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Skin > Diseases 2 > Flashcards

Diseases 2 Flashcards

1
Q

milia

A

any age
small epidermoid cysts
location: cheeks, eyelids, forehead, genitals
sun damaged skin
Tx: resolve spontaneously or removed with blade/needle

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2
Q

dermatofibroma

A 
common, benign fibrotic tumor
location: extremities
Hx: trauma (bites)
DIMPLE SIGN: pinching leads to dimpling
Tx: doesn't need if stable/asympotomatic
if growing/irregular: further evaluate
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3
Q

seborrheic keratosis

A

after 30, males more often and extensively
AD
benign (not pre-malignant), small, round or oval light tan that become dark (black) and raised over time
STUCK ON
location: epidermis of face, trunk, upper extremities
acute onset of multiple: CA
Tx: nothing unless pruritic

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4
Q

Leser-Trelat

A

sudden eruption of multiple seborrheic keratosis along tension lines (christmas tree distribution)
can be a marker for CA: adenocarcinoma COLON, breast, stomach, lung
lots of people have multiple that aren’t associated with CA

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5
Q

cherry angioma

A

greater than 40
benign aquired vascular neoplasms
location: trunk

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6
Q

keloid

A

30s, AA
exuberant fibrous repair of tissue following a cutaneous injury, extending beyond the original site (can be pruritic or painful, usually asymptomatic)
usually follows injury to skin or spontaneously
Tx: none, intralesional corticosteroid injections (painful), excision (recur even bigger so combine with corticosteroid), cryotherapy (painful)
PREVENT: avoid injury

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7
Q

hypertrophic scar

A

respects boundaries of scar

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8
Q

epidermal (epidermoid) cysts

A

mobile dermal nodule with central puncture filled with keratinaceous debris, oil
SMELLS: rancid, cheesy
if traumatized: rupture or become inflamed and abscess
may remain quiescent for years
Tx: surgical removal of entire lesion, if inflamed incise and drain

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9
Q

pilar cyst

A

AD
smooth, firm, dome shaped (0.5 to 5 cm)
keratin containing nodule to tumor with predilection for the SCALP
NO central puncture for draining

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10
Q

basal cell carcinoma

A

MOST COMMON
greater than 35, unless PTCH mutation
germinative keratinocytes (resemble basal layer)
metastasis is rare
Tx: excision, electrodessication and cutterage, cryosurgery, radiation, topical Tx
HEDGEHOG pathway

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11
Q

squamous cell carcinoma

A

epidermal keratinocytes (resemble spinous layer)
risk for metastasis: ear, lip, larger size, immunocompromised, depth, HPV, leukoplakia, Marjolin’s ulcer
met: lung, lymph
Tx: depends on progression, if invasive excise, if not: topical therapy, cryotherapy,

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12
Q

PTCH

A

BASAL CELL CARCINOMA

tumor suppressor gene: regulator of basal epidermal cell proliferation

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13
Q

risks for basal cell CA

A
  1. UV
  2. fair
  3. h/o sunburns (esp. blistering)
  4. family Hx
  5. immunosuppression (squamous cell occurs more in immunocompromised)
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14
Q

subtypes of basal cell carcinoma

A
  1. nodular
  2. superficial
  3. pigmented
  4. morpheaform (sclerotic)
  5. micronodular
  6. cystic
  7. infiltrative
    PTCH mutation
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15
Q

basal cell nevus syndrome (Gorlin Syndrome)

A 
AD, rare
mutation in PTCH1
BCCs at early age (~23 yrs)
MSK defects and jaw cysts
increased risk: medulloblastoma, fibrosarcoma
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16
Q

imiquimod

A

topical

Tx: superficial basal cell carcinoma

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17
Q

5-flurouracil

A

topical

Tx: superficial basal cell carcinoma

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18
Q

vismodegib

A

competitive antagonist of SMO

Tx: advanced Basal cell carcinoma (metastatic, recurrent, non-surgical)

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19
Q

progression of squamous cell carcinoma

A 
minimal atypia (actinic keratosis) to full thickness epidermal atypia confined above BM (SCC in situ)
to invasive
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20
Q

actinic keratosis

A

minimal atypia in pre-squamous cell carcinoma

Tx: topical therapy, cryotherapy

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21
Q

squamous cell carcinoma in situ

A

full thickness epidermal atypic confined above BM

Tx: topical therapy, intralesional, excision

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22
Q

Bowen’s disease

A

squamous cell carcinoma in situ

23
Q

Erythroplasia of Queyrat

A

squamous cell carcinoma in situ male: glans or prepuce
female: vulva
possibly HPV related

24
Q

risks for squamous cell carcinoma

A

p53 mutation

  1. UV
  2. HPV
  3. chronic inflammation
  4. scars (burn)
  5. chemicals, ARSENIC
  6. radiation
  7. leukoplakia
  8. IMMUNOSUPPRESSION
  9. chronic erosive mucosal lichen plannus
25
Q

keratocanthoma

A

SCC subtype
neoplasm of keratinocytes, rapidly grows over 2-6 weeks
painful
may spontaneously involute

26
Q

Marjolin’s ulcer

A

SCC subtype
ulcerated, invasive
background: chronic inflammation, scarring, radiation, trauma

27
Q

melanocytes

A

NEURAL CREST derived
can be other places than skin
dermal epidermal junction most common site

28
Q

ABCDE of melanoma

A
  1. asymmetric
  2. border: irregular, scalloped
  3. color: mottled, varigated, not uniform
  4. diameter: greater than 6 mm
  5. elevation
    changing mole, ugly duckling sign
29
Q

melanoma

A

caucasian, men, > 50 yrs
malignant, melanocytes
prognosis depends on DEPTH, ulcerated, lymph node involvement
met.: skin most
BRAF
Tx: cut it out early, vemurafenib, ipilimumab, nivolumab

30
Q

nevi

A

benign, melanocytes

NOT pre-melanoma

31
Q

BRAF

A

nevi, melanoma

32
Q

risks of melanoma

A
  1. lots of nevi ( >50), some grow out of moles
  2. giant congenital nevi
  3. atypical nevi, if multiple and familial
  4. Hx of blistering sunburns
  5. family Hx
  6. light complexion
  7. tanning bed use
  8. underlying immune dysfunction
33
Q

acquired melanocytic nevi

A

not at birth, usually before 30 yrs

junctional, compound, intradermal

34
Q

halo nevi

A

nevi that is being regressed
surrounded by depigmentation
more common in: vitiligo, familial, 0-20 yrs
relationship between melanocytic neoplasia and host immunity

35
Q

junctional nevi

A

flat, epidermal
dermal-epidermal junction above BM
2-3 mm diamter
deeply pigmented

36
Q

intradermal nevi

A

raised, dermal

larger, dome shaped

37
Q

congenital nevi

A

at birth, classified by size
pigment varies, irregular surface, hair
large/giant ( > 20 cm): small risk of melanoma in first 5 years of live in dermis

38
Q

atypical (dysplastic) nevi

A

common acquired nevi that appear unusual clinically
NOT precursors to melanoma
no increased risk unless many and family Hx of melanoma

39
Q

compound nevi

A

raised slightly
3-4 mm
moderately pigmented
melanocytes: intraepidermally and dermally

40
Q

Dysplastic Nevus Syndrome or BK mole syndrome

A

hundreds of irregular moles with family Hx of melanoma
CDNK2 (p16INK4A)
risk of melanoma increased

41
Q

CDNK2

A

tumor suppressor gene

MELANOMA

42
Q

p16INK4

A

tumor suppressor gene

MELANOMA

43
Q

nevi vs melanoma

  1. size
  2. symmetry
  3. circumscribed
  4. nests
  5. mature
  6. above/not basal layer
A 
Nevi
1. small 
2. symmetric
3. well circumscribed
4. nests are organized, discrete, uniform size and shape
5. melanocytes mature with descent into dermis
6. no melanocytes above basal layer
Melanoma
1. large
2. asymmetric
3. poorly circumscribed
4. nests are confluent, with irregular spacing, irregular sizes and shapes
5. do not mature with descent
6. melanocytes located above basal layer
44
Q

acral lentiginous melanoma

A

palmer, plantar, subungal

darker skin

45
Q

lentigo maligna melanoma

A

older patients on sun exposed skin
MELANOMA IN SITU
slow growing, radial growth

46
Q

nodular melanoma

A

men > women
sunexposed, no preceding radial growth
progression of in situ into invasive

47
Q

superficial spreading melanoma

A

red, white and blue sign

48
Q

amelonotic melanoma

A

melanoma in which cells do not make melanin: pink, red, purple, color of skin

49
Q

Breslow’s thickness

A

distance of involvement from stratum granulosum to deepest tumor cell
determines melanoma prognosis

50
Q

vemurafenib

A

BRAF inhibitor
Tx: metastatic melanoma
grow back after 6 mo.

51
Q

ipilimumab

A

CTLA4 inhibitor

Tx: metastatic melanoma

52
Q

CTLA4

A

inhibits T cell

53
Q

nivolumab

A

PD-1 inhibitor

Tx: metastatic melanoma

54
Q

PD-1

A

inhibits T cells

Skin (8 decks)

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