Dermatology Neoplasms, Arthropods, Common Changes, Peds, Misc Flashcards
Premalignant and Malignant Neoplasms
(4)
Actinic Keratosis
Squamous Cell Carcinoma
Basal Cell Carcinoma
Melanoma
Benign Neoplasms
(6)
Skin Tags
Seborrheic Keratoses
Cherry Angiomas
Dermatofibromas
Melanocytic Nevi
Lentigines
UV-induced lesion of skin
Common, up to 60% of WHITE older adults
Actinic Keratosis
Actinic Keratosis Characteristics
May re___, remain _____, or progress to (1)
S_____, e______ macules or patches with ____ texture in ___ exposed area
- Often develops (1) over (1) area
- Small to large in size__ - __ mm
May regress, remain unchanged, or progress to Squamous Cell Carcinoma
Scaly, erythematous macules or patches with rough texture in sun exposed area
- Often develops scale over reddened area
- Small to large in size 3-10 mm
Actinic Keratosis Treatment
- Topical (1) or (1), Cr___, PDT =
- Avoid ____, use protection (3)
- Topical 5-FU or Imiquimod, Cryo, PDT = photodynamic therapy
- Avoid sun, use protection (sunscreen, hats, umbrella, etc)
Malignant tumor of epithelial keratinocytes - skin and mucus membranes
2nd most common skin cancer
Squamous Cell Carcinoma
SCC Causes
- Induced by various carcinogens, but (1) is most common
- May arise from a precancerous (1)
- SCC arising in sun-damaged (1) less prone to metastasis than (1) SCC
- Assess for hx of: ra____, organ _____, excessive ___ exposure in _______
- Induced by various carcinogens, but SUN EXPOSURE is most common
- May arise from a precancerous actinic keratosis
- SCC arising in sun-damaged skin less prone to metastasis than mucosal SCC
- Assess for hx of: radiation, organ transplant, excessive sun exposure in childhood
SCC Characteristics
Usually arises as a (1), hyper____ or er____, ____ papule or nodule – per____* & g____* rapidly, b____*, t_____*
- Common sites =
- DDx =
Usually arises as solitary, hyperkeratotic or eroded, pink papule or nodule – persists* & grows* rapidly, bleeds*, tender*
- Common sites: scalp, face, ears, forearms, dorsal hands
- Aks, BCC, Verruca Vulgaris, Nummular dermatitis, Amelanotic Melanoma
The most common human/ human skin cancer
More than 400,000 new patients annually
Basal Cell Carcinoma
BCC Risk Factors
- Most commonly on (1) areas of -skinned, sun-____ individuals
- (1) Major carcinogenic factor
- Predisposing factors = ___-exposure, ionizing _____, imm_______
- Most commonly on sun-exposed areas of fair-skinned sun-damaged individuals
- UV exposure = major carcinogenic factor
- Predisposing factors: sun-exposure, ionizing radiation, immunosuppression
BCC Description
Trans_____ “p____” or “w____” (1) p___, erythematous papule
- Growth pattern =
- Associated Tel_______ - sometimes _____ ulceration
- _____ destructive, very _____ metastasizes
- Several clinical and histologic subtypes
Translucent, “pearly” or “waxy” pink, erythematous papule
- Very slow growing, enlarge slowly over time (sometimes many years)
- Associated telangiectasia- sometimes central ulceration
- Locally destructive, very rarely metastasizes
- Several clinical and histologic subtypes
Proliferation of markedly atypical melanocytes with the potential for dermal invasion and widespread metastasis
Any risk factors (3) - must see derm _____
Melanoma
- Any fam hx, tanning bed use, or hx of skin cancer must see derm annually*
- Top 2 rows mostly benign melanyctic nevi, as we get to bottom, start to get darker and more irregular, those are melanomas*
Melanoma Characteristics
- Median age of diagnosis (1)
- Prognosis depends on?
- Important predisposing factor (1), but not as clearly causative as with BCC or SCC
- Ask about hx of >__ severe or blistering ______ in childhood (2-fold increased risk)
- Some lesions arise (1), but some arise from “_____ lesions” such as large congenital nevi or “dysplastic” nevi
- Median age of diagnosis is 57
- Prognosis for all subtypes depends on the histologic thickness (Breslow level) of the tumor
- Sun exposure is an important predisposing factor, but not as clearly causative as in the base for BCC and SCC.
- Ask about hx of >5 severe or blistering sunburns in childhood (2-fold increases risk)
- Most lesions arise de novo, but some arise from “precursor lesions” such as large congenital nevi or “dysplastic” nevi
ABCDE’s of Melanoma
Ugly duckling sign =
- Asymmetry of shape: one half does not look like the other
- Border is irregular: scalloped, notched, discontinuous
- Color is uneven: multiple shades ranging from white to tan to brown to black occasionally some red as well
- Diameter is larger than 6mm in most cases
- Enlargement/Evolving/Extra: gradual increase in size and elevation
Mole that appears different than the rest, which does not belong?!
Note: raised lesions does not = melanoma
52 yo white male presents for annual well visit. On PE you note a 4mm ulcerated, excoriated red papule on the right sideburn. The patient states it is just a cut from nicking himself while shaving. He states this has been occurring for the past 2 years and he applies neosporin but it never fully heals. Your best intervention is to:
- Refer to derm for biopsy
- Prescribe Mupirocin 2% ointment TID
- Prescribe 5-FU cream BID
- Monitor for 6 months, if no change then refer to derm
1.Refer to derm for biopsy suspecting BCC
- Prescribe Mupirocin 2% ointment TID
- Prescribe 5-FU cream BID
- Monitor for 6 months, if no change then refer to derm
AKA - Acrochordons (Fibroepithelial polyps), soft fibromas, pedunculated fibromas
Skin Tags
Skin Tags
- Assess for hx of (1)
- (2) body parts of middle aged, often obese adults
- ____ colored, pe_______
- Range in size =
- Occasionally → in____ or ne____ (painful)
- Tx (3)
- Assess for hx of diabetes
- Neck and axillae of middle-aged, often obese adults
- Flesh colored, pedunculated
- Pin-head to grape size
- Occasionally → inflamed or necrotic (painful)
- Tx: no tx necessary or freeze, scissor snip, shave
Seborrheic Keratosis
P___, s__-colored, br____ish w____ st____ on papules and plaques
B_____, Pro_____, _____ predisposition, ubiquitous with _______
- May be ve_______, can get easily inflamed or irritated
- Scratching surface of the lesion creates (1)
- Differentials (2)
Pink, skin-colored, brownish waxy stuck on papules and plaques
Benign, proliferative - genetic predisposition, Ubiquitous with aging
- May be verrucous, can get easily inflamed or irritated
- Scratching surface of the lesion creates scaling
- melanoma or SCC
Seborrheic Keratosis Treatment
only reduces h___/bu__ of lesion
- A_____ lactate 12% (Lachydrin)
- Trich______ acid
- C____ (liquid nitrogen) - only option that will completely excise it
- ___orac 0.1% qd x 16 wks
Only reduces height/bulk of lesion
- Ammonium lactate 12% (Lachydrin)
- Trichoroacetic acid
- Cryo (liquid nitrogen) - only option that will completely excise it
- Tazorac 0.1% qd x 16 wks
Superficial benign fibrous histiocytoma) is a common cutaneous nodule of unknown etiology that occurs more often in women
Dermatofibroma
histiocytes = tissue macrophages/immune cells
Dermatofibroma
Very common, any age
- (1) most common site; also thighs, arms, back
- Possibly a scar-like reaction to (1), or shaving
- ____ growing, round to oval, ____ nodules
- Deep component is _____ to overlying skin
- A few millimeters to several centimeters
- (1) Sign/Test
- Tx is cosmetic =
- Legs most common site; also thighs, arms, back
- Possibly a scar-like reaction to insect bite, or shaving
- Slow growing, round to oval, firm nodules
- Deep component is attached to overlying skin
- A few millimeters to several centimeters
- Dimple sign- pucker’s when pinched
- Tx is cosmetic: excision, shave, cryo or punch biopsy
Fitzpatricks Sign
Retraction/Dimple Sign to test for dermatofibroma
If the skin over a dermatofibroma is squeezed a dimple forms, indicating tethering of the skin to the underlying fibrous tissue
Most common cutaneous vascular proliferations
3-4th decades, increasing with age
Cherry Hemangiomas
Cherry Hemangiomas Description
=
- Not ______, Completely _____
- No tx indicated, can do cosmetic treatment such as (2)
Tiny cherry red macules or papules
- Not blanchable, completely benign
- Laser, Electrodessication
Melanocytic Nevi
AKA (1)
Composed of (1): little pleo_____ or cellular a______
Begins to develop in _____ and appears after 6-12m, _____ with body growth, regress in ____ life
May ____ appearance during 1st few years of life
Common Moles
Composed of benign melanocytes: little pleomorphism or cellular atypia
Begins to develop in utero and appears after 6-12m, enlarges with body growth, regresses in later life
May change appearance during 1st few years of life
Melanocytic Nevi Description
Can be ____ in color or __colored
Rage in size from ____ to ____ (1cm - >20)
Small ____ to large raised _____
Giant nevi have an increased risk of turning into _____ in the lifetime
Can be uniform in color or multicolored
Range in size from small to giant (1cm to giant >20cm)
Small macules to large raised plaques
Giant nevi have an increased risk of turning into melanoma in the lifetime
- These 2 slides represent lesions that have been present for months or longer and gradually increasing in size. Firm or nodular on palpation. What is the most likely diagnosis?
- Seborrheic keratosis
- Squamous cell carcinoma
- Actinic (solar) keratosis
- Melanoma
Dorsal surface of a 78 yo man’s hand
- Seborrheic keratosis
- Squamous cell carcinoma
- Actinic (solar) keratosis
- Melanoma
Consideration for examining and treating lesions in primary care
- If the lesion doesn’t seem like it _____, it probably doesn’t
- Refer for annual FBEs if:
- Patients with more than ___ nevi on the skin
- hx of _____ or excessive sun exposure (lifeguards, golfers, boaters, etc.)
- _____ history of _____, especially a (1)
- Refer for any lesions that are not h_____, bl____, t____, or en_____
- Always educate on the importance of sun _____ & sun ______ measures
- Rec SPF of at least ___ reapplied Q2 hours, wide-brimmed ____, avoid sun am-pm, UV protective clothing, sunglasses with UV protection
- Confirm_______ referral in all melanoma pts or pts with lots of nevi
- If the lesion doesn’t seem like it belongs, it probably doesn’t
- Refer for annual FBEs if:
- Patients with more than 20 nevi on the skin
- hx of sunburns or excessive sun exposure (lifeguards, golfers, boaters, etc.)
- Family history of melanoma, especially a 1st degree relative
- Refer for any lesions that are not healing, bleeding, tender, or enlarging
- Always educate on the importance of sun avoidance & sun protective measures
- Rec SPF of at least 50 reapplied Q2 hours, wide-brimmed hats, avoid sun 10am-2pm, UV protective clothing, sunglasses with UV protection
- Confirm ophthalmology referral in all melanoma pts or pts with lots of nevi
Spider Bites Treatment
- I____ the wound
- R____ and el_____
- Treat with anti____ if indicated
- PO (1) and/or (1) ointment
- Look for central _____ or _____ center
- Irrigate the wound
- Rest and elevate
- Treat with antivenom if indicated
- PO ABX and/or Mupirocin ointment
- Look for central erosion or necrotic center
Ticks
Not all ticks cause disease in humans (monitor for systemic signs first, rash, fever, myalgia)
- (1) species carries (1) which can cause Lyme disease
- Dog tick and wood tick carries (1) species which can cause (1)
Not all ticks cause disease in humans (monitor for systemic signs first, rash, fever, myalgia)
- Ixodes Scapularis species carries Borrelia Bergdorfi which can cause Lyme disease
- Dog tick and wood tick carries R. Ricketssia species which can cause Rocky Mountain Spotted Fever
Tick Removal
What not to do?
What to do?
What to do: slow, gentle traction over several minutes
What do these pictures show?
1st pic =
3rd pic =
1st. pic: Classic erythema migrans (bullseye does not always present at the site of the bite)
Third pic: Atypical erythema migrans
Cimex Species (reddish/black bugs)
AKA (1)
Look for clusters of , _____ areas during ____, wake up every morning with (1)
Bed Bugs
Look for clusters of 3, exposed areas during sleep, wake up every morning with new lesions
Ctenocephalis Felix
AKA (1)
Prevalent in homes with (2)
Location of bites typically soley on (1)
Fleas
- Carpet or pets*
- Feet*
Head Lice
- Adult head lice are 2.1-3.3 mm in length. Head lice infest the head and neck and attach their ____ to the base of the hair shaft. Lice move by _____; they cannot hop or fly.
- Transmission =
- (1) does not play a role in transmission
- Treatment can be from obtained (1) or (1)
- Adult head lice are 2.1-3.3 mm in length. Head lice infest the head and neck and attach their eggs to the base of the hair shaft. Lice move by crawling; they cannot hop or fly.
- close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice.
- Both over-the-counter and prescription medications are available for treatment of head lice
Pediculosis Pubis
AKA (1)
Typically are found attached to hair in the pubic area and spread via _____ contact; sometimes are found on _____ hair elsewhere on the body such as?
Tx similar to head lice Rx (1) except need to tx (1)
Pubic Lice
Typically are found attached to hair in the pubic area and spread via sexual contact; sometimes are found on coarse hair elsewhere on the body such as eyebrows, eyelashes, beard, mustache, chest, armpits, etc.).
Tx similar to head lice (permetherin) except need to tx sexual partner
Sarcoptes Scabiei
AKA (1), the human (1)
- Mite burrows into the ____ layer of the skin where it lives and lays its eggs and excrimant → VERY (1) bc eggs hatch 7-10d later, need to retreat and will be itchy for a long period of time
- Transmission =
- Common outbreaks in (3)
- Typically ______ the first 2-6 weeks after infestation
- Look for very _____ nodules and papules in (3)
- Mite burrows into the upper layer of the skin where it lives and lays its eggs and excrimant → VERY PRURITIC bc eggs hatch 7-10d later, need to retreat and will be itchy for a long period of time
- spread by direct, prolonged, skin-to-skin contact with a person who has scabies
- Common outbreaks in nursing homes, extended-care facilities, and prisons
- Typically asymptomatic the first 2-6 weeks after infestation
- Look for very pruritic nodules and papules in interdigital web spaces, groin, and buttocks
Scabies Treatment
Rx (1)*
No OTC available
- Instructions: Apply from (1) to (1), (1) with it overnight then was all (2) in ___ water
- _____ in 1 week for (1) - coordinate with clothes cleaning
Permethrin cream 5% (Elimite)
- Neck to feet including between toes (oft intertriginal) - Sleep with it overnight then wash all bedding/clothing in hot water
Repeat in 1 week for hatching eggs - coordinate with clothes cleaning
What condition does this describe?
Distended hair follicles from decreased elastin caused by long hx of sun exposure resulting in open and closed comedones known as Solar or Senile comedones
Favre-Racouchot Syndrome
Diaper Dermatitis
AKA (1)
D____, e____, symmetrical ___
Look for s____ papules, pustules
- Keep area as ___ as possible!
- Tx with (1) or (1)
- In severe cases or if very pruritic → add (1)
Candidiasis
Dusky, erythematous, symmetrical plaque
Look for satellite papules, pustules
- Keep area as dry as possible!
- Tx with Nystatin OInt or Miconazole 2% Cream
- In severe cases or if very pruritic → add hydrocortisone
Angular Cheilitis
Causes (4)
Common in what population? (1)
- Salivary accumulation at angles of mouth
- Dental procedures
- Reaction to oral hygiene products
- Candidiasis or staph
Alcoholics malnutrition, poor oral hygiene, drooling, mouth guard, dental work etc.
Dense fibrous tissue nodules at site of previous trauma or inflammation
Differs from hypertrophic scars in that these never spontaneously resolve & occur beyond original borders/site of wound
Keloids
- Can also be from acne, that’s why we treat acne as asap*
- Can inject kenalog (steroid) into superficial part of scar to shrink and atrophy it*
Vitiligo Description
I____ w____ (1) or (1) with (1) edges
- Symmetry =
- Depigmented skin is very sensitive to (1) and can lead to higher incidence of (1) if patients are not careful
Ivory white macules or patches with sharply demarcated edges
- Typically symmetrical
- Depigmented skin is very sensitive to UV exposure and can lead to higher incidence of skin cancer if patients are not careful
Common disorder of hyperpigmentation affecting sun-exposed skin, most commonly face
Increased epidermal and/or dermal melanocytes
Melasma
Keratinization of hair follicles of the skin “chicken skin”
Keratosis Pilaris
What condition is shown in these pictures?
Where can this be treated?
Sebaceous cyst
Lesions can be excised in outpatient setting
Benign lesions associated w/hyperlipidemia
Small yellow to orange papules & plaques in periorbital region
Xanthelasma
Types of Alopecias (Hair Loss)
Lab considerations (6)
- Alopecia ______– common & often idiopathic
- Telogen Efluvium (always perform the pull test) =
- Lichen Planus Pilaris =
- _____ Erythematosus
- ______ mania
- Traction Alopecia
- Alopecia 2/2 _____ Capitus
- Alopecia 2/2 moderate to severe ____ Derm
CBC, BCP, TSH, ANA, Vit D and B12/folate, Fe pannel/serum ferritin
- Alopecia Areata – common & often idiopathic
- Telogen Efluvium (always perform the pull test) = temporary hair loss that usually happens several months after a person experiences a traumatic event or stress
- Lichen Planus Pilaris = condition that can cause swelling and irritation in the skin, hair, nails and mucous membranes
- Lupus Erythematosus
- Trichotillomania
- Traction Alopecia
- Alopecia 2/2 Tinea Capitis
- Alopecia 2/2 moderate to severe Seb Derm
