Diseases 4

Question 1

Seborrheic keratosis

• definition
• risk factors

Answer 1

• benign epithelial skin tumor - growth of immature keratinocytes
• UV, skin burn, older age, genetic tendency

Question 2

Seborrheic keratosis

-clinical features (6)

Answer 2

• multiple flat, hyperkeratotic (dark) papules and plaques
• sharply demarcated
• oval, round
• brown, black or skin color - “greasy”, “floss” or surface covered with warts
• face, trunk, upper extremities
• asymptomatic - it can be itchy, may bleed or get red

Question 3

Seborrheic keratosis

• diagnosis
• treatment

Answer 3

• anamnesis, clinical features, dermatoscopy, skin biopsy

- excision, curettage, electrodestruction, cryotherapy, laser therapy

Question 4

Actinic keratosis

• definition
• risk factors

Answer 4

• UVB - induced carcinoma in situ
• pre-cancerous lesion

-UV, I skin type, older age, men sex, immunosuppression

Question 5

Actinic keratosis

-clinical features (4)

Answer 5

• multiple lesions
• sharply bordered, skin colored/erythematous/ brown
• scaly papule/plaque
• skin areas exposed to sunlight: face, ears, scalp, hands, upper body

Question 6

Actinic keratosis

• diagnosis
• treatment

Answer 6

-clinical features + skin biopsy

• cryotherapy, curettage, electro destruction
• photodynamic therapy
• local medication: immunomodulators, retinoid, diclofenac

Question 7

Basal cell carcinoma

• definition
• risk factors

Answer 7

• slow-growing, locally invasive, malignant epidermal skin tumor
• UV, ionizing radiation, older age, skin type I-II, Gorlin-Goltz syndrome (multiple bcc in childhood), chemical toxins, genetics

Question 8

Basal cell carcinoma

-types (6)

Answer 8

Nodular 
Superficial
Pigmented 
Morpheiform 
Ulcerative 
Fibroepithelioma of Pincus

Question 9

Basal cell carcinoma - clinical features of:

1. nodular type
2. superficial type

Answer 9

1. most common, papule/nodule, pearly/shiny/skin colored or pinkish, blood vessels on the surface, may have a central ulcer or bleed spontaneously, translucent epidermis
2. younger patients, multiple/multifocal, trunk/shoulders, pink/red, scaly irregular plaques, thin rolled borders, slow growth, bleed and ulcerate easily

Question 10

Basal cell carcinoma - clinical features of:

3. pigmented type
4. morpheaform type
5. infiltrative type

Answer 10

3. brown, blue or grey, nodular/superficial histology, face/trunk
4. mid-facial sites, skin-colored, waxy, scar-like, prone to recur after treatment, infiltrate cutaneous nerves (perineural spread)
5. pink/red, plaque, scaly surface, irregular and ill-defined margin, can be elevated/depressed, palpable induration at tissue edges

Question 11

Basal cell carcinoma - clinical features of:

3. pigmented type
4. morpheaform type
5. infiltrative type

Answer 11

3. brown, blue or grey, nodular/superficial histology, face/trunk
4. mid-facial sites, skin-colored, waxy, scar-like, prone to recur after treatment, infiltrate cutaneous nerves (perineural spread)
5. pink/red, plaque, scaly surface, irregular and ill-defined margin, can be elevated/depressed, palpable induration at tissue edges

Question 12

Basal cell carcinoma

• diagnosis
• treatment

Answer 12

-CE + dermatoscopy + biopsy

• surgical removal
• cryosurgery, radiotherapy, laser, photodynamic, curettage, topical (fluocouracil)
• monitor every 6-12 months

Question 13

Squamous cell carcinoma

• definition
• pathogenesis

Answer 13

• malignant, infiltrating, invasive skin cancer from keratinocytes
• develops from precancerous skin conditions

-UV, HPV 16, 18, radiotherapy, arsenic, chemical carcinogens, immunosuppression

Question 14

Squamous cell carcinoma

• clinical features
• localization

Answer 14

• hyperkeratotic papule and plaque
• frequently with crust and ulcerated

-scalp, dorsum of hands, lips, shin, ear, genitalia, mucous membranes

Question 15

Squamous cell carcinoma

• diagnosis
• treatment

Answer 15

-clinical signs + biopsy

• excision, palliative chemotherapy if no operation possible, control of lymph nodes for spread
• check up 3-6 months for 5 years

Question 16

Melanoma

• definition
• predisposing factors
• gained factors

Answer 16

• highly malignant tumor arising from melanocytes –> metastasis = almost impossible to stop it
• I-II skin phototype, positive family history, gender (women>men), albinism, ethnic dependence
• insolation, skin burns, high-social economic status

50% arise from moles!!!

Question 17

Melanoma

-types (5)

Answer 17

1. Nodular
2. Superficial spreading
3. Acral lentiginous
4. Lentigo maligna
5. Mucosal and internal organs

Question 18

Melanoma

-location

Answer 18

• women’s - calf’s skin
• men - trunk
• 52% - scalp, neck, trunk area

Question 19

Melanoma - clinical features of:

1. nodular type
2. superficial spreading
3. acral lentiginous

Answer 19

1. sun lighted body parts, age 40-60, duration of horizontal phase: months
2. trunk, age 30-60, duration of horizontal phase: one month to 2 years
3. in limbs, age 40-60, duration of horizontal phase: years

Question 20

Melanoma - clinical features of:

1. nodular type
2. superficial spreading
3. acral lentiginous

Answer 20

1. sun lighted body parts, age 40-60, duration of horizontal phase: months, reddish-brown-black
2. trunk, age 30-60, duration of horizontal phase: one month to 2 years, variable pigmentation
3. in limbs, age 40-60, duration of horizontal phase: years, brown-black pigmented macule, ulceration may occur, Hutchinson’s sign (dark linear patch arising from the nail)

Question 21

Melanoma - clinical features of:

4. lentigo maligna
5. mucosal and internal organs

Answer 21

4. face, calf, age >60, duration of horizontal phase: one to 10 years, irregular pigmentation, large and irregularly shaped patch
5. mouth, genitals, eyes, CNS, lymph nodes, age: adults, duration of horizontal phase: short

Question 22

Melanoma

• diagnosis
• treatment
• prevention

Answer 22

• dermatoscopy, LN palpation, LF biopsy
• surgical excision!
• avoid sunlight, solariums,
• use sun protective clothing
• sunscreen

Question 23

Dermoscopy - ABCDE criteria

Answer 23

A - asymmetry 
B - border 
C - color 
D - diameter > 6mm 
E - evolving

Question 24

Melanocytic nevi

-definition

Answer 24

• pigmented nevus characterized by melanocytes changes in epidermis or dermis which don’t connect in to nests with each other
• pigmented nevus: limited macule or nodule composed of tumor changed and proliferated melanocytes
• classified as: nevoid cell nevus and melanocytic nevus

Question 25

Melanocytic nevi | -risk factors

Answer 25

- congenital: family history, fair skin and red hair | - acquired: UV radiation,

Question 26

Melanocytic nevi | -sub-types (5) and their clinical features

Answer 26

1. Lentigo simplex - increased amount of melanocytes in basal layer. Round or oval shaped brown macules, scattered distribution. Do not increase in number during sun exposure 2. Cafe au lait macule - circumscribed tan macule, usually present at birth. Irregular tan macules and patches. 3. Mongolian spot - blue-gray sacral patch, most often on trunk or buttocks 4. Blue nevus - flat or slightly emerged, from grey to black blue color papule. Head, Waist or external surfaces of hand and feet 5. Becker nevus - hyperpigmented, increased hairs and increased smooth muscles. Large patch or plaque, present at birth. usually on trunk

Question 27

Melanocytic nevi | -clinical features (4)

Answer 27

freckles - increased melanin in epidermis with normal to reduced number of melanocytes - flat, multiple, small tan or light - brown macules - increase in number during sun exposure

Question 28

Melanocytic nevi - diagnosis - treatment

Answer 28

-anamnesis, clinical features, dermatoscopy - no atypia --> no removal - atypia --> only excision - usage of laser, electro destruction and cryotherapy

Question 29

Signs of atypia (6)

Answer 29

- fast increase - waviness of nevus contours - inflammatory effects (swelling, redness pain) - bleeding and ulceration - itchiness - changes of color, diversity