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X Clin Med Exam 1 > L2 Intro and skin CA > Flashcards

L2 Intro and skin CA Flashcards

1
Q

Stratum corneum

A

superficial layer with shedding dead skin cells

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2
Q

Stratum lucidum

A

layer found on plantar and palmar surfaces

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3
Q

Stratum granulosum

A

keratinization

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4
Q

Stratum spinosum

A

spiny-shaped cells (strength and flexibility)

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5
Q

Stratum basale

A

cells germinate: keritinocytes

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6
Q

Order of epidermal layers

A

Come, (Let’s) Get SunBurn

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7
Q

Types of epidermal cells

A

keratinocytes
melanocytes
merkel cells
langerhans cells

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8
Q

keratinocytes

A

most common cell in epidermis
form a barrier
in deepest layer they are called basal cells

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9
Q

Langerhan’s cells

A

Dendritic cells scattered through the epidermis
derived from bone marrow
“macrophages of the skin”

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10
Q

Merkel cells

A

Mechanoreceptors

abundant in fingertips

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11
Q

Melanocytes

A

pigmented cells that help protect against UV rad.

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12
Q

Dermis

A

support structure

contains: blood & lymph vessels, nerves, hair follicles, glands, and fibrous tissue

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13
Q

Layers of the dermis

A

Papillary
Reticular
Ground substance

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14
Q

Papillary dermis

A

superficial, loose, fine collagen fibers

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15
Q

Reticular dermis

A

deep dermis, densely packed & think collagen bundles. elastic fibers

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16
Q

Ground substance

A

proteoglycans and glycosaminoglycans

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17
Q

Basement Membrane Zone (BMZ)

A 
dermal-epidermal junction
two layers: 
basal lamina
reticular connective tissue
defects here are the basis for many blistering diseases
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18
Q

Hypodermis (subcutis)

A

Fibroblasts, adipose, and macrophages

subcutaneous fat

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19
Q

Eccrine glands

A 
covers most of the body
releases at the surface of the skin
function in temp reg
coiled gland in deep dermis (secretion)
Straight duct extends to epidermis (transportation)
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20
Q

osmolarity of sweat

A

begins isotonic with plasma, but electrolyte reabsorption in duct causes it to be hypotonic

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21
Q

apocrine glands

A

concentrated in axilla and anogenital regions
secretes into the sac of the hair follicle
fluid is odorless when released, bacteria makes it smell rank
driven by adrenaline

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22
Q

vellus hair

A

short and fine hairs

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23
Q

terminal hair

A

long and thick hairs

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24
Q

bulb

A

enlargement at base of hair follicle

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25
Q

Pathogenic mechanisms

A 
ACID
Type 1: immediate/allergy
Type 2: cytotoxic
Type 3: immune complex
Type 4: delayed sensitivity
26
Q

Type 1: immediate

A

IgE
allergies
mast cells and basophils
Ex: hives, bronchospasm

27
Q

Type 2: Cytotoxic

A

Circulating IgG or IgM

react to surface antigen

28
Q

Type 3: Immune complex

A

Antigen-antibody complexes are introduced to the tissue causing inflammation
IgG or IgM

29
Q

Type 4: Delayed sensitivity

A

cell-mediated immunity

24-48 hours after exposure

30
Q

curettage

A

scraping skin away with curette

31
Q

electrodessication

A

high freq current applied to lesion, drying it out/burning

32
Q

cryotherapy

A

tissue is destroyed using -40°C liquid nitrogen

33
Q

Punch biopsy

A

round cookie cutter that cuts through the epidermis, dermis, and subcutis

34
Q

solar lentigo

A

age spot/freckle
local proliferation of melanocytes
well-circumscribed margins
no tx required

35
Q

Seborrheic Keratosis (SK)

A 
common tan-black warty, waxy, "stuck-on", benign epidermal lesion
proliferation of immature keratinocytes
"barnacles of aging"
genetic link to multiple
can have Leser-Trelat sign
36
Q

ISK

A

irritated SK

may be pruritic, painful, or bleed if rubbed

37
Q

Leser-trelat sign

A

christmas tree-like pattern seen in SK, if also assoc with skin tags and acanthosis nigrans, there is a possible association with GI and lung cancers

38
Q

evaluation and treatment of SK

A

typically clinical
may bx if needed
reassurance
can be removed if ISK

39
Q

Keratoacanthoma (KA)

A

benign
Hallmark: rapid growth over 6-8 weeks
round, flesh colored nodule w/ central keratin plug

40
Q

KA management

A

majority resolve spontaneously in 6-9 mo
usually bx before then
difficult to dx

41
Q

Actinic Keratosis (AK)

A 
aka solar keratosis
considered pre-cancer
may progress to SCC
M>F
erythematous, scaly/gritty macule or papule
may be tender
42
Q

Subtypes of AK

A 
hypertrophic (thickened)
atrophic (scale absent)
cutaneous horn
pigmented
Actinic cheilitis (lip)
43
Q

Dx of AK

A

typically clinical based on visualization and touch
dermoscopy
shave or punch bx to differentiate from SCC

44
Q

management of AK

A 
may resolve, but could reoccur
isolated: cryotherapy or surgical excision
multiple: field treatment
photodynamic therapy
topical 5-fluorouracil
imiquimod
skin surveillance for SCC progression
45
Q

skin cancer

A

most common cancer in the us.

melanoma vs malignant non-melanoma

46
Q

Basal Cell Carcinoma

A 
BCC
most common skin cancer
arises from basal cells of epidermis
Nodular is most common subtype
flesh-colored, pinkish
pearly papule/nodule
TELANGIECTASIAS
central ulceration with rolled border
head and neck
47
Q

BCC tx and prognosis

A 
surgical removal, cryotherapy, radiation, 
if superficial can use 5% FU cream 
metastasis is rare
may recur
locally invasive
48
Q

Squamous Cell Carcinoma (SCC)

A 
2nd most common skin cancer
males 50-70
immunosuppressed
may arise in area of previous skin injury that doesn't heal
papule, plaque, nodule
pink, red, skin colored
might be pruritic or tender
scaly, exophytic, indurated, friable
appears warty/hyperkeratotic
no defined border, vessels, or pearly color
49
Q

SCC tx

A

surgical
wide excision with clear margins, MOHS, curettage and cryotherapy
non-surgical
radiation if poor surgical candidate
if SCC in situ: creams, gels, phototherapy

50
Q

SCC prognosis

A

rate of metastasis is 5%
increases if lesion is >2cm diameter and >4 mm deep or recurrent
surveillance every 3-6 mo for 2 yrs then 6-12 mo for 3 years, then annually

51
Q

MOHS

A

complete margin analysis
higher cure rates
spares normal tissue
costly/long procedure

52
Q

Excisional bx

A

fast, cheap
higher recurrence rate
can be done by more providers

53
Q

Malignant melanoma (MM)

A 
3% of skin cancers
avg age at dx is 40
risk factors: >5 atypical nevi, >25 nevi
immunosuppression
personal/family hx
UV
asymptomatic
mostly new lesions (de novo)
some from pre-existing nevus
pigmented papule/nodule
ABCDE
54
Q

Melanoma subtypes

A

superficial spreading
nodular
lentigo maligna
Acral lentiginious

55
Q

superficial spreading melanoma

A 
most common subtype of melanoma
confined to epidermis
younger pop
radial>vertical spread
men: backs
women: back and legs
56
Q

nodular melanoma

A

rapid vert growth
minimal radial growth
agressive
inflamed and friable nodule

57
Q

lentigo maligna melanoma

A

elderly with chronic sun exp
slow progression radially with rapid vertical growth
typically more superficial

58
Q

acral lentiginous melanoma

A 
darker skin
spreads superficial then vertical
M>F
larger lesions due to delay in dx
palmar, plantar, subungual
59
Q

subungual melanoma

A

great toe or thumb
hx of trauma
dark streak involving proximal nail fold

60
Q

amelanotic melanoma

A

minimal or absent pigment

extensive ddx: psoriasis, dermatitis, BCC, SCC

61
Q

Treatment of Melanomas

A

wide surgical excision is gold standard with 2 cm clear margins depending on depth and tumor size
possible lymph node bx
follow up every 3 months

X Clin Med Exam 1 (7 decks)

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