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Clin Med I > Keratosis and Skin Cancer > Flashcards

Keratosis and Skin Cancer Flashcards

1
Q

Curettage

A

Scraping the skin away with a curette, a ring-shaped instrument

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2
Q

Electrodessication

A

High-frequency current is applied to the lesion, destroying the tissue by drying it out

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3
Q

Cryotherapy

A

Tissue is destroyed by freezing to -40 C or below using liquid nitrogen

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4
Q

Biopsy

A

Incisional (portion)

Excisional (whole)

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5
Q

Solar Lentigo

A

“Age spot” “Senile freckle”

  • Local proliferation of melanocytes (UV damage in sun exposed areas)

Very Common

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6
Q

Clinical Presentation of Solar Lentigo

A

Well circumbscribed

Small brown macule often found in groups

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7
Q

Seborrheic Keratosis (SK)

A

Common benign epidermal lesion
- Proliferation of immature keratinocyte

Develop typically after age 50
- “barnacles of aging”

Genetic link to excess multiple SKs

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8
Q

Clinical Presentation of Seborreic Keratosis

A

Tan to black with warty, waxy, “stuck-on” appearance

Well demarcated, oval/round/irregular shape

May have single SK or hundreds

  • Chest, back, head, and neck
  • “Christmas tree” appearance on back due to Blaschko Lines

ISK: Irritated SK

  • caused by rubbing/friction
  • may have pruritus, pain, bleeding
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9
Q

Leser-Trelat Sign

A

Associated with SK

Sudden onset of multiple SKs with inflammatory base

    • skin tags
    • acanthosis nigricans (A skin condition characterized by dark, velvety patches in body folds and creases.)

Possible association with GI and lung cancers

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10
Q

Clinical Presentation of Keratocanthoma

A

Hallmark: rapid growth over 6-8 weeks

Round, flesh colored nodule, with central keratin plug
- More commonly found in sun exposed areas +/- hair distribution

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11
Q

Risk Factors of Keratocanthoma

A

Middle-age to elderly with fair skin

Increased UV radiation or chemical carcinogens

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12
Q

Management of Keratocanthoma

A

Majority resolve spontaneously in 6-9 months

Due to difficult dx, requires biopsy and treatment
- Excisional biopsy preferred (Mohs)

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13
Q

Actinic Keratosis (AK)

A

Also known as solar keratosis

Originate from keratinocyte

Considered pre-cancerous
- May progress to SCC (disease continuum, 8% risk per year)

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14
Q

Risk Factors Actinic Keratosis (AK)

A

Increasing age

M>F

Light skin complexion (Fitz I,II)

Chronic UV light exposure

History of sunburns

Immunosuppression

Genetic syndromes

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15
Q

Clinical Presentation of Actinic Keratosis

A

Erythematous, scaly/gritty macule or papule

May be tender

Subtypes:

  • Hypertrophic: thickened
  • Atrophic: scale absent
  • AK w/ cutaneous horn
  • Pigmented
  • Actinic cheilitis (lip)
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16
Q

Diagnosis of Actinic Keratosis

A

Typically clinical diagnosis based on visualization and touch

Dermoscopy may be helpful

Shave or punch biopsy

  • lesion > 1cm
  • rapid growth
  • ulceration or pain associated

*If lesion is >6mm: consider SCC in situ

17
Q

Management of Actinic Keratosis

A

May spontaneously resolve (20-30%) but could reoccur

Isolated lesions: cryotherapy or surgical intervention

Multiple lesions: field treatment

  • Topical fluorouracil cream: preferred
  • Photodynamic therapy (PDT): topical photosensitizer selectively destroy target cells
  • Imiquimod (Aldara)
18
Q

Basal Cell Carcinoma (BCC)

A

Arises from basal layer of the epidermis

Nodular BCC is most common type

Flesh-colored or pinkish
Pearly papule/nodule
Telangiectasias
May have central ulceration w/ rolled border

Most common on head and neck

19
Q

Sebaceous Hyperplasia

A

BCC DDx

Enlarged oil gland with central clearing

Look for telangiectasias

20
Q

Fibrous Papule

A

BCC DDx

Benign angiofibroma

Skin colored/ pinkish papule on the nose

No telangiectasias and lacks pearly texture

21
Q

BCC Treatment

A

Surgical: preferred

  • Curettage & dessication
  • Excision with 4 mm margins
  • Mohs for high risk or cosmetic reasons

Nonsurgical
- Radiation for poor surgical candidates

Superficial BCC

  • Imiquimod cream
  • 5% fluorouracil cream
  • Photodynamic therapy
22
Q

Squamous Cell Carcinoma (SCC)

A

Originates from keratinocytes

Males 50-70 years

Risk Factors: UV exposure including tanning beds, genetic alterations, chemical carcinogen exposure

May arise from previous skin injuries: burns, scars, etc.

23
Q

Clinical Presentation of SCC

A

Papule, plaque, or nodule

Pink, red, or skin colored

Often asymptomatic, may be pruritic or tender

Lesion appears scaly, exophytic, indurated, and/or friable

Commonly appears warty

24
Q

Treatment of SCC

A

Surgical: preferred

  • Wide excision: margins based on risk
  • Mohs: recommended for high risk and cosmetic

Non-surgical

  • Radiation (poor surgical candidate, residual tumor)
  • Curettage & Dessication or cryotherapy (select low-risk or SCC in situ)

Less effective options for SCC in situ

  • Imiquimod cream
  • 5% fluorouracil cream
  • Photodynamic therapy
25
Q

Risk Factors of Malignant Melanoma

A

Fair skin, blue eyes, red/blonde hair, freckling

> 5 atypical nevi, >25 nevi

Immunosuppression

Personal or family history of melanoma: genetic

predisposition in small percentage

Prolong UV exposure

26
Q

Melanoma

A

Usually asymptomatic

Most de novo with some arising from pre-existing nevus

Pigmented papule, plaque, or nodule

ABCDEs

27
Q

ABCDEs of Detecting Melanoma

A

A - Asymmetry: shape or color

B - Border: irregular

C - Color: dark or variations

D - >6mm (pencil eraser)

E - Evolving: changes in the above

28
Q

Superficial Spreading Melanoma

A

Most common subtype (70%)

Confined to epidermis

Often younger population

Radial spread > Vertical growth

Men: back
Woman: legs and back

29
Q

Nodular Melanoma

A

Rapid vertical growth

Minimal radial growth

Aggressive

Nodule is inflamed and friable

30
Q

Lentigo Melanoma

A

Elderly w/ chronic sun exposure

Slow progression radially with rapid vertical growth
- typically remains more superficial

31
Q

Acral Lentiginous

A

Darker skin (african/asian ancestry)

Spreads superficial, then vertical

M > F

Larger lesions due to delay in dx
- palmar, plantar, or subungual

32
Q

Melanoma Considerations

A

Subungual

  • Great toe or thumb
  • history of trauma
  • dark streak & involves proximal nail fold

Amelanotic

  • minimal or absent pigment
  • extensive ddx
33
Q

Treating Melanoma

A

Wide surgical excision is the gold standard w/ 2cm clear margins

Regional lymph node dissection/sentinel node biopsy

Advanced metastatic disease:

  • radiation
  • chemotherapy
  • immunotherapy/targeted therapy: adjunct therapy

Follow up every three months

Clin Med I (5 decks)

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