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Clinical Medicine > derm overview > Flashcards

derm overview Flashcards

1
Q

name the innermost layer of the epidermis. What is its function

A

stratum basalis (basal layer): proliferation center of the epidermis

  • in normal skin, cell division above the basal layer is scant or absent
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2
Q

Name the layer of the epidermis above the stratum basalis

A

stratum spinosum (spinous layer)

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3
Q

Name the epidermal layer that lies above the stratum spinosum

A

stratum granulosum (granular cell layer)

  • acquire lamellar granules
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4
Q

Name the epidermal skin layer that lies the most superficially. What is its function?

A

stratum Corneum (cornified layer)

  • serves as major physical barrier of the skin
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5
Q

How long does it take a cell from the stratum basalis to reach the stratum corneum in normal skin

A

4 weeks

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6
Q

Type I (immediate) immune process involves what type of immunoglobulins and cell types. What is the response?

A
  • Mast cells and Basophils
  • IgE
  • hives; bronchospasm; laryngeal edema
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7
Q

Type II (cytotoxic) immune response involves what type of reaction? What immunoglobulins are used

A
  • IgG or IgM react with surface antigen and activate complement
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8
Q

Type III (immune complex) involves what type of immune response? What immunoglobulins are used

A

antigen-antibody complexes deposited in tissues causing inflammation. Activates complement, increased vascular permeability

  • IgG and IgM
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9
Q

Type IV immune response involves what?

A
  • delayed hypersensitivy; usually occurs 24-48 hrs after exposure
  • cell mediated immunity
  • ex: poison ivy
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10
Q

function of melanocytes

A

cells found in epidermis: melanin pigment help protect skin against UV radiation

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11
Q

function of langerhan’s cells

A

found in epidermis

  • dendritic cells that have immunologic function; “macrophages of skin;” present antigens to lymphocytes
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12
Q

many blistering diseases arise from defects in what skin layer

A

basement membrane zone: dermal-epidermal junction

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13
Q

what important structures are contained within the dermis

A

vessels; nerves; and skin appendages (eccrine, apocrine, and sebaceous glands, hair follicles; nails)

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14
Q

Location and function of eccrine gland

A
  • location: coiled gland dermis; straight duct extends to epidermis
  • temperature regulation
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15
Q

function and location (on body) of apocrine glands

A
  • no known function
  • bacteria acting on gland secretions leads to body odor
  • concentrated in axillary and anogenital regions
  • duct drains into midportion of follicle
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16
Q

name the two different types of hair follicles. Give thier description

A
  • vellus hairs: short and fine (forehead)
  • terminal hairs: long and think (scalp/axilla)
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17
Q

what is the bulb of a hair follicle

A

enlargement at base of follicle

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18
Q

superficial fungal infections affect what bodily structure? What type of immune response do they illicit

A
  • affect mucous membranes
  • induce cell-mediated immunity
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19
Q

risk factors for developing fungal infections

A
  • moisture
  • steroids
  • pregnancy
  • Abx
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20
Q

scraping the skin away with a curette, a ring shaped instrument

A

curettage

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21
Q

high frequency current is applied to the lesion, destroying the tissue by drying it out

A

electrodessication

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22
Q

tissue is destroyed by freezing to -40 C or below using liquid nitogen

A

cryotherapy

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23
Q

tiny round cookie cutter like tool that is rotated on the surface of the skin until it cuts through all the layers of the skin, including the dermis, epidermis and the upper parts of the subcutis

A

punch biopsy

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24
Q

seborrheic keratosis: benign or malignant? cause?

A
  • common, benign condition of hyperpigmentation
  • due to epidermal hyperplasia
  • age related; genetic disposition
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25
Q

tan to black papule; often descirbed as warty; greasy; scab-like or rough “stuck-on” appearance with a irregular border (but well-circumscribed); 2mm-3cm in size but can be larger

A

seborrheic keratosis (SK)

26
Q

variant of SK, multiple skin-colored or white, dry, scaly lesions often seen on the extremities

A

stucco keratoses

27
Q

multiple, small brown/black papules commonly found on the face of darker-skinned people

A

dermatosis papulosa nigra

28
Q

sudden appearence of multiple SK with an inflammatory base. Can be associated with many skin tags. May indicate internal malignancy (usually stomach, colon, or breast)

A

Lesler-Trelat sign

29
Q

Treatment options for SK

A
  • treatment
  • cryotherapy (liquid nitrogen)
  • curettage with electrocautery
  • shave or excisional biopsy
30
Q

RAPIDLY GROWING neoplasm (4-6 weeks) of the epithelium that is biologically BENIGN but histologically resembling a squamous cell carcinoma

  • usually resolves on own within 6 months
A

keratoacanthoma

31
Q

actinic keratosis (AK): benign or malignant? cause?

A
  • common, benign condition but often times is precursor to skin CA (SCC)
  • slightly more common in males
  • due to sun exposure
  • age related
  • rarely seen in darker skin types
  • about 1/2 resolve if patient avoids sun exposure
32
Q
  • less than 1mm-several cm
  • scale or as a dry or rough patch
  • skin colored; white or light colored, can be pink: felt more easily than seen
  • “pick at scale but keeps returning”
  • sun exposed areas
A

actinic keratosis

33
Q

treatment options for AK

A
  • 5-fluorouracil cream (Efudex): can temporarily cause red ulcerations and crusting
  • imiquimod (Aldara)- immune modulator
  • cryotherapy
  • curettage
  • cosmetic resurfacing-chemical peels
34
Q

95% of all skin cancers are what type? The other 5%?

A

95% are basal cell carcinoma or squamous cell carcinoma (SCC)

5% malignant melanomas

35
Q

90% of skin ca are caused by what?

A

sun exposure

  • skin CA risk doubles if patient has five or more serious sunburns
  • prior skin CA
  • smokers (SCC only)
36
Q

most common type of skin CA

A

3/4 skin CA are BCC

37
Q

basal cell carcinoma arise from what layer of skin? growth rate?

A
  • arise from basal cell layer
  • tends to grow slowly. rarely metastasizes but can invade local tissue
38
Q

firm or hard nodule or papule, often described as pearly or waxy and often times have a depressed center

  • can be ulcerated with rolled borders
  • telangiectasias
  • often bleed with minimal trauma or may be oozing or crusting
A

basal cell carcinoma

39
Q

most common type of BCC

A

nodular

40
Q

BCC subtype

A

ulcerative BCC

41
Q

BCC subtype

A

superficial BCC

42
Q

BCC subtype

A

pigmented BCC

43
Q

BCC treatment

A
  • biopsy
  • when in doubt, cut it out
  • curettage/electrodessication
  • excisional biopsy
  • cryotherapy
44
Q

what is mohs micrographic surgery used for

A

highest cure rate for BCC and SCC and is the treatment of choice for locally recurrent skin CA

45
Q

what skin CA accounts for 10-30% of all skin CA

A

SCC

46
Q

This type of skin CA may occur where skin has suffered injury ex: burns, scars, long-standing sores

A

SCC

47
Q
  • varies dramatically
  • color: skin colored; erythematous; yellowish
  • may be ulcerated
  • often have rough surface with thick hyperkeratotic scales
  • occures on sun exposed skin
A

squamous cell carcinoma

48
Q

treatment options for SCC

A
  • simple surgical resection
  • if lesion >2 cm, recurrent, on face/genitalia: may require Mohs surgery
  • cryotherapy
  • may require radiation or chemotherapy
49
Q

SCC follow up: what is the chance of a new tumor within 2 years of initial growth

A

40%

50
Q

malignant melanoma often metastasize where?

A

lung, brain, lymph nodes

51
Q

malignant melanoma orginate in what cells

A
  • originate in melanocytes
  • most tumors are brown or black
  • men>women
  • darker skin tones are slightly more protective
  • often arises in normal skin
52
Q

malignant melanoma risk factors

A
  • sun exposure
  • family hx of melanoma
  • personal hx of melanoma
  • atypical moles
53
Q

most common type of malignant melanoma. Describe it

A

superficial spreading melanoma

  • often seen in younger population
  • may appera in previously benign mole
  • radial spread preceds vertical growth
54
Q

in situ malignant melanoma but becomes this when it becomes invasive. What is it characterized by

A

lentigo maligna

  • long period of horizontal growth followed by rapid vertical invasion
  • found in older population
55
Q

this type of malignant melanoma is most commonly seen in african americans or darker skinned people; often appears as a black or brown discoloration under the nails; on soles of feet; or palms of hands; spreads superficially before vertical growth

A

acral letiginous melanoma

56
Q

what is the most aggressive type of MM? What is it characterized by?

A

Nodular melanoma

  • rapid vertical growth (weeks to months) but little to no radial growth
  • appears as nodule that is often inflammed or friable
  • usually black
57
Q

breslow’s staging of MM

A

measures thickeness

58
Q

clark’s staging of MM

A

measures layers of skin involved

59
Q

if a MM is ulcerated, what does this mean in terms of prognosis

A

worse

60
Q

treatment for malignant melanomas

A
  • wide surgical excision with 0.5-3cm clear margins
  • chemotherapy (DTIC)
  • immunotherapy (interferon-alpha)
  • follow up every 3 months
61
Q

ABCDs of melanoma

A
  • A: asymmetry
  • B: border irregularity
  • C: color (uneven)
  • D: diameter > 6 mm
  • other warning signs: new nodule; color spreads into surrounding skin; redness or swelling beyond mole; itching; bleeding
62
Q

localized erythematous patches or plaques on trunk > 5cm; usually itchy; may see lymph node swelling

A

Mycosis Fungoides (Cutaneous T cell Lymphoma)

**biopsy is key

Clinical Medicine (6 decks)

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