Dermatology Exam 2 Flashcards by Rodrigo N

MC benign cutaneous neoplasm; tend to be hereditary

Discrete raised, rough, hyperkeratotic, papules to plaque. verrucous appearing “stuck on “ Greasy

Tx= None, Liquid N2 ( may recur after tx)

Seborrheic Keratitis

Chewed gum

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2-3 mm dome shaped papules brown to clack.

Hyperkeratotic, pedunculated or verrucous papules
cheeks around eyes bilaterally. MC Africans / Hispanics

Tx=none Liquid N2–> hypopigment
Electrocautery, curette. Shave or excise tx 1 1st see response

Dermatosis papulosis Nigra

(Morgan Freeman)

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AKA “Barnacles” from vascular insufficiency. (Xerosis) MC in elderly light skin pts w/ peripheral edema

1-10mm round, dry hyperkeratotic papules warty lesions
Stuck on lesion @ ankles, feet (dorsum) fore arms and hands

Tx= none (poor healing & infection) Will recur

Stucco Keratosis

Stuck on but at feet

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skin colored to brown, soft pedunculated 1mm-1cm at eyelids, neck, goring, buttocks axilla & waist.

MC in obese

Tx= Large lesion- Excision
small lesion- Scissor excision, electro desiccation, cryo surgery

Acrochordon Skin Tags

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3-10 mm slightly raised, pink-brown, sometimes scaly hard growths 1- 10 lesions that retract beneath skin surface.

MC @ ant lower legs (Shaving) reactive to trauma collection of fibroblasts, endothelial cells & histocytes

Pruritic or tender then asymptomatic. Dimples when squeezed.

Tx- Removal w punch biopsyor reg excision. cryosurgery to decrease color; If rapid growth = invasive tumor

Dermatofibromas (Nipple looking)

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Small tumors of enlarged glands. Begin as small yellow papules, become dome shaped with central puncta.

Location =Face. Sun damage with oily skin > 30 y/o

collection of mature ____ Glands

Tx- none Curette, shave bx, electrosurgery, can extend into dermis and scar. (Differ w BCC w/ telangectasia)

Sebaceous Hyperplasia

Volcanic gland looking

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Benign tumor adipose tissue MC. Soft pillow, mobile sub Q lesions. 1-10+ cm at trunk and extremeties

MC in mid 20s Asymptomatic. Tender if large and blood vessels component.

Tx- Excision or none (will not recur) if fast growing- consider malignant

Lipoma (Chaplin)

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Sweat duct tumor. 1-3 mm small, firm, flesh, colored dermal papules. under eyes/lower lids;

Less common on forehead, chest, abdomen, Vulva. Young women 20-30s asymptomatic

Tx- None (risk scarring) cosmetic= electro desiccation & curettage.. elevation and excision shave w #11

Syringoma

Sandy eye granules

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Tumors that grow on nerves throughout the body
(Nerve sheath tumor) flesh pinkish-white;

soft pedunculated, 2-20 cm button hole sign= invaginated through skin with pressure; firm waxy

Aillary freckles and café-au-lait spots( von recklinhausen NF1) VR -NF1

Tx - none (Bothersome = excise) 2 or more suspect VR NF1

Neurofibroma

Different size stuck spitballs

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Raised red hyperpigmented firm shiny smooth surface. Abnormal large scar. extends beyond borders of wound

MC shoulders and chest; predisposed- 2ndary infx, may become painful or pruritic

Tx - No effective therapy; intralesion steroid/5FU, laser

Hypertrophic Scar Keloid

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Epithelial tumor solitary discrete, smooth dome shaped red papule rapid expansion to 1-2 cm hyperkeratotic core

Limbs MC sun exposed surfaces MC > 60 y/o possible viral HPV; self resolves, but don’t wait = appears to SCC

TX excise send to path r/o SCC: recureent= Intralesion 5FU or methotrexate

Keratoacanthoma

Donut with Central core

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Persistent localized rough feelin to skin- starts as are of increased vascularity. Erythema w scale. (ears and hand)

Sharp, adherent, yellow scale as lesion progresses. may resent as cutaneous horn (r/o SCC)
MC elderly w sun exposure (Pinna)

Tx- photo protection- complete skin exam ( Have all RF for SCC and BCC)

Actinic Keratosis

Yellow crusty nose

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Lesion on superior aspect of pinna and tender, thin________ __________ __________.

A degeneration of underlying collagen

Tx- excise it and special pillow for sleeping

Chondrodermatitis Nodularis Helicis

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Well defined borders, slightly elevated, red scaly plaques; very slow lateral growth.

Not localized to visible lesion (extends to follicles)

Low grade malignancy F/U q 6 mths slow growth

Tx= Electro desiccation and Curettage (ED and C)
LN2; Excision; Large =5 FU cream

Bowen’s Disease (AKA SCC In Situ)

Non regular/circular raised red w plaque

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Women- MC LEs (Labia or oral mjucosa); Men- Scalp and ears. (Glans Uncircumcised)

Assoc. w/ HPV 8 Moist, red smooth, slightly raised plaque

Tx- 5FU Aldara or Laser

Erythroplasia of queyrat

Bowen’s Disease

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2nd MC skin Cancer; UVA UVB MC precursor
Red, scaly persistent; hypertrophic lesion w ulcer or horn lip=ulcer

> M;W elderly sun exposed asymptomatic
Tx- ED and C (Small) Excision w Margins (Large)

Examine Lymph nodes F/U 12 mths

Squamous Cell Carcinoma (SCC)

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pink/skin colored pearly firm, dome shaped papule has rolled border “ rodent ulcer”; bleed scabbing sore

MC invasive skin Cancer 85 % head and neck; Superficial= trunk > 40 y/o

sun induced malignant proliferation of basal layer of epidermis. Most Important RF= Inability to tan

Tx- Detect early; refer to derm-Mohs Micrographic sx

Basal Cell Carcinoma (BCC) Rarely mets

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A, B C D E of Nevi examination

Asymmetry *Border irregularity
Color variation * Diameter
Evolving (Size, shape or new lesion)

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Sharply circumscribed uniform colored papules or macules Common, enlarge in pregnancy/Puberty

Anywhere including palms, soles, mucosa: Common in exposed areas. w or w/o hair

TX- follow up w ABCs ; >100 F/U 6-12 mths ; Sx excision in suspected lesions

Melanocytic Nevus (Mole)

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What are the three types of melanocytic Nevus?

Junction Nevi

Compound Nevi

Dermal Nevi

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Type of Melanocytic nevi that nests in the epidermis/dermal junction. flat or slightly elevated

Light Brown-Brown black w uniform pigment < 0.5-0.8cm MC in child hood after age 2

Junctional

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Melanocytic Nevus nests into the dermis: slightly elevated to dome shaped, smooth or warty surface with or without hair

Uniformly round, oval and symmetric; white periphery = Halo nevus

Compound

raised Nipple like

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All nevus cells in Dermis, sometimes in fat cells. Dome-shaped verrucous MC, pedunculated, sessile (raised)

Broad based, Skin colored, brown to black with hair lighter with age; common in adults

Dermal (Gua- a mole)

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Considered a special Nevi: found at birth 1-20 cm. Most grow proportionally w child

Increased risk of malignancy if >=5% BSA or >20 Cm

Tx- Small= observe Med= remove @ puberty Large=Increased incidence of malignant melanoma even w removal

Congenital Melanocytic Nevi

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AKA speckled lentiginous nevus; MC in adolescence, at birth or early infancy; Hairless oval irregular shape brown macule Dotted w darker brown to black papular spots not related to sun exposure. Tx- None Rare malignancy

Nevus Spilus | Spotted Macule

Either brown macule, a patch of hair or both. No nevus cells. Unilateral upper back or shoulder, upper arm, submammary Never reported malignancy; This____ plus assoc. w ipsilateral breast or limp hypoplasia, scoliosis, Spina B. Tx- Too large to remove; Hair removal laser tx and pigment

Becker's Nevus | Xavier

compound or dermal nevus that develops a white border; MC in adolescence, may herald onset of vitiligo 1 or > hypopigment to white lesions that contain a central brown, red , black nevus. No melanin in halo Trunk= MC never palms or soles; Woods lamp-white BX if suspect malignant

Halo Nevus

Blue black lesions dermal melanocytes(flattened) before birth migratory arrest. MC scalp and presacral dermatomal pattern Birth to childhood blue black "Tyndall effect" melanin deeper in skin Asians, African; butt or back confused w abuse TX none fades during 1st few years

Mongolian Spot

Blue-black pigmentation in 1st-2nd branch of trigeminal nerve; Affects sclera, conjunctiva and surrounding skin of eye No visual changes; At birth or later darken w age. Common in Asians esp. females Tx Laser to lighten lesions (Monito Glaucoma)

Nevus of Ota

Hairless red or reddish brown, dome shaped papule/nodule 0.3-1.5 cm appear suddenly MC in children- neck, head and lower extremities Histologic similarity to melanoma

Spitz Nevus (AKA Benign Juvenile Melanoma)

Slightly elevated round, regular < 5mm large amount of pigment in dermis MC on extremity dorsum of hands Confused w malignant melanoma; develops in childhood Tx - remove cosmetic

Blue Nevus | Blue Black round

Brown-black macules on lower lip; MC in young adult women; Resemble freckles but no change w sun exposure Cryotherapy or laser if desired

Labial Melanotic Macule

Begin to appear near puberty to 4th decade; >5mm flat or raised center " Fired Egg" -look for ABCDEs Dark or irregular shades of brown and pink irregular borders; MC at back upper lower limbs sun protected areas; screen family members Dx 3 of following: >5mm, irreg. border, irreg. margin, varying shades, popular macular components; refer opthalmaogy Tx- Bx and excise w/ margins f/u 6-12 mths

Dysplastic Nevus | multiple asymmetric freckles

Raised variations in pigment and borders, alteration of skin; Hx of atypical moles 5th MC cancer Dx age 57 Incr. Risk >100 moles congenital nevus. 20 cm; chronic tanning, repeated sunburns; Back MC in men; Arms legs in women: Non cutaneous MM mouth nose eyes Superficial spreading MC Blue nodule or black or brown black macule pigment (Lentigo Maligna)

Malignant Melanoma

Brown black and tendency to remain flat under nail late, sudden appearance of pigment at proximal nail fold (Hutchinson's sign) very poor prognosis Palms soles terminal phalanges and mucous membranes

Acral Lentiginous (Malignant Melanoma)

Malignant melanoma level I (Depth)

Restricted to 98% of epidermis

Malignant melanoma level II

Papillary Dermis

Malignant melanoma level III

fill papillary dermis

Malignant melanoma level IV

reticular Dermis

Malignant melanoma level V

invade subcutis 44%

Malignant melanoma growth that is ______ has a better prognosis. Once changes it changes to_______ prognosis worsens and development is rapid.

Horizontal; Vertical

80% of Malignant melanomas arise on areas normally

covered by clothing

Skin types and suggested Sunscreen Type I

Always burn easily, never tans Celtic Irish heritage SPF 25-30

Skin types and suggested Sunscreen Type II

Burns easily tans slightly ( Fair skin individuals Blonde) | SPF 25-30

Skin types and suggested Sunscreen Type III

Sometimes burns then tans gradually SPF 15

Skin types and suggested Sunscreen Type IV

Burns minimally always tans well Dark Hispanic & Asians SPF 15

Skin types and suggested Sunscreen Type V

Burns rarely, tans deeply (Middle eastern, asian black) SPF 15

Skin types and suggested Sunscreen Type VI

Almost never burns, deep pigment

Protection against UV damage

SPF of 15-30 daily Apply 15-30 min. prior to exposure Re-apply every 2 hrs or after exposure to water Avoid su exposure peak hrs 10a.m - 3 p.m wear dark , loose, dry clothing tight weave, brim hat

UVA agents are effective against _____ nm wavelength

320-400

UVB agents effective against_______ nm wavelength

290-320-

Sun induced wrinkling on back of neck that forms a rhomboidal pattern

Cutis rhomboidalis

Photoaging pigmentation Red brown reticulated pigmentation with talangiectasias, atrophy, prominent hair follicles, chest and back

Poikiloderma of Civatte

Photoaging papular change Comedones and cysts around the eyes

Favre Racouchot

Photoaging papular change yellow papules dull to birght that may coalesce to from plaques

Solar Elastosis

Photoaging change treatments:

prevention is key Retinoids (3-6 mths) Chemical peels, dermabrasion or lasers

Related to Niacin deficiency characterized by Dermatitis, diarrhea, and Dementia 3 Ds phase I Symmetric erythema, sunburn, worse w re-exposure; Bullae after erythema then rupture brown scale Phase II late cutaneous phase: lesion becomes hard, rough, cracked, blackish and brittle " goose skin" Butterfly Malar ( Lupus) Casal's necklace or Kravat. Hand glove or gauntlet spares the heel Tx Niacin 50-100mg ASA 325

Pellagra

Contraindications to niacin

Hypersensitivity Peptic ulcer dz Hepatic dz active Gout Arterial hemorrhage * causes Acanthosis Nigrans

MC light induced skin Dz seen by PCPs UVA>UVB MC female fairskin inversely related to latitude Singapore and Sweden Exposure incr. tolerance= "Hardening": Nonscarring pruritic rash in sun exposed areas symmetric papule MC V exposed area, back of hands, forearms lower legs Dx Immunofluorescence Bx to R/O SLE TX=steroids; Psoralen (PUVA) Antimalarials

Polymorphous Light eruption

Intensely itchy papules, plaques, nodules-face MC Hemorrhagic crust, lichenification, Actinic cheilitis feature Native americans North, central S. America TX=steroids; Psoralen (PUVA) Antimalarials

Actinic Prurigo

Phototoxic Agents

Lime and Doxy TCNs, Sulonomides, Ibuprofen Naproxen, Amiodorone Diltiazem

Acquired symmetric brown hyperpigmentation involves face and neck of genetically predisposed women DPP> LPP Slowly develop w/o inflammation faint or dark; Pregnancy, OCPs, Estrogen progesterone, Thyroid, phenytoin Dysfunction; may resolve post partum or OCP DC Tx difficult, Hypopgmentation agents chem peels, lasers

Melasma (Chloasma) Mask of pregnancy

Melasma Tx

Hydroquinone (Most effective Bleaching Agent) Triluma Combo Hydroquinone, tretinoin, Fluocinolone

Tan to brown macules due to localized proliferation of melanocytes from exposure to sunlight lesions round, ovalwith slight irregular ill defined border scattered , discrete lesions, stellate, sharply defined few mm> 1cm cytokines mediated response to UV Tx- None; Cryotherpay Topical retinoids

Solar Lentigo (Grandma spots)

Asymptomatic white spots or arms or legs of middle aged or elder 2-5mm white spots sharp demarcated borders Tx- Avoid sun or UV light : Tretinoin, LN2, steroids, Dermabrasion

Idiopathic Guttate Hypomelanosis IGH (White spots)