Dermatology #3 Flashcards
MC type of skin cancer
basal cell carcinoma
Explain a basal cell carcinoma
slow growing, local invasion, no METs
MC on head, neck, trunk, nose
What does a basal cell carcinoma LOOK like
Small, raised, pearly, raised borders and central ulceration with telangiectasias that is friable (bleeds)
What diagnostic should be done for basal cell carcinoma
Punch or shave biopsy
Treatment for basal cell carcinoma
Moh’s for facial involvement
Cryotherapy, Imiquimod, 5-FU
2nd MC type of skin cancer
Squamous Cell Carcinoma
Risk factors for SCC
Sun exposure (biggest)
Actinic Keratosis
HPV Infection
What is Bowen’s Disease?
SCC in situ (hasn’t invaded the dermis yet)
Symptoms of a SCC
Erythematous, elevated nodule with white scaly or crusted, bloody margins
Nonhealing ulcer or erosion on the head, lips, hands, neck
Because a shave biopsy is often inadequate, what is the diagnostic of choice for SCC?
Punch or excisional biopsy
Treatment for SCC
-Surgical excision
-Moh’s, Imiquimod, 5FU
-Chemo if METs
MCC of skin-related cancer death
Melanoma
Where does a melanoma usually MET to?
Liver, lungs, lymph nodes, brain
Biggest risk factor for melanoma
UV radiation
Large number of nevi, tanning, etc.
What is the MC type of melanoma and where does it occur in both genders?
Superficial spreading
-Trunk in men
-Legs in women
What is acral lentiginous?
Type of melanoma that occurs in dark-skinned people on the palms, soles, nail beds
Explain ABCDE and how it relates to melanoma?
Symptoms of melanoma and when you should be suspicious
Asymmetry
Borders (irregular)
Color (varied)
Diameter (>6 mm)
Elevation
Diagnostics for melanoma
-Full thickness excisional biopsy + lymph node biopsy
How much should you excise based on size of melanoma?
> 1-2mm thick: take 2 cm
2-4 mm thick: 2cm marginal tissue
A Kaposi Sarcoma is associated with _______ and is predominantly in which population?
HHV8 infection
HIV with CD4 < 100
Symptoms of Kaposi Sarcoma and Treatment
Painless, nonpruritic macular papule or nodules brown, red in color, plaque or violaceous lesions
HAART therapy if HIV related
Chemotherapy
Condyloma Acuminata are _______ and appear as cauliflower like lesions on the genitals. How do you diagnose these?
Genital warts
Whitening of the lesion with acetic acid
Although 80% of condyloma acuminata spontaneously resolve, what are some treatment options?
Cryotherapy
Topical Podofilox
What is the vaccine given to prevent genital warts and what is the schedule?
2 doses, 6 months apart
Gardasil 9: 6, 11, 16, 18, 31, 33, 45, 52, 58
Name the 9 HPV strains protected against in Gardasil 9. Is this vaccine safe in pregnancy?
6, 11, 16, 18, 31, 33, 45, 52, 45
Not safe in pregnancy
Molluscum Contagiosum is due to _______ and appears as
Poxvirus
Discrete, dome-shaped flesh colored or pearly waxy papules with central umbilication
Treatment for molluscum contagiosum
None needed
HSV Type 1 vs HSV Type 2
Type 1: Saliva (oral lesions)
Type 2: Sexual contact (genital lesions)
Explain primary lesions of Type 1 vs Secondary lesions
Primary: Tonsillopharyngitis in adults and gingivostomatitis in kids
Secondary: herpes labialis (cold sore) grouped vesicles on erythematous base
What is a herpetic whitlow?
on finger, from contact of a Type 1 lesion
Happens a lot in health care workers
What is the most sensitive and specific test for HSV? But what is the gold standard for HSV 1?
PCR
HSV Serology for Type 1
What other diagnostic can be done for HSV and what is seen?
Tzanck smear: multinucleated giant cells
Treatment for HSV
Orał Valacyclovir or Acyclovir
Varicella Zoster Virus, caused by ______, has two parts. Which is which.
HHV 3
Primary/Varicella (Chickenpox)
Secondary (Zoster) Shingles
Symptoms of Varicella
-Prodrome Period
-Erythematous macules–> papules–>vesicular –> crust over
-Asynchronous rash that evolves
-Dew drops on a rose petal
True or False: Chickenpox can spread 48 hours PRIOR to onset of the rash
True
What is seen on a Tzanck smear of VZV, even though it is mostly a clinical diagnosis?
Multinucleated giant cells (same as HSV)
Treatment for Varicella
-12 years or younger: supportive
-13 years or older: Acyclovir
Two MC complications of varicella
-Bacterial superinfection (MC in kids) and varicella PNA (leading cause of death)
Risk factors for Zoster
Age > 50
Immunocompromised
Describe the rash of VZV Zoster
-Eruption of painful rash that is unilaterally present in a single dermatome that doesn’t cross the midline
What is a common condition associated with Zoster and what is the treatment?
Post-herpetic neuralgia
Gabapentin or Pregabalin
–TCA if no relief with above
What is given post-exposure as prophylaxis to those exposed to Zoster or if they are immunocompromised?
VZ IG
Post Exposure to varicella, what should be given? And to whom?
VZ IG given within 96 hours of exposure to immunocompromised, newborns of moms with VZV, or those with no evidence of immunity
Neonatal Varicella occurs if the mom has the virus in what time frame?
5 days before to 2 days after delivery
When should VZ IG be given to neonates at risk for varicella and when is it not needed?
If mom has it 5 days prior to 2 days post delivery
Not needed if infection in mom > 5 days before birth
What is herpes zoster ophthalmicus?
Shingles in the ophthalmic division of CNV (Trigeminal Nerve)
Symptoms of herpes zoster opthalmicus
Unilateral pain in eye, forehead, top of head
Keratitis, uveitis, conjunctivitis
Hutchinson’s Sign: vesicles at the tip of the nose
What diagnostic is done for herpes zoster opthalmicus and what is seen?
Slit lamp examination: dendritic branching with fluorescein
Treatment for herpes zoster ophthalmicus
Oral acyclovir
What is Herpes Zoster oticus?
AKA Ramsay-Hunt Syndrome
VZV in facial nerve (CNVII)
If CNVIII is involved, what should you expect in herpes zoster oticus?
Vestibular disturbances (vertigo, dizziness, etc.)
Symptoms of herpes zoster oticus
Triad: Ipsilateral facial paralysis + ear pain + vesicles in ear canal/auricle
Treatment for herpes zoster oticus
Valacyclovir + Prednisone
What are veruccae, what causes them, and what is one common exam finding?
Warts caused by HPV
Thrombosed capillaries
Cervical warts, MCC by which strains of HPV, increase the patient’s risk for cervical cancer
HPV 16 and 18
Although most veruccae resolve within 2 years, what are some treatment options you can give the patient?
Topical: Imiquimod, 5-FU
Cryotherapy
MC opportunistic pathogen
Candida
What is seen on exam in a patient with oropharyngeal candidiasis (thrush)?
Friable white plaques that leave erythema if scraped off
Treatment for thrush
Nystatin swish and swallow
Clotrimazole troches
What is seen on exam in a patient with Candida Esophagitis?
On endoscopy, you see white linear plaques
Treatment for Candida Esophagitis
Oral Fluconazole
How do you diagnose Candidiasis in general?
KOH smear = budding yeast and pseudohyphae
What is intertrigo?
Candida infection that causes pruritic beefy red rash with distinct borders and satellite lesions in moist areas
What is the treatment for intertrigo
Clotrimazole topical
