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Skin/Musculoskeletal Medicine > dermatology > Flashcards

dermatology Flashcards

1
Q

what is a macule?

A

A flat, circumscribed region of skin with different color or texture (example: freckle)

completely flat!!! localized hyperpigmentation

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2
Q

what is a macule patch?

A

A large macule (> 1 cm) or a coalescence of macules (example: vitiligo)

still flat!

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3
Q

what are papule?

A

raised area, A palpable, circumscribed change in consistency or contour of the skin (example: acne vulgaris)

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4
Q

A papule larger than 1 cm in diameter

(example: neurofibroma)?????

A

Nodule

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5
Q

Plaque

A

a clump! larger raised area. A coalescence of papules (example: psoriasis)

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6
Q

Vesicle

A

A circumscribed, clear fluid filled lesion; a blister (example: Herpes simplex)

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7
Q

Bulla

A

A large vesicle (example: bullous

pemphigoid)

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8
Q

Pustule

A

A vesicle filled with inflammatory cells

(example: acne vulgaris)

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9
Q

Wheal

A

localized area of swelling…edema. A palpable, circumscribed, area of edema with central pallor and peripheral erythema (example: hives) that usually disappears relatively quickly.

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10
Q

Purpura

A

large area of bleeding into the skin…. Discoloration of the skin due to the presence of blood in the tissue, outside of blood vessels; will not blanch with pressure (example: vasculitis)

Petechiae A punctate region of purpura (tiny dots)

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11
Q

Comedo

A

plugged hair follicle… A plug within a hair follicle canal which is composed of keratin and sebum; a blackhead (example: acne vulgaris)

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12
Q

Milium

A

A white papule composed of whorls of keratinized epidermal cells beneath the skin surface (example: milia)

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13
Q

Burrow

A

A horizontal tunnel in the stratum corneum produced by a parasite (example: scabies)

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14
Q

Scaly

A

too much keratin produced. Characterized by exfoliation of surface keratin cells (example: psoriasis)

Hyperkeratotic Having very thick scale (example: icthyosis)

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15
Q

Eroded

A

Showing a superficial defect in the skin surface which does not penetrate through the epidermis (example: abrasion)

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16
Q

Ulcerated

A

Showing a skin defect which penetrates through the epidermis (example: diabetic foot ulcer)
looking at dermis

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17
Q

EXCORIATED

A

SCRATCHING THEMSELVES!!!!! Eroded or ulcerated, often in a linear fashion, due to scratching (example: dermatitis factitia)
LINIEAR

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18
Q

Erythematous

A

Reddened; due to vasodilation with increased blood flow. Blanches with pressure (example: viral exanthem)

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19
Q

*Hyperpigmented

A

Dark; due to increased

amount of melanin (example: nevus)

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20
Q

*Hypopigmented

A

Light; due to decreased amount of melanin (example: vitiligo)

Lose melanocytes (white)

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21
Q

Lichenified

A

Showing thickening with accentuation of the normal skin markings; usually a sign of chronicity associated with scratching or rubbing (example: atopic dermatitis)

elbows, knees due to constant pressure

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22
Q

Verrucous

A

usually a papule, scaly and hyperkeritotic Characterized by velvety or roughened wart-like change (example: verruca vulgaris

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23
Q

Telangiectatic

A

Showing dilated small arterioles or capillaries coursing parallel to the skin surface (example: spider telangiectasia)

PERMANENT, related to Erythematous

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24
Q

Atrophic

A

Emaciated or thinned (example: striae)

in groin, seen when over use of steroid cream

25
Q

Vitiligo

A

Partial or complete loss of melanocytes
Well demarcated macules/patches
Hand/wrist, axillae, perioral/periorbital, anogenital
Pathogenesis: autoimmune

26
Q

ALBINISM

A

No melanin produced (or decreased)
Inherited defect in tyrosinase
has normal melanocytes but cant do anything!!!

27
Q

Vitiligo vs ALBINISM

HYPOPIGMINTATION

A

Vitiligo is autoimmune lymphocyte mediated melanocyte destruction – normal enzyme
associated with other autoimmune disorders: pernicious anemia, thyroiditis
LATER ON IMMUNE ATTACK

Albinism is congenital absence of enzyme and melanin is not made or is decreased
Enzyme loss of defect in transport to melanosomes

28
Q

NEOPLASM

A

SOME MUTATION that regulates cell divison clonal population of cells that are abnormal. Originate from one cell, mole!!!

29
Q

freckles

A

too much melanin

30
Q

Melasma

A

normal mealnocytes and they are stimulated to make more melain.

Pregnancy, oral contraceptives, hydantoin
Mask like facial hyperpigmentation
Cheeks, forehead, temples
Sunlight makes it worse
Melanocytes have enhanced pigment transfer to keratinocytes or macrophages
Resolves after pregnancy over or drug discontinued

31
Q

Solar Lentigo

A

not a mealanocytes issue. Hyperpigmentation of basal epidermis due to excess melanin production
Sun protective mechanism of melanocytes

32
Q

Lentigo simplex

A

Too many melanocytes (Melanocytic Hyperplasia)
Localized hyperplasia of melanocytes
All ages
Not sun related (vs. solar lentigo)
Small brown macules
Histopathology: Increased melanocytes, increased pigment in stratum corneum and basal epidermis, rete ridges elongated/thinned

33
Q

Neoplasia benign

A

Neoplasm with no capability for metastasis

Can be destructive or symptomatic – this does NOT define malignancy!

34
Q

Neoplasia Malignant (Cancer)

A

Neoplasm with potential for metastasis and subsequently growth/proliferation at distant site
Often locally destructive but may not be!

35
Q

Melanocytic Neoplasms benign

A 
Nevi, in situ, ex. mole
Junctional, compound, dermal
Spitz/spitzoid
Atypical (dysplastic)
Dermal variants
Blue nevus
Many others
Melanoma
36
Q 
Types of Nevi/Moles
common
congenital
blue
spitz
halo
dysplastic/atypical
A

Common: Acquired or congenital
Congenital: Large ones have increased risk of melanoma
Blue: confused with melanoma clinically
Spitz: difficult to distinguish from melanoma under microscope occasionally
Halo: immune reaction to nevus cells
Dysplastic/Atypical: potential precursor of melanoma

37
Q

Most common pigmented lesion
Most start life within the epidermis
As they grow will start to populate the dermis

A

Nevi – Common (acquired) and Congenital.

Melanocytes grow in nests along junction (junctional nevus) and in time enter dermis (compound nevus) after aging become intradermal only

ABCD

Not in the genetic make up to be malignant. Can cross the basement membrane and enter the dermis

38
Q

Blue nevi

A

Dark blue/brown papules
Often clinically concerning for melanoma
Benign
Deep blue color due to deep pigmentation
Tyndall effect – light scatter properties
Entirely dermal proliferation of spindled melanocytes with many melanophages
can be in the dermis too, wont metasize

39
Q

Dysplastic Nevi

A

Multiple dysplastic nevi = marker of increased risk of melanoma
Isolated dysplastic nevus = probably no or only minimal risk of melanoma
Usually graded by pathologist
Mild, moderate, severe atypia
Can excise mild depending on clinical circumstances, should excise mod/severe

All Benign!!!

40
Q

Malignant Melanoma

A

Malignant neoplasm of melanocytes
Used to be uniformly deadly
Most arise in skin
Other sites: oral/anogenital mucosa meninges, esophagus, eye
Risk factors: fair skin, sun exposure, many DPN

Usually asymptomatic, may itch
Change in color or size of pre-existing lesion

41
Q

CLASSIC teaching is the ABCD’s:

A

Asymmetry
Border
Color
Diameter (>6mm or pencil eraser)

42
Q

Melanoma in situ

A

Radial growth (in situ)
Superficial, epidermis
Cannot metastasize
Treat aggresively

43
Q

Melanoma vertical growth

A

Vertical growth
Dermal invasion
Formation of nodule
Potential to metastasize

44
Q

Breslow’s depth

A

Probability to metastasize is best predicted by depth of invasion

Measured in millimeters
Breslow depth is best for prognosis
Beyond 1mm worst survival

45
Q

Seborrheic keratosis

A 
Common epithelial neoplasm
Trunk, head, neck are typical
“stuck on”
Brown and velvety papules/plaques
Leser-Trelat Sign – paraneoplastic, rapid growth of numerous seborrheic keratoses
Increases with age
Beingin

Sharply demarcated
Variable melanin/histologically overlap with lentigo
Exuberant keratin formation
Horn cysts

46
Q

Epithelial Cyst

A

Down growth of epidermis which becomes cystic
Filled with keratin
Subcutaneous or dermal nodule
Rupture easily and become inflamed
Subtypes: epidermal, pilar, dermoid, steatocystoma multiplex

47
Q

Actinic keratosis

Benign form

A

Benign neoplasm of epidermis (may precede squamous cell carcinoma)
Induced by sunlight (most common), ionizing radiation, arsenicals, hydrocarbons
Rough spots on skin (less than 1 cm)
Sun exposed skin
Cytologic atypia of basal layer, hyperkeratosis
abnormal stratium cornia

Some will progress to squamous cell carcinoma (malignant) if untreated (most likely 1%)
Treated by liquid nitrogen, curettage, topical chemotherapy

48
Q

Squamous cell carcinoma counter to actinic keratosis….

A

Common neoplasm on sun exposed skin in older people
Risk factors sun (#1), carcinogens, chronic ulcer, old burn scar,
Also xeroderma pigmentosum, chemotherapy or organ transplant

In situ: contained above the basement membrane (full thickness atypia)
Invasive: invades basement membrane and dermis
Less than 5% will metastasize

49
Q

Basal cell carcinoma

A 
Most common human malignancy
Slow growing, usually older adults
Rarely metastasize
Risk factors:  sun exposure, light pigment, XP
Pearly papule with telangiectasia

Resemble basal cell layer of epidermis
Arise from base of epidermis, possibly hair follicle derived (controversial)
Clefts are common between base of neoplasm and dermis

50
Q

Adnexal neoplasms can be a clue to internal pathology

A

Cowden’s syndrome

Muir Torre syndrome

51
Q

Cowden’s syndrome

A

Hereditary condition prone to multiple hamartomas and malignancy
Skin: multiple trichilemmomas (face), benign keratoses on acral skin
Mucosal papules, cobblestoning tongue
Internal: breast, endometrial and thyroid carcinoma
Cerebellar lesions
Mutation in PTEN (tumor suppressor gene)

if many!!

52
Q

Sebaceous hyperplasia

A

Acquired, localized increase in sebaceous glands, not neoplastic
Glands larger than normal
Common on the face
Yellow papule

53
Q

Sebaceous adenoma

A

Benign neoplasm

Lobular circumscribed proliferation of sebocytes and the peripheral basaloid epithelial cells

54
Q

Sebaceous carcinoma

A

Malignant neoplasm
Most are periocular (inner/outer lid)
A periocular sebaceous neoplasm is most likely carcinoma, not adenoma or hyperplasia
Extraocular forms less common but more likely to occur in Muir Torre syndrome
Metastasis common, death in 20%

55
Q

Muir-Torre Syndrome

A

related to sebaceous carcinoma and adenoma

Hereditary syndrome
Germline mutations in DNA mismatch repair proteins: (MLH1, MSH2), MSH6, PMS2
These repair errors in base pairing during replication, especially in 1-2 bp repeats (microsatellites)
Skin: Sebaceous adenoma and carcinoma, keratoacanthomas
Internal carcinomas: Colon/rectal, endometrial, ovarian
Represents subset of hereditary non-polyposis colorectal carcinoma syndrome (HNPCC)

Young/adult patient with sebaceous adenoma or carcinoma, test for MTS
Immunohistochemistry
Fast, relatively inexpensive
Highly sensitive
If loss of staining (indicating loss of DNA mismatch repair protein), genetic testing for confirmation

56
Q

Dermatofibroma

A

Very common
Dermal proliferation of histiocytes and fibroblasts
Commonly on legs
Tan brown firm papules
Etiology unknown – many are clearly reactive hyperplasia (After bug bite) and resolve, others uncertain

pinch test
Spindled fibroblasts
Foamy histiocytes
Multinucleated giant cells
Collagen trapping
Epidermal hyperplasia
Well differentiated fibrosarcoma of skin
Rarely metastasize/locally aggressive
Protuberant nodule within a firm plaque
Often nodular in kids
Storiform bland spindled cells
Honeycomb infiltration of fat
57
Q

Capillary hemangioma

A

Well formed vascular spaces in dermis

Clinically must separate from malignant vascular neoplasms (Kaposi’s sarcoma, angiosarcoma)

58
Q

Where to biopsy?

for rash and lesions

A

For rashes – non-ulcerated/intact skin, usually sample center and edge, next to the ulcer
Discrete lesions
Needs to be representative in horizontal AND vertical axis
Think about depth

59
Q

To shave or punch…???

A

Shave: use for superficial (epidermis) lesions (many BCC, AK, SCC in situ, pigmented macules)
Better cosmetics, no sutures, electrocautery

Punch: use for neoplasms involving the dermis (nodular BCC, SCC, melanoma, etc.) and most rashes
Requires sutures
Various sizes 1.5 mm – 8 mm

Skin/Musculoskeletal Medicine (10 decks)

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