Diseases 2 Flashcards by Savannah Smith

milia

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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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

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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

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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

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cherry angioma

greater than 40
benign aquired vascular neoplasms
location: trunk

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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

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hypertrophic scar

respects boundaries of scar

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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

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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

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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

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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,

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PTCH

BASAL CELL CARCINOMA

tumor suppressor gene: regulator of basal epidermal cell proliferation

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risks for basal cell CA

UV
fair
h/o sunburns (esp. blistering)
family Hx
immunosuppression (squamous cell occurs more in immunocompromised)

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subtypes of basal cell carcinoma

nodular
superficial
pigmented
morpheaform (sclerotic)
micronodular
cystic
infiltrative
PTCH mutation

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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

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imiquimod

topical

Tx: superficial basal cell carcinoma

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5-flurouracil

topical

Tx: superficial basal cell carcinoma

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vismodegib

competitive antagonist of SMO

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

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progression of squamous cell carcinoma

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

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actinic keratosis

minimal atypia in pre-squamous cell carcinoma

Tx: topical therapy, cryotherapy

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squamous cell carcinoma in situ

full thickness epidermal atypic confined above BM

Tx: topical therapy, intralesional, excision

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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

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

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

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

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 1. size 2. symmetry 3. circumscribed 4. nests 5. mature 6. 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