually too large to remove with excision

  • Hair may be shaved or permanently removed
  • Laser tx for removal of hair and pigmentation
72
Q
A

Halo Nevus

Compound or dermal nevus that develops a white border
Typically occurs around age 15
May herald onset of vitiligo

NOT MALIGNANT
MC to trunk

Tx- none needed, Bx if suspicious
Eval with Woods lamp for vitiligo

73
Q

A pt presents with a Hairless, red or reddish-brown, dome shaped papules/nodules

Think

A

Spitz Nevus

MC to head, neck, or LE

Occurs most in children
And appears suddenly

Tx: remove and send to path

74
Q

A pt presents with a slightly elevated, round, regular Nevus, MC to the extremities and dorsum of the hand

Think

A

Blue Nevus

Often confused with malignant melanoma

  • Develops in childhood
  • Remains unchanged
  • History is discriminator

Tx: none

75
Q

A pt presents with Blue-black lesions dermal melanocytes (more flattened) mc to the presacral area

A

Mongolian Spot

No treatment necessary

Caused by Appear blue-black due to “Tyndall effect” of melanin deeper in skin

76
Q

A pt presents wtih Blue-black pigmentation in 1st - 2nd branch of trigeminal nerve
Affects the sclera, conjunctiva and skin around eye

A

Nevus of Ota

Get a Visual acuity and document baseline

Treatment

  • Laser to lighten lesions
  • Monitor patient for glaucoma
77
Q

A pt presents with Brown-black macules on lower lip
Common in young adult women
Resemble freckles, but no change w/ sun exposure

A

Labial melanotic Macule

Treat with Cryotherapy if desired

78
Q

A pt presents with Brown-black macules on lower lip
Common in young adult women
Resemble freckles, but no change w/ sun exposure

A

Labial melanotic Macule

Treat with Cryotherapy if desired

79
Q

How does polymorphic light eruption appear in dark skinned individuals

A

most common morphology is grouped, pinhead-sized papules in sun-exposed areas

80
Q

What are the coomorbidites assoc with Vitiligo

A

Alopecia areata

hypothyroidism

Graves dz

Addison disease

pernicious anemia

DM1

melanoma

81
Q

How is a Nevus different than a melanocyte

A

Larger, lacks dendrites, has more abundant cytoplasm, and contains coarse granules

Senoir 21-2 (77 decks)

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