Dermatology- Malignancy

Question 1

ABCDE criteria for assessing risk of melanoma

Answer 1

Asymmetry
Border irregularity
Color variation (within session or with others)
Diameter ≥6mm
Evolving appearance overtime

Question 2

How can nodular melanoma present

Answer 2

May not meet any ABCDE criteria
Ugly duckling sign
Palpable modularity
Symptomatic: itch, bleed, sensory

Question 3

Management of suspected melanoma

Answer 3

Full thinks excision biopsy with initial margins of 1-3mm of normal tissue

Question 4

Ugly duckling sign

Answer 4

a lesion that is substantially different from others (e.g shape, color). Ugly Duckling has a 90% sensitivity for melanoma

Question 5

Most important prognostic indictor for malignant melanoma

Answer 5

Breslow depth.

Distance from the epidermal granular cell layer to the deepest visible melanoma cells.

Question 6

Presentation of basal cell carcinoma

Answer 6

Enraging 
Skin-colored, pearly nodule ±rolled borders
Telangiectatic vessels 
Usually Head or neck
± central ulceration, local invasion

Question 7

Initial management of suspected basal cell carcinoma

Answer 7

Biopsy to confirm and assess for high-risk histologic features.

Excisional preferred to not miss aggressive histology.

Question 8

Tx basal cell carcinoma

Answer 8

Excision with 4mm margins

Low-risk tumors: topical fluorouracil, topical imiquimod, C&E

Question 9

Presentation of cutaneous squamous cell carcinoma

Answer 9

• Enlarging nodule commonly on extremities
• Keratinized (thickened rough surface)
• Ulcerates (crusting/ bleeding)
• Perineural invasion ( local neurologic symptoms; numbness, paresthesias)

Question 10

Rick factors for cutaneous Squamous cell carcinoma

Answer 10

• More common in transplant/ immunosuppressive therapy
• Sunlight
• Fair skin
• Chronic inflammation/ scar formation
• Ionizing radiation exposure