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(PA school) CAM I > Dermatology III > Flashcards

Dermatology III Flashcards

1
Q

List 4 malignant neoplasms

A

1) Basal Cell Carcinoma (BCC)
2) Squamous Cell Carcinoma (SCC)
3) Melanoma
4) Kaposi Sarcoma

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2
Q

1) What is the most common cancer?
2) Demographic, age of onset, & etiology?
3) Where does it most commonly occur?

A

1) BCC
2) Onset >40 y/o, M>F, ultraviolet light (UVB)
3) In fair-skin (I-III) rare in brown & black skin (V-VI,) 70% on face/chest. “Danger sites”: medial/lateral canthi, nasolabial fold, post-auricular

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3
Q

Basal cell carcinoma (BCC):
1) List risk factors
2) Describe the Sx and speed of progression

A

1) Fair skin (I-III), albinos, light-colored eyes, red hair, prolonged sun exposure, northern European ancestry, older age, heavy sun exposure in youth, tanning beds
2) Slow growing, usually asymptomatic, but can bleed/scab or feel sensitive if on a nerve

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4
Q

What are the clinical & histologic sub-types of BCC?

A

1) Clinical: superficial, nodular, pigmented, morpheaform
2) Histologic: superficial, nodular, micronodular, infiltrative

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5
Q

Basal cell carcinoma (BCC):
1) DDxs?
2) How is it diagnosed?
3) Txs?

A

1) All smooth papules, melanoma, all non-painful ulcers (SCC, syphilis)
2) Clinical, confirmed microscopically with biopsy
3) Excision with primary closure
-Cryosurgery & electrosurgery (limited)
-Mohs is best for morpheaform & lesions in danger or cosmetically sensitive sites and scalp
-Topical (5-fluorouracil ointment & imiquimod) for superficial lesions below neck
-Treatment depends on location, size and type

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6
Q

1) What is the most common subtype of BCC?
2) What does it look like?

A

1) Skin-colored or reddish, translucent (“pearly”), well-defined, firm, smooth papule or nodule with telangiectasia
2) Erosions & melanin stipples; Ulceration with crust & rolled border

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7
Q

Pigmented BCC:
1) What colors can it be?
2) What does it feel/ look like?
3) DDxs?

A

1) Brown, blue, or black
2) Hard, firm; Round, oval, can be ulcerated
3) Superficial spreading melanoma, nodular melanoma

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8
Q

Morpheaform BCC:
1) What is this form also called? What % of BCC cases?
2) What does it look like?

A

1) Sclerosing BCC; 5-10% of BCC cases
2) Smooth, flesh-colored or light erythematous papules or plaques, atrophic. ill-defined borders.
-Scar-like appearance in some areas

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9
Q

Squamous cell carcinoma (SCC):
1) Demographic/ age of onset?
2) Risk factors?
3) What types of lesions can it present as?

A

1) >55 y/o, M>F
2) Sun exposure, light-colored skin, easily burns/poor tanning, outdoor occupations-pilots/truckers/farmers, immunosuppression (organ transplant, HIV,) chronic inflammation, industrial carcinogens
3) Solitary or multiple macules, papules, plaques, ulcers

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10
Q

SCC:
1) Is it always smooth?
2) What may it arise from?
3) Does it progress quickly?
4) How is it diagnosed?

A

1) Hyperkeratotic or scaling
2) May arise from AK
3) Can rapidly evolve
4) Biopsy (shave, punch, or excisional)

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11
Q

Squamous cell carcinoma (SCC)
1) How is it treated in situ?
2) What about invasively?

A

1) Imiquimod or 5-fluorouracil, curettage & electrodessication
2) Excision or Mohs surgery

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12
Q

Superficial SCC
1) What is the most common site?
2) How does it typically present?
3) What is a DDx?

A

1) Most common site = trunk
2) Slightly scaly, macules, patches, or thin plaques light red to pink in color. Telangectasias may be seen.
3) Actinic keratosis (AK)

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13
Q

Why is MMS the preferred method?

A

Offers superior histologic analysis of tumor margins while permitting maximal conservation of tissue compared with standard surgical excision
-Recurrence rates tend to be lower with MMS compared to other modalities, including standard electro-desiccation and curettage, radiation, and cryotherapy

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14
Q

What are some indications for Mohs Micrographic surgery (MMS)?

A

1) Lesions on nose, ears, eyes, lips, scalp, hands, and cosmetically sensitive areas
2) Aggressive histologic subtypes: infiltrative, sclerosing, morpheaform, or micronodular
3) Large tumors or tumors with indistinct clinical borders
4) Recurrent tumors

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15
Q

What is the leading cause of death due to skin disease and least common type of skin cancer?

A

Melanoma

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16
Q

1) What is the most common malignant tumor of the skin?
2) Demographic?
3) Etiology/ pathogenesis?

A

1) Melanoma
2) 1 in 4 cases before age 40
3) Lifetime risk 2% Caucasians, 0.1-0.5% non- Caucasian
Etiology & pathogenesis unknown (likely due to exposure to solar radiation)

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17
Q

1) What is the single most important prognostic factor for melanomas?
2) Describe this
3) How many major clinicohistologic types are there?

A

1) Tumor thickness at time of Dx
2) 10-year survival related to thickness in mm
<1 mm = 95%,
1-2 mm = 80%
2-4 mm = 55%
3) Four

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18
Q

List the different presentations of melanoma (4 major clinicohistologic types) and how common they are

A

1) Superficial spreading 70%
2) Nodular 15%
3) Lentigo 5%
4) Acral lentiginous 5-10%

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19
Q

What is the single most important Hx reason for close eval and possible referral of a spot?

A

History of a changing mole (evolution, including bleeding & ulceration)

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20
Q

What is the mnemonic for clinical features of pigmented lesions suspicious for melanoma?

A

A: Asymmetry
B: Border irregularities (ill-defined)
C: Color variation (variegation)
D: Diameter > 6 mm
E: Evolution (changing in shape, size, color, or is new)

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21
Q

1) What are some DDxs for melanoma?
2) How is melanoma diagnosed?

A

1) Melanocytic lesions, non-melanocytic lesions, benign nevi
2) Clinical, ABCDE criteria, “ugly duckling” sign

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22
Q

Melanomas:
1) Describe how to Dx
2) Describe Tx options

A

1) Excisional biopsy-must take wide margin (1 cm margin for every 1mm of lesion depth.) vs punch biopsy
2) Excision & histology, followed by re-excision with borders based on thickness of tumor (pathology report)
-Referral to centers with expertise in melanomas for intermediate-to-high risk patients
-Sentinal lymph node biopsy: All lesions >1 mm thickness & high-risk histologic features (ulcers)

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23
Q

Kaposi sarcoma:
1) What is it? What is it linked with?
2) How does it present? How many variants are there and who are they seen in?
3) Tx?

A

1) Systemic endothelial cell tumor
Linked with HSV-8 infection
2) Purple, brown, black patches, plaques, & nodules
4 clinical variants (seen in those with immunodeficiencies/ HIV/AIDS)
3) Radiation, chemotherapy, antivirals- typically responds to treatment

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24
Q

1) What is the difference between nevus and nevi? Benign or malignant?
2) What nevi can be dome shaped?
3) What are some other characteristics that can be found?

A

1) Nevus (single), nevi (plural); benign
2) Small congenital nevi, especially when on the face.
3) Sometimes they are mamillated (with small protuberances) and have hypertrichosis (increase in density and coarseness of hairs).

25
Q

Congenital nevus:
1) What is it called when they’re >20cm (in an adult)?
2) When is the risk of developing melanoma is ~ 5-10% with congenital nevi?
3) What should a provider do for these?

A

1) Large or Giant
2) For large/giant congenital nevi
3) Monitor yearly with photos

26
Q

What are groups of similar nevi sometimes called?

A

Signature nevi

27
Q

Atypical nevi:
1) What are they also called? Benign or malignant?
2) What do they share clinical features with?
3) What do these increase the risk of? In who?
4) Demographic?

A

1) Dysplastic nevi; benign acquired melanocytic nevi
2) Melanoma: asymmetry, irregular borders, color variegation, diameter > 5mm
3) Increased risk of melanoma: pts with >50 nevi with >1 atypical nevi & 1 nevus >8 mm
4) Children & adults, M=F; 5% of Caucasian population, rare in Japanese
-Occur in almost all patients with familial cutaneous melanoma

28
Q

Atypical nevi:
1) Where can they occur?
2) Where do they rarely occur?
3) How may they present?
4) How are they diagnosed?

A

1) Any location, most common on trunk & extremities
2) Rarely on chronically sun-exposed skin (face, hands)
3) Variegated color with tan, brown, black and pink macules
4) May have “fried egg” appearance
5) Clinical, dermoscopy, biopsy if suspect melanoma

29
Q

1) What is a basic rule of biopsies?
2) Why?
3) What happens if this rule isn’t followed?

A

1) Never do a superficial shave biopsy of a pigmented lesion that is a possible melanoma.
2) Most important determinant of survival in melanoma is the Breslow depth, or tumor thickness, of the initial tumor.
3) If a shallow shave biopsy does not contain the entire depth of the lesion, that information is unknown.

30
Q

Why not initially excise the entire lesion? Explain

A

It is best to biopsy the lesion in order to obtain histologic confirmation prior to surgical removal, as biopsy may have revealed:
1) A benign growth, in which case excision would have been unnecessary
2) A tumor different from suspected lesion that may have required a different management approach
3) Melanomas require large margins

31
Q

1) What is a contraindication to skin biopsies?
2) When should you use caution?

A

1) Infection
2) If patient on blood thinners

32
Q

Abscesses:
1) What are they & what’s the most common cause?
2) How do they usually present?
3) Risk factors?

A

1) Collection of pus in dermis or subcutaneous space; S. aureus (MSSA, MRSA)
2) Skin erythema, edema, warmth and fluctuance, very painful
3) Skin disruption or inflammation, edema, obesity, immunosuppression, pre-existing skin infection, skin breaks (toe web spaces)

33
Q

Describe how to treat abscesses (4 things)

A

1) The patient needs to stop mashing it-may further damage surrounding tissue. Damaged tissue does not heal.
2) Must perform incision and drainage (I&D) irrigation
3) Have patient apply heat/warm compress afterwards
4) Do not typically need PO antibiotics
-Typically, will heal up after drainage without further antibiotics or treatment

34
Q

Cellulitis:
1) What is it?
2) Where is it usually located?
3) What is usually the cause?
4) What are the typically Sx?
5) What may it progress to?

A

1) Diffuse, spreading infection of dermis & subcutaneous tissue
2) Usually on lower leg; unilateral
3) Group A Beta-hemolytic streptococci or S. aureus
4) Edema, erythema, pain, warmth
5) May progress to chills, fever, malaise (possible septicemia, hypotension, shock)

35
Q

Cellulitis:
1) 2 DDxs?
2) Tx?
3) When should you admit?

A

1) DVT, necrotizing fasciitis
2) Antibiotics (IV vs PO) ex/ PO Cephalexin 500mg PO BID IV/IM Cefazolin 0.5- 1 gm q6-8 hr
Mark borders to monitor progress
3) Severe local symptoms, WBC > 10K, failure to respond to PO antibiotics, systemic symptoms

36
Q

1) What is a similar form of cellulitis? What causes it?
2) Primary characterisitic?
3) Demographic?
4) Risk factors?
5) Other Sx?

A

1) Erysipelas; beta-hemolytic strep
2) “St. Anthony’s Fire” rash
3) Young & old
4) Prior episode, skin break, nephrotic syndrome, prior injury, HIV, alcoholism, obesity, pregnancy
5) Pain, malaise, fever, chills

37
Q

Erysipelas:
1) Where is it on the body?
2) Tx?

A

1) Lower limbs & butterfly distribution on face, borders better defined than cellulitis, skin is shiny
2) IV vs PO antibiotics
-Cephalexin 500mg PO q12hr,
-Cefazolin 0.5 – 1 gm q6-8 hr

38
Q

Impetigo:
1) What is it?
2) Who is it most common in?
3) Etiology?
4) Course of the condition?
5) Tx?

A

1) Contagious superficial bacterial infection
2) Most frequent in children 2-5 y/o
3) S. aureus, Group A strep
4) Papules progress to vesicles, surrounding erythema, then pustules, then honey-colored crust
5) Topical antibiotics (mupirocin) especially in nares BID x 5d, PO antibiotics as indicated for underlying infection -cephalexin 250-500 mg PO q 6-12 h x 5-7 d – will treat group A strep and S. aureus ( for <12 yo 25-50 mg/kg/d q6-8 2000mg/d max)

39
Q

1) Who is the Rule of Nines for?
2) When should you transfer to burn unit?
3) What % is the palm?

A

1) Adults
2) 5-10% BSA
3) 1%

40
Q

1) When is a burn considered severe?
2) What are the ABCs of burns?
3) What is the formula for fluid? (don’t need to memorize)
4) What is a predictor of worse burn outcomes?

A

1) >20% TBSA
2) Airway, Breathing, Circulation, Disability, Exposure
3) Parkland formula: adults: 4ml/kg x % TBSA, ½ given first 8 hrs = MLs of fluid needed in first 24 hrs
-Also Tetanus/pain meds
4) Hyperglycemia: predictor of worse outcomes

41
Q

1) What is a lipoma? Is it benign?
2) Where is it most common?
3) What is the Tx?

A

1) Benign subcutaneous fatty tumor; soft round, lobulated, mobile
2) Most common on neck, trunk, & extremities
3) Reassurance or surgical removal

42
Q

Epidermal inclusion cyst (EIC):
1) What is it?
2) What does it look like?
3) What is a key characteristic?

A

1) Benign growth of upper hair follicle, very common on scalp
2) Firm, dermal papule or nodule; overlying black comedone (punctum) on face, base of ears, or trunk
3) Expressible foul-smelling cheesy material

43
Q

Epidermal inclusion cyst (EIC):
1) Size?
2) What can it mimic?
3) Tx options?

A

1) 0.3 cm – several cm
2) May become red & drain (mimics abscess)
3) None if asymptomatic-tell patients not to manipulate
I&D
-Surgical excision if symptomatic

44
Q

Pressure ulcers:
1) Cause?
2) Who are they seen in?
3) Risk factors?

A

1) Body weight over bony prominence creates friction and pressure
2) Elderly/bedridden
3) Poor nursing care, lack of sensation, hypotension

45
Q

1) Tx options for pressure ulcers?
2) What should you make sure isn’t happening?

A

1) Repositioning / reduce pressure; Antibiotics/Surgery
2) Consider osteomyelitis

46
Q

What are the 4 stages of pressure ulcers?

A

Stage I-Non blanching erythema, skin intact
Stage II-Epidermis/dermis layer
Stage III-full thickness (to sub Q)
Stage IV-muscle and bone

47
Q

Vitiligo:
1) What is it?
2) Who does it affect?
3) What may it involve?

A

1) White macules, complete absence/destruction of melanocytes
2) 1% population, all races
3) May enlarge to affect entire skin, often starts on knuckles or around mouth

48
Q

Vitiligo:
1) What can it cause?
2) Tx?

A

1) Psychological problem
2) Oral PUVA psoralen (drug) and ultra-violet radiation
-Can use tinted creams/makeup to cover lesions in cosmetically sensitive areas

49
Q

Melasma:
1) Who is it most common in?
2) What is it?
3) What can cause it? Explain

A

1) Very common females»>males 9:1
2) Hyperpigmented sharply demarcated macules in sun exposed areas, usually face malar/frontal; benign
3) Exposure to sunlight; can be idiopathic, but usually hormone related
-Pregnancy, OCP
-Some meds = anti-seizure, photosensitive meds (ATBs, anti-HTN)

50
Q

Melasma Tx options?

A

1) Hydroquinone 3% soln, 4% crm azelaic acid 20% crm
Can be compounded or in combo with tretinoin or glycolic acid
2) PREVENT with sun blocks, hats, UV protectant on car windows
Lasers can worsen

51
Q

Photosensitivity reactions:
1) What are they?
2) Where do they occur?
3) Prevention?
4) How to Tx the photoaging aspect?

A

1) Abnormal response to sunlight exposure
2) Only sun exposed areas
3) Sun block, UV blocking clothes, hats
4) Laser and prevention, hydroquinone

52
Q

Photosensitivity reactions: What are the 4 types? Describe each

A

1) Sunburn type: Photoreaction to drugs (mimics sunburn)
2) Photoallergic rash: macules, papules or plaques
3) Urticarial: solar urticaria
4) Chr sun exposure = photoaging

53
Q

How should you treat photosensitivity reactons?

A

Time, cool bath, avoid sunlight, NSAIDs as needed, topical steroids for sunburn if indicated

54
Q

Syphilis:
1) What is the etiology?
2) What is a nickname for this condition?
3) How is it transmitted & what is its primary first Sx?

A

1) Treponema pallidum (spirochete)
2) “The Great Imitator/Masquerader”; 10 million cases annually
3) STI; painless chancre

55
Q

Syphilis:
1) What are the secondary Sx?
2) Tx?

A

1) Maculopapular rash on trunk, extremities (palms and soles)
2) 2.4 million units penicillin G IM/IV QD x7d

56
Q

List the classes of steroid potencies and give an example of each
(Use C = cream, F = foam, G = gel, L = lotion, O = ointment, S = solution)

A

Class 1: Very high potency
-Clobetasol 0.05% C F G L O
Class 2: High potency
-Fluocinonide 0.05% C G O S
Class 3: High potency
-Triamcinolone 0.1% O (good)
Class 4: Mid potency
-Triamcinolone 0.1% C
Class 5: Mid potency
-Hydrocortisone butyrate 0.1% cream
Class 6: Low potency
-Desoride 0.05% C L O (really only for babies)
Class 7: Low potency
-**Hydrocortisone hydrochloride: .25% CL; .5%, 1%, 2%, 2.5% CLOS,

57
Q

Continuous daily Tx w. steroids for longer than ________ weeks is not recommended

A

4

58
Q

List some adverse effects of topical steroids (that can happen w continuous daily use)

A

1) Bruising
2) Skin thinning
3) Tinea incognito
4) Prominent capillaries
5) Stretch marks
6) Localized pustular psoriasis

59
Q

List 3 steroids and how to dose them

A

1) Clobetasol propionate 0.05% foam >12 yrs
2) Desonide 0.05% foam/ gel >3 months
3) Hydrocortisone butyrate 0.1% cream >3 months

(PA school) CAM I (29 decks)

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