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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
A pregnant pt presents with symmetric brown hyperpigmentation of the face and neck without signs of inflammation Think
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) ```
26
What is the most common Benign cutaneous neoplasm
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
27
A pt presetns with a “stuck on” “greasy” macule of brown or black verrucous Think
Seborrheic Keratosis Cut it out even though its not malignant (dont take the chance of miss dx)
28
What separates SK from Melanoma
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
29
What is Lesner-Trelat sign
In SKs R/O malignant melanoma in dark lesions “Leser-Trelat” Sign – sudden appearance of multiple SKs: —Rare sign of internal malignancy
30
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
Stucco Keratosis 2/2 Vascular insufficiency, xerosis, Benign proliferation of keratinocytes Completely benign
31
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
Dermatosis papulosa Nigra Common in African Americans Completely Benign Tx directed at cosemtics - freezing (can cause hypopigmentation) - scissor snip, or removal
32
A pt presents Skin colored to brown Soft Pedunculated 1mm - 1cm raised lesions Located in areas with lots of rubbing Think
Skin Tags, Aka Acrochordon MC in obese pts Smaller lesions may not require anesthesia - Scissor excision - Electrodessication - Cryosurgery Larger lesions Anesthetize and excise
33
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
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
A pt presents with raised, red or hyper pigmented, firm or shiny, smooth surface,-a hypertrophic scar Think
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
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
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
A pt presents with a white to yellow, hard, keratosis conical lesion On sun exposed sites MC in men and elderly Think
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
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
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
What is the DDX of BCC and Sebnaceous Hyperpplasia
BCC – haphazard arrangement of vessels on surface SH – vessels occur only within the valleys bordered with small yellow lobules
39
What is the differnce between hypertrophic scars and keloids
HS usually regress over time And Keloids do not
40
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
Syringoma MGMT: None, risk of scaring young skin Cosmetically: can remove shave with an 11 blade Completely benign
41
A pt presents with a segmented, firm, waxy Nevus that appears after adolescence, Think
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
What is the most common vascular malformation
Cherry Angioma
43
A pt presents with 0.5- to 5-mm, smooth, firm, deep red papules MC to the trunk or proximal extremities Think
Cherry Angioma no tx necessary May shave or exisce as desired
44
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
Telangiectasia Treatment with electrodessication or laser ablation
45
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
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
What is the most benign soft tissue tumor
Lipoma
47
A pt presents with soft pillowy, mobile, lesion On the truck or extremities Think
Lipoma, Management Excision or no Txt Prognosis Once removed normally don’t recur If fast growing consider malignant transformation
48
What is the most common skin cancer and most common malignant neoplasm in humans
Basal Cell Carcinoma
49
What is the highest risk fx for BCC
Highest risk: Intense, intermittent exposure vs. equal dose of continuous exposure And the inability to tan (light light skin)
50
Define: Malignant proliferation in basal layer of epidermis
BCC
51
What is the standard appearance for BCC
There isnt one it varies Think about this if there is a weird lesion on skin exposed areas
52
Most common form of BCC
Nodular Pink/skin colored, “pearly” !!(opalescence) Firm, dome shaped papule Evolves - ulcerates and has elevated, rolled borders and telangiectasias —“rodent ulcer”
53
A pt presents with a bleeding/scab/sore that heals and recurs “A zit that wont go away” Think
Classical presentation for a BCC
54
What is the most common location for a BCC
NOSE (nodular) Trunk (superficial)
55
What is the approach to BCC
Deferral to derm With an annual TBSE (total body examination) May stop if tumor free x 3 years
56
``` Define SCC (Squamous Cell Carcinoma) confined to the epidermis -Premalignant ```
Actinic Keratosis
57
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
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
What is the difference between actinic keratosis and SCC
SCC invades the invades the dermis
59
What are the standard and alternate treatment for Actinic Keratosis
5-fluoruracil (5-FU, Efudex cream) - standard Imiquimod (Aldara cream) – alternative
60
What is Bowen Dz
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
What is Bowens Disease of the Mucosa called
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
A pt presents with a red, scaly, persistent, deep, hypertrophic lesion with ulcer/ induration Most commonly to sun exposed areas Think
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
SCC on what location has the greatest chance to Metz
on the lips So excision + margins
64
What is the approach to Nevus evaluation
ABCDE! ``` Asymmetry Borders Color Diameter (>5mm) Evolution (changes) ```
65
Any lesion that changes in appearance should get what
Bx!
66
What is the F.u for a pt with more than 100 Nevi
If >100 nevi, follow at 6-12 month intervals
67
What are the three types of Melanocytic Nevi
-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
Dermal Nervus | Dome shaped most common
69
What is a “birth mark”
Congenital Melanocytic Nevi Grows proportionally with child growth Prophylactic removal only if LARGE -malignancy risk
70
What is Nevus Spilus
Speckled Lentiginous Nevus Rare malignancy risk Hairless, oval or irregularly shaped brown macule Dotted w/ darker brown to black papular spots
71
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
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
A pt presents with a Hairless, red or reddish-brown, dome shaped papules/nodules Think
Spitz Nevus MC to head, neck, or LE Occurs most in children And appears suddenly Tx: remove and send to path
74
A pt presents with a slightly elevated, round, regular Nevus, MC to the extremities and dorsum of the hand Think
Blue Nevus Often confused with malignant melanoma - Develops in childhood - Remains unchanged - History is discriminator Tx: none
75
A pt presents with Blue-black lesions dermal melanocytes (more flattened) mc to the presacral area
Mongolian Spot No treatment necessary Caused by Appear blue-black due to “Tyndall effect” of melanin deeper in skin
76
A pt presents wtih Blue-black pigmentation in 1st - 2nd branch of trigeminal nerve Affects the sclera, conjunctiva and skin around eye
Nevus of Ota Get a Visual acuity and document baseline Treatment - Laser to lighten lesions - Monitor patient for glaucoma
77
A pt presents with Brown-black macules on lower lip Common in young adult women Resemble freckles, but no change w/ sun exposure
Labial melanotic Macule Treat with Cryotherapy if desired
78
A pt presents with Brown-black macules on lower lip Common in young adult women Resemble freckles, but no change w/ sun exposure
Labial melanotic Macule Treat with Cryotherapy if desired
79
How does polymorphic light eruption appear in dark skinned individuals
most common morphology is grouped, pinhead-sized papules in sun-exposed areas
80
What are the coomorbidites assoc with Vitiligo
Alopecia areata hypothyroidism Graves dz Addison disease pernicious anemia DM1 melanoma
81
How is a Nevus different than a melanocyte
Larger, lacks dendrites, has more abundant cytoplasm, and contains coarse granules

Senoir 21-2 (77 decks)

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