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Clinical Med I > Derm - SK, AK, and Skin Cancer - Exam 1 > Flashcards

Derm - SK, AK, and Skin Cancer - Exam 1 Flashcards

1
Q

What is curettage?

A

Scraping the skin away with a curette (a ring-shaped instrument)

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2
Q

What is electrodessication?

A

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

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3
Q

What is cryotherapy?

A

Tissue is destroyed by freezing to -40°C or below using liquid nitrogen

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4
Q

What are the benefits of treatment with an excisional biopsy?

A
  • Less expensive unless reoccurrence
  • Faster
  • More providers can offer treatment
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5
Q

What are the benefits of treating with Mohs surgery?

A
  • Complete margin analysis
  • Higher cure rates
  • Sparing of normal tissue
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6
Q

What are the cons of treating with Mohs surgery?

A
  • Higher cost
  • Longer appointment
  • Subspecialist
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7
Q

How is the tissue examined in Mohs Micrographic Surgery (MMS) and what benefit does this provide?

A

Tumor margins are assessed in office to maximize tissue conservation; lowers recurrence rates

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8
Q

What are the 3 primary indications for Mohs surgery?

A
  1. Recurrent tumors
  2. Tumors > 0.6cm on the face or > 2.0cm on the body/ extremities
  3. High risk anatomic locations (eyelids, nose, ears, lips, genitalia, fingers)
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9
Q

What is the process used in Mohs surgery?

A

First thin layer removed (removing visible lesion on skin) then additional layers removed until all cancer is removed

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10
Q

What is a solar lentigo?

A

A local proliferation of melanocytes caused by UV damage in sun exposed areas; very common

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11
Q

What are solar lentigos often referred to as?

A

“Age spots” or “senile freckles”

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12
Q

What is the clinical presentation of a solar lentigo?

A
  • Well circumscribed

- Small brown macule, often found in groups

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13
Q

In what case would you treat a solar lentigo?

A

Cosmetic considerations only (otherwise typically no treatment required)

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14
Q

What is a seborrheic keratosis (SK)?

A
  • common benign epidermal lesion caused by proliferation of immature keratinocytes
  • develop typically after age 50 (“barnacles of aging”)
  • genetic link to excess multiple SK’s
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15
Q

What is the typical clinical presentation of a seborrheic keratosis?

A
  • Tan to black with warty, waxy, “stuck on” appearance
  • Well demarcated, oval/ round/ irregular shape
  • May have single SK or hundreds
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16
Q

What areas of the body are SK’s typically found and what pattern can they display?

A

Chest, back, head, neck; Christmas tree appearance of back due to Blaschko Lines

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17
Q

What is an ISK?

A

An SK that has become irritated as a result of rubbing/ friction; may have pruritus, pain, or bleeding

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18
Q

What is the Leser-Trélat sign?

A
  • Sudden onset of multiple SK’s with inflammatory base; present with skin tags and acanthosis nigricans
  • Possible association with GI and lung cancers
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19
Q

How is an SK diagnosed?

A
  • Typically clinical diagnosis

- Biopsy may be needed if diagnosis uncertain

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20
Q

What should be considered with an SK?

A

-Reassurance; consider removing for cosmetic reasons or some ISK’s

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21
Q

What are the treatment options for an SK?

A

Cryotherapy, shave biopsy with 15 blade, curettage, electrodessication

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22
Q

What is the clinical presentation of a keratoacanthoma?

A
  • Hallmark: rapid growth over 6-8 weeks
  • Round, flesh colored nodule with central keratin plug
  • More commonly found in sun exposed areas
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23
Q

What are the risk factors for a keratoacanthoma?

A
  • Middle-age to elderly with fair skin

- Increased UV radiation or chemical carcinogens

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24
Q

What is the management for keratoacanthoma?

A
  • Majority resolve spontaneously in 6-9 months

- Due to difficult diagnosis, requires biopsy/ treatment (excisional biopsy is typically preferred)

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25
Q

Why is treatment of a keratoacanthoma controversial?

A

Benign vs. pseudo-malignant appearance; many consider less aggressive squamous cell carcinoma with rare metastatic potential

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26
Q

What is an actinic keratosis (AK)?

A

A pre-cancerous lesion originating from a keratinocyte (also known as solar keratosis)

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27
Q

What type of skin cancer does an actinic keratosis have the potential to develop into?

A

Squamous cell carcinoma (SCC); 8% risk per year

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28
Q

What are the risk factors for AK’s?

A
  • Increasing age
  • Male
  • Light skin complexion (Fitz I, II)
  • Chronic UV light exposure
  • History of sunburns
  • Immunosuppression
  • Genetic syndromes
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29
Q

What is the Fitzpatrick Scale used for and what are the levels?

A

-Classifying skin types; I (very fair)- VI (very dark)

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30
Q

What is the clinical presentation of an AK?

A
  • erythematous, scaly/ gritty macule or papule (feels like sandpaper)
  • may be tender
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31
Q

How is an AK diagnosed?

A
  • typically clinical diagnosis based on visualization/ touch
  • dermoscopy may be helpful
  • shave or punch biopsy if unable to differentiate from SCC
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32
Q

In what cases would you consider a shave/ punch biopsy for diagnosis of an AK?

A
  • lesion > 1cm
  • rapid growth
  • ulceration or pain associated
  • caution if lesion is > 6mm- consider SCC in situ)
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33
Q

What should be considered in the management of AK’s?

A

May spontaneously resolve (20-30%) but could reoccur

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34
Q

How are AK’s treated?

A
  • Isolated lesions: cryotherapy or surgical intervention

- Multiple lesions: fluorouracil cream (preferred), photodynamic therapy (PDT), imiquimod (Aldara)

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35
Q

What is the spectrum of development of an SCC?

A

Photodamaged skin > AK > SCC in situ (Bowen’s Disease) > invasive SCC

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36
Q

What are risk factors for skin cancer?

A
  • Sun exposure, sunburns, tanning beds
  • More exposure= higher risk
  • Fair skin higher risk than dark skin
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37
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma (BCC)

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38
Q

What does BCC arise from?

A

Basal layer of epidermis

39
Q

What is the clinical presentation of BCC?

A
  • flesh-colored or pinkish
  • pearly papule/ nodule
  • telangiectasia
  • may have central ulceration with rolled border
  • most common on head and neck
40
Q

What is the most common subtype of BCC?

A

Nodular BCC

41
Q

How else may a BCC present besides the classic pearly papule/ nodule?

A

Superficially as a pink patch similar to AK or SCC in situ; pigmentation may also be present

42
Q

What method of treatment is preferred for BCC (Nodular)?

A

Surgical (vs. nonsurgical)

43
Q

What surgical options exist for the treatment of BCC?

A
  • Curettage and Desiccation
  • Excision with 4mm margins
  • Mohs for high-risk or cosmetic reasons
44
Q

What non-surgical options exist for the treatment of BCC (Nodular)?

A

Radiation (for poor surgical candidates)

45
Q

What are common treatment options for superficial BCC?

A
  • Imiquimod cream
  • 5% fluorouracil cream
  • Photodynamic therapy
46
Q

What is the prognosis for BCC?

A
  • Locally invasive
  • May recur requiring routine f/u for surveillance (6-12 mo. X 2 years then annual f/u)
  • Metastasis is rare
  • Higher risk for developing other NMSC (non-melanoma skin cancers)
  • Appropriate education
47
Q

What is the second most common type of skin cancer?

A

Squamous cell carcinoma (SCC)

48
Q

What cells do SCC’s originate from?

A

Keratinocytes

49
Q

What are the risk factors for SCC?

A
  • Males (50-70 y/o)
  • UV exposure (including tanning beds)
  • Genetic alterations
  • Chemical carcinogen exposure
50
Q

What can a SCC arise from?

A

An area of previous skin injury (ex. burns, scars)

51
Q

What is the clinical presentation of SCC?

A
  • Papule, plaque, nodule
  • Pink, red, or skin colored
  • Often asymptomatic, may be pruritic or tender)
  • Lesion appears scaly, exophytic, indurated, friable
  • Commonly appears warty
52
Q

What treatment option is preferred for SCC?

A

Surgical (vs. non-surgical)

53
Q

What are the possible surgical options for the treatment of SCC?

A

Wide excision and Mohs

54
Q

What are the margins based on in regards to treatment of SCC with a wide excision?

A

Margins based on risk

55
Q

When is Mohs recommended for the treatment of SCC?

A

Recommended for high-risk and cosmetic considerations

56
Q

What are non-surgical options for the treatment of SCC?

A

Radiation, curettage, desiccation, or cryotherapy

57
Q

When is radiation considered as a treatment option for BCC?

A
  • Poor surgical candidates

- Residual tumor

58
Q

When is curettage & desiccation or cryotherapy considered for the treatment of SCC?

A

Select low-risk or SCC in situ

59
Q

What are the less effective treatment options for SCC in situ?

A

5-fluorouracil therapy, imiquimod cream, photodynamic therapy

60
Q

What is the prognosis of SCC?

A

Rate of metastasis is 5%; rate increases if lesion > 2cm in diameter, > 4mm deep, or recurrent

61
Q

What are the guidelines for surveillance of SCC?

A

Every 3-6 months x 2 years –> then every 6-12 months x 3 years –> then annually for life (AAD)

62
Q

What is the average age of those diagnosed with MM?

A

40 y/o (rare in children)

63
Q

What are risk factors for MM?

A
  • Fair skin, blue eyes, red/ blonde hair, freckling
  • > 5 atypical nevi, >25 nevi
  • Immunosuppression
  • Personal/ family history of MM (genetic predisposition in small percentage)
  • Prolong UV exposure (blistering sunburns, UVA tanning bed exposure)
64
Q

What is the clinical manifestation of MM?

A
  • Usually asymptomatic
  • Most de novo with some arising from pre-existing nexus
  • Pigmented papule, plaque, or nodule
  • ABCDE’s
65
Q

What are the ABCDE’s of MM?

A 
A- asymmetry- shape or color
B- border- irregular
C- color- dark or variations
D- diameter- >6mm (pencil eraser)
E- evolving- changes in above
66
Q

What are the subtypes of MM?

A

Superficial spreading, Nodular, Lentigo maligna, Acral lentiginous

67
Q

What is the most common subtype of MM and where on the body is it typically found?

A

Superficial spreading melanoma (70%); men: backs, women: back and legs

68
Q

What part of the skin does superficial spreading melanoma affect and how does it grow?

A

Confined to epidermis; radial spread > vertical growth

69
Q

What populations does superficial spreading melanoma typically affect?

A

Often younger populations

70
Q

How does nodular melanoma present clinically?

A

Nodule is inflamed and friable

71
Q

Describe the growth pattern of nodular melanoma

A

Rapid vertical growth, minimal radial growth; aggressive

72
Q

What populations typically exhibit lentigo malignas?

A

Elderly with chronic sun exposure

73
Q

Describe the growth pattern for lentigo malignas

A

Slow progression radially with rapid vertical growth; typically remains more superficial compared to nodular MM

74
Q

In what populations are acral lentiginous lesions most common?

A
  • Darker skin (African/ Asian ancestry)

- Male > Female

75
Q

Describe the growth pattern of acral lentiginous lesions

A

Spreads superficial then vertical; larger lesions due to delay in diagnosis

76
Q

What areas of the body are typically affected by acral lentiginous lesions?

A

Palmar, plantar, or subungual surfaces

77
Q

What are two atypical presentations of melanoma?

A

Subungual and amelanotic

78
Q

What are the common characteristics of subungual melanoma?

A
  • Great toe or thumb
  • History of trauma
  • Dark streak and involves proximal nail fold
79
Q

What are the common characteristics of amelanotic melanoma?

A
  • Minimal or absent pigment

- extensive differential diagnosis

80
Q

What should be done prior to taking a biopsy of a melanoma?

A

Photograph lesion; document size and landmark (dermatologist can also triage images)

81
Q

How much skin should be taken in a biopsy of a melanoma?

A

Entire lesion + 1-2mm

82
Q

What factors should be considered when determining the prognosis of melanoma?

A

Breslow depth, ulceration, mitotic rate, lymph node involvement

83
Q

Who is the greatest risk for lethal melanoma?

A

Males over 50 living alone

84
Q

Describe the screening considerations for melanoma patients

A

Screen high risk patients in PCP and screening every 6 months x 2 years then annually

85
Q

How are tumors staged for melanoma?

A

TNM- tumor, node, metastasis

86
Q

What is the gold standard for treating melanoma?

A

Wide surgical excision with 2cm clear margins

87
Q

What other treatments are used for patients with melanoma besides surgical excision?

A

Region lymph node dissection/ sentinel node biopsy

88
Q

What treatments are used for advanced metastatic disease?

A
  • Radiation
  • Chemotherapy- may be used alone or in combo with other agents
  • Immunotherapy/ targeted therapy- adjunct therapy
89
Q

How often are melanoma patients advised to follow up?

A

Every 3 months

90
Q

What precautions should be taken to prevent melanoma?

A
  • Avoid getting burned and tanning
  • Daily moisturizers with sunscreen (15+)
  • Sunscreen SPF 30+ with planned sun exposure
  • Sun protective clothing when in the sun (including hats and sunglasses)
  • If possible, avoid the sun 10am-4pm or find shade
  • Avoid tanning beds
  • Routine skin exams
91
Q

What guidelines should be followed in regards to sunscreen application/ protection?

A
  • Apply 30 min prior to activity and reapply every 2 hours

- Keep infants out of the sun, sunscreen only > 6 months of age

92
Q

How does sebaceous hyperplasia present clinically?

A
  • Enlarged oil gland with central clearing

- Telangiectasia wraps around (versus “over lesion” for BCC)

93
Q

How does a fibrous papule present clinically?

A
  • Benign angiofibroma
  • Skin-colored/ pinkish papule on the nose
  • No telangiectasia and lacks pearly texture

Clinical Med I (24 decks)

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