Dermatology and Oncology Flashcards by Denisse Tiangco

No primary skin lesions just manifestation of liver disease

Inc SGPT
Bile acid in subcutaneous tissue
Pruritus, icterus/jaundice

Multifetal pregnancy, genetic influence

Intrahepatic cholestasis of pregnancy

Pruritus gravidarum

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Pruritus gravidarum Tx

Ursodeoxycholic acid

relief of pruritus

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Autoimmune bullous disease manifesting as plaque or pustule

Initially pruritic and urticarial palaques followed by 1-2 weeks vesicles or bullae

Periumbilical distribution with sparing of mucous membranes, scalp and face

Not related to HSV

Reaction between maternal IgG antibody and collagen 17 in basement membrane of skin and amniotic epithelium

Eosinophilic degranulation damaging dermal-epidermal junction

First pregnancy at 2nd or 3rd tri

Pemphigoid gestationis

Herpes gestationis

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Associated with adverse perinatal outcomes

Intrahepatic cholestasis of Pregnancy
Pemphigoid gestationis

Resolve following delivery without scarring

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Gold standard for Dx of Pemphigoid gestationis

Immunoflourescent skin tissue

Skin biopsy

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Pemphigoid gestationis Tx

Topical high potency corticosteroids
Oral antihistamine
Oral steroid - Prednisone 
Plasmapheresis
IV IG

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Direct immunoflouresence of peri-lesional skin showing linear deposition of C3 along BM

Pemphigoid gestationis

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Most common lesion in pregnancy
Cause unknown

Pregnancy-specific dermatosis with intensely pruritic 1-2mm erythematous papules that coalesce to form urticarial plaques

Late in pregnancy
Starts with striae manifesting as elevated hyperemia

Excoriations and secondary fungal infection

Rash affects abdomen and proximal thigh (97%)

Pruritic Urticarial Papules and Plaques of Pregnancy

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PUPPP Tx

Oral antihistamines
Topical corticosteroids
Emollients.

Resolves within several days of delivery
Leaves no scarring

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Most common
Dry, thickened scaly red patches

Extremity flexures, nipples, neck, face
Elevated IgE

Eczema

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5-10 mm itchy erythematous papules and nodules

Extensor surfaces, trunk

Prurigo of pregnancy

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Rare, small papules and sterile pustules

Trunk

Pruritic folliculitis of Pregnancy

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Surgery for neoplasm classically performed after

12-14 weeks to minimize abortion in first trimester

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Radiation SE

Microcephaly
Mental retardation

Late exposure: IUGR and brain damage

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Chemotherapy is withheld before expected delivery at

3 weeks before

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Tumors that frequently metastasize to placenta

Malignant melanoma
Leukemia
Lymphoma
Breast cancer

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In the fetus, metastasis takes place in

Liver
Subcutaneous tissue

80% mort

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Endocervical polyp asymptomatic in pregnancy tx

Typically (atypical glandular cells of undetermined significance) AGUS

Polypectomy/Excision

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HPV vaccination on pregnancy

Not recommended

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CIN 1, 2, 3 and adenocarcinoma in situ in pregnancy Tx

Allowed to delivery vaginally and further eval planned after delivery until 6 weeks postpartum

Cervical conizariob or excision of cone shaped cylindrical wedge from cervix that includes transformation zone and all or a portion of endocervical canal may be done with

Loop electrosurgical excisional procedure (LEEP)

Cold knife conization

Can develop scars in such a way that cervix will not dilate during labor

Cicatricial cervical stenosis

Cervix becomes very thin and opening will be difficult to locate the external os wherein cruciate incision should be done

Avoid in pregnancy due to abortion, membrane rupture, hemorrhage and preterm delivery

Conglutinated cervix

Invasive cervical cancer Dx in pregnancy

Cervical punch biopsy
70% stage 1
vaginal bleeding

Stage IA1 Cervical CA tx

Definitive therapy until 6 weeks postpartum

True invasive cancer more than Stage IA1 Tx

First half of pregnancy: immediate treatment regardless of age of gestation Radiation: death of fetus Curettage: labor Later half: pregnancy safely continued until fetal viability/lung maturity; neoadjuvant chemotherapy

Stage IA - Early stage IIA Tx

CS followed by radical hysterectomy with B pelvic lymph node dissection Before 20 weeks: 12 weeks hysterectomy performed with fetus in situ (double effect) In later pregnancy, hysterotomy first Advanced stage: chemoradiation combination

Leiomyoma in pregnancy

Asymptomatic Chronic pain or acute pain (hemorrhagic infarction) Tx: analgesics Not removed in CS bec bloody and known to regress

Corpus luteum cyst Endometriomas Benign cystadenomas Mature cystic teratomas Tx

Surgical removal 14-20 weeks | give time for masses that will regress to do so

Pregnancy luteoma from luteineized stromal cells Inc androgen 25% virilized, 50% female fetus with virilization Tx

Spontaneously regress postpartum

Large theca-lutein cyst after first tri High HCG More common in GTD, twins and hydrous Resolve postpartum

Tx surgery not needed

Ovarian cancer ``` Most common: Germ cell Sex cord stromal Low malignant potential Epithelial tumors ``` Tx

Surgery done at diagnosis regardless of gestation once mass is suspected to be malignant

Can be given in diagnosis of ovarian ca while awating pulmonary maturation (after 12 weeks gestation)

Neoadjuvant chemotherapy

Most frequent cancer in pregnant women

Breast cancer

Protective factors for breast cancer

Multiparity | Breast feeding

Most common presenting symptom of breast cancer

Palpable mass 90%

Breast ca diagnosis

Triple test (99%) Clinical exam Ultrasound and mammography with abdominal shield Biopsy CXR with abdominal shield Liver UTZ Skeletal MRI without contrast

Breast cancer Tx

Chemo and surgery delayed to second trimester of pregnancy | Radiation given after delivery

It is recommended that pregnancy be delayed in breast cancer after

2-3 years

Most common lymphoma in childbearing age Painless enlargement of lymph node above diaphragm

Hodgkin disease

Hodgkin Early-disease Stage Tx

Chemotherapy delayed and done after first trimester After first tri, give single-agent chemotherapy (Vinblastine)

Multi-agent tx in Hodgkin is only given

upon termination of pregnancy 34 weeks

Hodgkin Advanced stage Tx

Full chemotherapy given regardless of AOG | Before 20 weeks, therapeutic abortion

From B cells, T cells or NK cells 5-10% have HIV EBV, HHVS 8, Hep C

Non-hodgkin disease Tx: full tx at second trimester Chemotherapy and immunotherapy (Rituximab)

Leukemia Mx

Induction therapy during pregnancy Post remission maintenance after pregnancy and stem-cell Complications: Infection and hemorrhage Inc incidence of preterm delivery and stillbirths

Malignant melanoma tx

``` Resection of primary tumor LN dissection (sentinel) ```

Strongest determinant of maternal survival in malignant melanoma

Clinical stage Worst prognosis: deep cutaneous invasion or regional involvement have the worst prognosis Pregnancy avoided for 3-5 years after surgical resection

Colon CA in pregnant Tx

In later pregnancy after first tri, therapy can be delayed until fetal maturation Surgery is avoided bec lower rectal lesion ay cause dystocia or delivery may cause tumor hemorrhage CS