Diseases 2 Flashcards
milia
any age
small epidermoid cysts
location: cheeks, eyelids, forehead, genitals
sun damaged skin
Tx: resolve spontaneously or removed with blade/needle
dermatofibroma
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
seborrheic keratosis
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
Leser-Trelat
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
cherry angioma
greater than 40
benign aquired vascular neoplasms
location: trunk
keloid
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
hypertrophic scar
respects boundaries of scar
epidermal (epidermoid) cysts
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
pilar cyst
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
basal cell carcinoma
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
squamous cell carcinoma
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,
PTCH
BASAL CELL CARCINOMA
tumor suppressor gene: regulator of basal epidermal cell proliferation
risks for basal cell CA
- UV
- fair
- h/o sunburns (esp. blistering)
- family Hx
- immunosuppression (squamous cell occurs more in immunocompromised)
subtypes of basal cell carcinoma
- nodular
- superficial
- pigmented
- morpheaform (sclerotic)
- micronodular
- cystic
- infiltrative
PTCH mutation
basal cell nevus syndrome (Gorlin Syndrome)
AD, rare mutation in PTCH1 BCCs at early age (~23 yrs) MSK defects and jaw cysts increased risk: medulloblastoma, fibrosarcoma
imiquimod
topical
Tx: superficial basal cell carcinoma
5-flurouracil
topical
Tx: superficial basal cell carcinoma
vismodegib
competitive antagonist of SMO
Tx: advanced Basal cell carcinoma (metastatic, recurrent, non-surgical)
progression of squamous cell carcinoma
minimal atypia (actinic keratosis) to full thickness epidermal atypia confined above BM (SCC in situ) to invasive
actinic keratosis
minimal atypia in pre-squamous cell carcinoma
Tx: topical therapy, cryotherapy
squamous cell carcinoma in situ
full thickness epidermal atypic confined above BM
Tx: topical therapy, intralesional, excision
Bowen’s disease
squamous cell carcinoma in situ
Erythroplasia of Queyrat
squamous cell carcinoma in situ male: glans or prepuce
female: vulva
possibly HPV related
risks for squamous cell carcinoma
p53 mutation
- UV
- HPV
- chronic inflammation
- scars (burn)
- chemicals, ARSENIC
- radiation
- leukoplakia
- IMMUNOSUPPRESSION
- chronic erosive mucosal lichen plannus
keratocanthoma
SCC subtype
neoplasm of keratinocytes, rapidly grows over 2-6 weeks
painful
may spontaneously involute
Marjolin’s ulcer
SCC subtype
ulcerated, invasive
background: chronic inflammation, scarring, radiation, trauma
melanocytes
NEURAL CREST derived
can be other places than skin
dermal epidermal junction most common site
ABCDE of melanoma
- asymmetric
- border: irregular, scalloped
- color: mottled, varigated, not uniform
- diameter: greater than 6 mm
- elevation
changing mole, ugly duckling sign
melanoma
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
nevi
benign, melanocytes
NOT pre-melanoma
BRAF
nevi, melanoma
risks of melanoma
- lots of nevi ( >50), some grow out of moles
- giant congenital nevi
- atypical nevi, if multiple and familial
- Hx of blistering sunburns
- family Hx
- light complexion
- tanning bed use
- underlying immune dysfunction
acquired melanocytic nevi
not at birth, usually before 30 yrs
junctional, compound, intradermal
halo nevi
nevi that is being regressed
surrounded by depigmentation
more common in: vitiligo, familial, 0-20 yrs
relationship between melanocytic neoplasia and host immunity
junctional nevi
flat, epidermal
dermal-epidermal junction above BM
2-3 mm diamter
deeply pigmented
intradermal nevi
raised, dermal
larger, dome shaped
congenital nevi
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
atypical (dysplastic) nevi
common acquired nevi that appear unusual clinically
NOT precursors to melanoma
no increased risk unless many and family Hx of melanoma
compound nevi
raised slightly
3-4 mm
moderately pigmented
melanocytes: intraepidermally and dermally
Dysplastic Nevus Syndrome or BK mole syndrome
hundreds of irregular moles with family Hx of melanoma
CDNK2 (p16INK4A)
risk of melanoma increased
CDNK2
tumor suppressor gene
MELANOMA
p16INK4
tumor suppressor gene
MELANOMA
nevi vs melanoma
- size
- symmetry
- circumscribed
- nests
- mature
- above/not basal layer
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
acral lentiginous melanoma
palmer, plantar, subungal
darker skin
lentigo maligna melanoma
older patients on sun exposed skin
MELANOMA IN SITU
slow growing, radial growth
nodular melanoma
men > women
sunexposed, no preceding radial growth
progression of in situ into invasive
superficial spreading melanoma
red, white and blue sign
amelonotic melanoma
melanoma in which cells do not make melanin: pink, red, purple, color of skin
Breslow’s thickness
distance of involvement from stratum granulosum to deepest tumor cell
determines melanoma prognosis
vemurafenib
BRAF inhibitor
Tx: metastatic melanoma
grow back after 6 mo.
ipilimumab
CTLA4 inhibitor
Tx: metastatic melanoma
CTLA4
inhibits T cell
nivolumab
PD-1 inhibitor
Tx: metastatic melanoma
PD-1
inhibits T cells
