derm overview Flashcards by Alex Steinmann

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

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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Name the layer of the epidermis above the stratum basalis

stratum spinosum (spinous layer)

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Name the epidermal layer that lies above the stratum spinosum

stratum granulosum (granular cell layer)

acquire lamellar granules

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

stratum Corneum (cornified layer)

serves as major physical barrier of the skin

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

4 weeks

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

Mast cells and Basophils
IgE
hives; bronchospasm; laryngeal edema

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

IgG or IgM react with surface antigen and activate complement

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

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

IgG and IgM

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Type IV immune response involves what?

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

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function of melanocytes

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

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function of langerhan’s cells

found in epidermis

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

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many blistering diseases arise from defects in what skin layer

basement membrane zone: dermal-epidermal junction

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what important structures are contained within the dermis

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

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Location and function of eccrine gland

location: coiled gland dermis; straight duct extends to epidermis
temperature regulation

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function and location (on body) of apocrine glands

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

vellus hairs: short and fine (forehead)
terminal hairs: long and think (scalp/axilla)

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what is the bulb of a hair follicle

enlargement at base of follicle

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

affect mucous membranes
induce cell-mediated immunity

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risk factors for developing fungal infections

moisture
steroids
pregnancy
Abx

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

curettage

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

electrodessication

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

cryotherapy

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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

punch biopsy

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seborrheic keratosis: benign or malignant? cause?

common, benign condition of hyperpigmentation
due to epidermal hyperplasia
age related; genetic disposition

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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

seborrheic keratosis (SK)

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

stucco keratoses

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

dermatosis papulosa nigra

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)

Lesler-Trelat sign

Treatment options for SK

* treatment * cryotherapy (liquid nitrogen) * curettage with electrocautery * shave or excisional biopsy

**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

keratoacanthoma

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

* 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

* 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**

actinic keratosis

treatment options for AK

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

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

95% are basal cell carcinoma or squamous cell carcinoma (SCC) 5% malignant melanomas

90% of skin ca are caused by what?

sun exposure * skin CA risk doubles if patient has five or more serious sunburns * prior skin CA * smokers (SCC only)

most common type of skin CA

3/4 skin CA are BCC

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

* arise from basal cell layer * tends to grow slowly. rarely metastasizes but can invade local tissue

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

basal cell carcinoma

most common type of BCC

nodular

BCC subtype

ulcerative BCC

BCC subtype

superficial BCC

BCC subtype

pigmented BCC

BCC treatment

* biopsy * when in doubt, cut it out * curettage/electrodessication * excisional biopsy * cryotherapy

what is mohs micrographic surgery used for

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

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

SCC

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

SCC

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

squamous cell carcinoma

treatment options for SCC

* simple surgical resection * if lesion \>2 cm, recurrent, on face/genitalia: may require Mohs surgery * cryotherapy * may require radiation or chemotherapy

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

40%

malignant melanoma often metastasize where?

lung, brain, lymph nodes

malignant melanoma orginate in what cells

* originate in melanocytes * most tumors are brown or black * men\>women * darker skin tones are slightly more protective * often arises in normal skin

malignant melanoma risk factors

* **sun exposure** * family hx of melanoma * personal hx of melanoma * atypical moles

most common type of malignant melanoma. Describe it

superficial spreading melanoma * often seen in younger population * may appera in previously benign mole * **radial spread preceds vertical growth**

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

lentigo maligna * long period of horizontal growth followed by rapid vertical invasion * found in older population

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

acral letiginous melanoma

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

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

breslow's staging of MM

measures thickeness

clark's staging of MM

measures layers of skin involved

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

worse

treatment for malignant melanomas

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

ABCDs of melanoma

* 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

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

Mycosis Fungoides (Cutaneous T cell Lymphoma) \*\*biopsy is key