Keratotic Disorders/Neoplasms / Vascular Lesions

Question 1

Answer 1

Actinic keratosis

• gritty papule with erythematous base
• lesions are often rough
• Primarily occur at sites with greatest amount of sun exposure
• consider bipsy (especially in immunosuppressed pts)
• tx: liquid nitrogen, 5-fluorouracil → will lead to redness (MEANS IT IS WORKING)

Question 2

Dysplastic Nevi

Answer 2

atypical mole

• can be a marker for someone to have higher risk of melanoma
• often will have a signature nevus = multiple of the same type of dysplastic nevi
• diagnosis: clinical can do biopsy to r/o malignancy
• tx: if multiple dysplastic nevi = should be seen for regular skin assessments
  
  • giant congenital nevus are risk factors for melanoma**

Question 3

Answer 3

Keratoacanthoma

• type of squamous cell carcinoma
• rapidly growing erythematous, crateriform nodules with a rolled border and central keratotic plug
• → key finding: **CENTRAL CRUSTING**
• tx: will often resolve after being shaved off

Question 4

Answer 4

Basal Cell Carcinoma

**most common type of skin cancer**

• papule or nodule with pearly appearance, smooth surface, well defined and firm, may have telangiectasia
• ulcerating type: ulcer with crust and pearly border
• diagnosis: biopsy!
• tx: for small and low risk areas (<1cm and not on the face and scalp) : liquid nitrogen, dessication and curretage, Imiquimod , surgical excision = best option
• for face/scalp = MOHs

Question 5

Answer 5

Squamous Cell Carcinom

• keratotic papule or nodule within a background of sun-damaged skin
• tenderness is common
• diagnosis: biopsy
• tx: surgical excision with clear margins
  
  • MOHs for high risk area of the body

Question 6

Answer 6

Malignant Melanoma

**most common cause of skin cancer-related death**

• ABCDEFG
• most common sites: males: back, upper extremities
  
  • females: back, lower legs
• diagnosis: BIOPSY the entire lesion
  
  • if ulceration = poorer prognosis
• tx: refer to dermatology
  
  • pt requires skin cancer screening every 3-4 months

Question 7

Answer 7

Lentigo Maligna

type of melanoma

• MOST COMMON on the face
• usually has papules, nodules, or plaques along with appearance of red, white, blue or grey: should check for lymphadenopathy
• diagnosis: shave biopsy and dermoscopy → will be more intense or have variations of browns/black than solar lentigo
• tx: refer to dermatology
  
  • requires skin cancer screening every 3-4 months