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Derm wk 3 Flashcards

1
Q

Red, crusted bump

dry and rough, lotion does not help

sometimes itchy, friable

A

Good description example:

Well circumscribed, 2 cm, erythematous NODULE w central ulceration and crust. The lesion is firm with palpation.

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2
Q

Squamous Cell Carcinoma

A

Cell or origin: Keratinocyte

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3
Q

Squamous cell carcinoma

A

Erythematous nodule, rolled borders, CENTRAL ulceration, crust, growth looking thing

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4
Q

Squamous Cell Carcinoma has all sorts of appearances

A

Papule, plaque, nodule
Pink, scaly, or red
Exophytic- with outward growth
i.e.: Cutaneous horn

Friable

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5
Q

Are Squamous Cell Carcinoma lesions symptomatic?

A

Often not at first, may be ITCHY and TENDER

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6
Q

“SCC in situ”

A

Bowen’s Dz

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7
Q

“SCC in situ” aka Bowen’s dz

A

Circumscribed pink/red patch or thin plaque w scaly or rough surface

confined to Epidermis, does not invade past dermal-epidermal junction

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8
Q

“SCC in situ” aka Bowen’s dz almost looks like

A

Cellulitis or Erysipelas

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9
Q

Can have SCC of the Nail

A

males 50-70s

Nails appear warty, subunqual hyperkeratosis, oncholysis oozing, destruction of nail plate

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10
Q

Tx for SCC

A

Surgical excision- make sure borders got all CA

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11
Q

What does invasive mean?

A

that the carcinoma cells are in the DERMIS

if not, it will be called “in situ”

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12
Q

Surgical tx options for SCC

A

Surgical excision

  • excision w margins
  • Mohs

Curettage and Electrodesiccation or Cryosurgery
-for in situ SCC

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13
Q

If pt can’t have surgery and has SCC, what are options?

A

Radiation
Photodynamic therapy
5-Fluorouracil
Imiquimod

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14
Q

5-Flour

A

Antimetabolite, meaning it interferes w DNA synthesis

Approved for AK, Basal Cell, and SCC who can’t have surgery

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15
Q

Imiquimod

A

Immune response modifier

Induces pro-inflammatory cytokines

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16
Q

Imiquimod

A

for AK of Scalp and FACE

for Superficial Basal cell CA

Non surgical SCC

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17
Q

What indicates a better response rate when using Imiquimod?

A

a greater inflammatory response

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18
Q

Higher rates of METs if:

A
  • on Ears, lip without hair, scalp, mask of face
  • in Scars, chronic ulcers, burns, sinus tracts, anogenital region
  • Immunosuppressed
  • Tumor was caused by arsenic ingestion
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19
Q

Pts w NON-metastatic SCC need f/u how often?

A

every 6-12 mo for 3 years

then yearly

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20
Q

AK- Actinic Keratosis

A

have the potential of turning into —> SCC Squam Cell CA

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21
Q

Do all AK turn into SCC?

A

No, risk within one year is 8%

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22
Q

The order of skin progression is:

A

Photo damaged skin –> AK–> SCC in situ (bowens) –> Invasive SCC

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23
Q

SANDPAPER lesion

red, flat papule or thin plaque with a rough and gritty scale

A

Actinic Keratosis

AK

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24
Q

Red, scaly patches

A

Actinic Keratosis

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25
Cutis Rhomboidalis nuchae
Reddish neck w rhomboidal furrows (wrinkes) -example of sun damage
26
Solar Elastosis
fine nodularity, pebbly surface -example of sun damage
27
When you think of "old people arms" w easy bruising
Actinic (senile) Purpura Extravasated erythrocytes and increased perivascular inflammation
28
Actinic Cheilitis represents
AK on the lips, often the lower lip
29
Option to treat Actinic Keratosis
Cryotherapy w liquid nitrogen
30
What is Cryotherapy?
FREEZE it off w liquid nitrogen
31
Freeze ball should be
1.5x the size of the lesion
32
AK treatment
MANY options, helpful to include Dermatologist to guide therapy - Liquid nitrogen - Curettage and electrocautery - 5-FU - Imiquimod - Ingenol mebutate gel - Photodynamic therapy - Diclofenac
33
How does Diclofenac work?
It's a POTENT NSAIDs approved for AK
34
Ingenol Mebutate
cause cell death then inflammatory response approved for AK
35
Pts w AK should have regular skin exams how often?
every 6-12 months
36
How often to re-apply sun screen?
every 2 hours
37
Extra caution in sun when you are around:
Water, Snow, or Sand All intensify the damage rays of sun
38
Altered tumor suppressor gene in SCC and also AK
p53
39
What's the big difference b/w SCC and AK, because they both can be rough and scaly
SCC protrude more, can be crazy looking and stick out AK are papules or thin plaque
40
Good description of Basal Cell CA
Solitary, 5 mm pearly pink papule with telangiectasias, on R zygomatic cheek
41
SubQ injection can be provided prior to intradermal
bc subQ is much less painful
42
Results on biopsy indicating Basal Cell CA
Rounded nests of basaloid cells, peripheral palasaiding, fibromyxoid stroma and clefts
43
What do you need to do before excising what you think to be a Basal Cell CA?
Biopsy the lesion first!
44
What gene mutation is usually involved with Basal Cell CA?
PTCH1
45
Although Basal cell CA are often Nodular, they can also present like:
``` Infiltrative Sclerotic Ulcerated Pigmented Superficial ```
46
Difference b/w Basal Cell CA scale and SCC in situ scale
Basal: fine scale SCC in situ: Keratotic scale crust
47
Tool used to help evaluate skin lesions
Dermoscope good for pigmented lesions
48
Benign angiofibroma
fibrous papule Small, homogenous skin colored/pink papule on the nose No telangiectasias or pearly texture
49
Morpheaform/Infiltrative Basal cell CA requires what treatment?
Excision with Mohs micrographic surgery
50
Surgery options for BCC
Curette and Desiccation Cryosurgery Excisional surgery Mohs microscopic
51
Is Mohs good?
YES offers complete histologic analysis of 100% tumor margins while permitting max conservation of tissue Recurrence rates are lower s/p Mohs
52
Indication for Mohs surgery
Nose, ears, eyes, lips, scalp, hands Basically HEAD, or hands Agressive type Large tumors or tumors w indistinct borders Recurrent tumors
53
Non surgical tx for Basal Cell CA is considered when:
Superficial Nodular Imiquimod 5-FU Photodynamic Radiation
54
Basal cell CA prognosis
Locally invasive METs are rare BUT at greater risk for developing other types of skin CA in the future, should f/u regularly
55
BCC f/u
every 6-12 mo for 2 years, then can do self exams
56
Warning signs of BCC
``` Open sore Reddish patch or irritated area Shiny bump or nodule Pink growth Scar like area ```
57
ABCDEs of Melanoma
``` Asymmetry Borders Color Diameter Evolving ```
58
Most common skin CA
Basal cell head or neck
59
Good way to describe Melanoma
___(size) dark blue to black plaque w asymmetry, irregularly notched borders and a pink erythematous rim
60
To decrease discomfort with injection
what can be added to lidocaine? Bicarb
61
Where do Melanocytes typically live?
Basal layer
62
Where do Melanocytes hang out in cancerous Melanoma??
In the upper portions of epidermis BAD NEWS BEARS
63
When nuclei are large and of different shapes, this is abnormal and known as
Cytologic atypia
64
Clinical sx of Melanoma
often A-sx
65
Most common type of Melanoma
Superficial spreading on the back, and legs in women. growth is mostly horizontal
66
Other types of Melanoma
``` Nodular Lentigo maligna Acral Lentiginous (gnarly looking) Subungual (nailbed) Amelanotic (presenting like something else, the key here is that it is evolving) ```
67
Breslow depth
how to measure depth of Melanoma
68
A good thing to think about before sending someone for biopsy about a lesion concerning for Melanoma
Take a picture of the lesion
69
What is the single most important prognostic factor for survival and clinical mgmt of Melanoma?
Thickness or depth of the tumor
70
What other things hint at a bad prognosis with Melanoma?
Ulceration | Involvement of lymph nodes or distant mets
71
3 prog factors review
Breslow Ulcer Lymph involvement
72
How often to f/u for Melanoma if pt has stage 1-2?
every 6-12 mo for 5 years, then annually
73
How often to f/u for Melanoma if pt has stage 2b-4?
every 3-6 mo for 2 years, then every 3-12 mo for 3 years, then annually
74
Who is at the greatest risk for Lethal Melanoma?
White males over 50 who live alone
75
How many moles are concerning?
>25 or >5 Atypical moles or 1st deg relative with biopsy proven Melanoma

Clinical Prep (41 decks)

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