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Dermatology > Lecture 10: Benign Neoplasms, Hyperplasias, and Pigmentary Disorders > Flashcards

Lecture 10: Benign Neoplasms, Hyperplasias, and Pigmentary Disorders Flashcards

1
Q

Where do seborrheic Keratoses MC appear?

The Great Imitator

A

Chest and back

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2
Q

What does a seborrheic keratosis look like?

A

Stuck-on papules/plaque with well-defined borders

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3
Q

As you grow older, what happens to SKs?

A

Increased in incidence and number

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4
Q

A patient presents with a flat wrinkled plaque. It kinda looks like a postage stamp. What is this?

A

Flat SK

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5
Q

What symptoms are SKs associated with?

A

None.

They become itchy or painful with you irritate or traumatize them!

Leave them alone

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6
Q

Lichenoid keratosis is an inflamed SK. It has a pinky and shiny appearance that mimics that of…

A

Nodular or cystic BCC

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7
Q

What is dermatosis papulosa nigra?

A

Papular seborrheic keratoses on dark skin.

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8
Q

A patient presents with rapid onset of numerous SKs. Your preceptor says this is the sign of Leser-Trelat. You should be worried that this patient may have underlying….

A

Adenocarcinoma of the GI tract

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9
Q

Generally, how do you differentiate seborrheic Keratosis from a smooth skin tag/acrochordon?

A

Seborrheic has NO pedunculation

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10
Q

A patient presents with what you suspect is seborrheic keratosis. You aren’t too sure, so to examine it, you would….

A

Use side-lighting to look for a coarse, waxy scale that can be removed.

Hold the penlight/dermatoscope parallel to the skin surface.

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11
Q

Specifically, what kind of dermoscopy is good to view seborrheic keratosis?

A

Non-polarized dermoscopy

The ridges and fissures should form a cerebriform pattern

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12
Q

Dx of seborrheic keratosis is made…

A

Clinically

Dermoscopy is to differentiate it

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13
Q

If you biopsy SK, the histopathology would probably show…

A

Sharply demarcated proliferation of monotonous epidermal keratinocytes

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14
Q

A patient is worried about their SK diagnosis. You should let the patient know that…

A
  • SK itself is not malignant.
  • However, if they start getting a bunch suddenly, we would consider internal cancer.
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15
Q

A patient has both small and regular SKs. For the small SKs, you would use… For the regular ones, you would use…

A
  • Small: chemical peels
  • Regular: Cryosurgery (but may cause dyspigmentation)
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16
Q

A giant SK is best removed via…

A

Shave excision

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17
Q

Melasma MC appears on the…

A

face

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18
Q

Clinically, how does Melasma appear?

A
  • Macular
  • Hyperpigmented
  • Sharply defined
  • Uniform
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19
Q

How do you treat melasma?

A

Tri-Luma QHS

Fluocinolone + Hydroquinone + Tretinoin

Can also do laser stuff

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20
Q

Your patient is starting to develop melasma. To further prevent it, you counsel them to…

A
  • Wear some sunscreen > 30 SPF with titanium dioxide and zinc oxide
  • Remove estrogen exposure
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21
Q

What exactly is a solar lentigo?

A

Sun spot: melanocyte proliferation

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22
Q

Classic patient with solar lentigo

A

40yo white person

40+ & fitzpatrick type 1&2

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23
Q

How do solar lentigos feel?

A

Macular

Flat mat

Irregular borders
Ill defined

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24
Q

The two tx options for solar lentigo include…

A
  • Cryo
  • Laser
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25
Q

Describe an acrochordon/skin tag

A
  • pedunculated papilloma
  • Constricted at the base
  • Skin-brown colored

1-10 mm

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26
Q

Classic patient for an acrochordon/skin tag

A

Obese middle-aged female with acanthosis nigricans or metabolic syndrome

or elderly

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27
Q

Acrochordons/skin tags are MC found in…

A

Intertriginous areas

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28
Q

Acrochordons can become bigger and numerous during…

A

Pregnancy

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29
Q

Acrochordons have 3 primary tx options, which are…

A
  • Snipping
  • Electrodesiccation
  • Cryo
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30
Q

What is the pathology of an epidermal inclusion cyst?

Sebaceous cyst

A

Collection of keratin and lipid rich debris in an epithelial sac within the dermis

31
Q

Classic patient with an epidermal inclusion cyst

A

30-50yo male with minor penetrating trauma into his dermis.

32
Q

Epidermal Inclusion cysts are known for …. and they are MC found on….

A
  • Rancid cheese odor when popped.
  • Face/trunk/neck/scrotum
33
Q

Normally, epidermal inclusion cysts are asymptomatic. However, if … occurs, inflammation will result.

A

Cyst wall rupture

34
Q

You only need to C&S epidermal inclusion cysts if….

A

Recurrent infection

35
Q

What two locations prompt imaging/FNA of an epidermal inclusion cyst?

Normally a clinical dx.

A
  • Breast
  • Bone

Atypical locations

36
Q

When do you I&D an epidermal inclusion cyst?

A
  • Cosmetic concern
  • Inflamed
  • Infected (+/- abx)
37
Q

Ideal surgical excision of an epidermal inclusion cyst is done when it is not … and with complete removal of ….

A
  • NOT inflamed
  • Complete removal of cyst sac

Punch, minimal incision, or elliptical excision

38
Q

If you find an epidermal inclusion cyst in an atypical location, your next step after imaging and FNA is to ….

A

Call surgery

39
Q

What is the MC soft tissue tumor?

40
Q

What characterizes a classic lipoma?

A
  • Soft, painless, slow growing
  • Found on trunk/UE
  • 1-10 cm in size
41
Q

When is a biopsy of a lipoma indicated?

A
  • Pain
  • Mvmt restricted
  • Rapid growing
  • Firm

Do surgery if it hurts, looks ugly, or dx is unclear.

42
Q

Where is a venous lake MC found?

A
  • Face
  • Lips
  • Ears
43
Q

The symptoms of a venous lake/dilated venule include…

A

None, its asymptomatic

44
Q

Venous lakes MC appear after the age of…

45
Q

Just to make sure a venous lake is not melanoma, you should…

A
  • Compress it with pressure
  • Light it up with diascopy
  • Dermoscopy showing its vascular
46
Q

The only reason to treat venous lakes are…

A

Cosmetic

Electrosurgery
Laser
Surg excision

47
Q

What is the pathogenesis of urticaria?

A
  • Mast cells and basophils release vasoactive substances
  • Extravasation of fluid into the dermis

Vasoactive: histamine, leukotrienes, C4, PGEs

48
Q

Complement-mediated Rxns with urticaria include…

A
  • Infections
  • Serum sickness
  • Transfusion Reactions
49
Q

An acute urticarial reaction occurs within…

A

6 weeks

Infection, allergy, cant see the rest

chronic: recurrent, most days of the week, > 6 wks - physical, autoimmune

50
Q

Describe the clinical findings associated with urticaria

A
  • Raised erythematous wheals
  • central pallor
  • Resolves ideally within 24hrs.
  • Changes shape and size rapidly
51
Q

The triple regimen therapy for acute urticaria in the ED should include a drug from these 3 classes:

A
  • H1: loratidine, benadryl, etc
  • H2: -tidines (ranitidine, famotidine)
  • Prednisone
52
Q

What generally precipitaes pyogenic granulomas?

A

Minor trauma

53
Q

T/F : Pyogenic granuloma is filled with pus

A

False, i think its filled with blood

54
Q

Pyogenic granulomas are treated via … or …

A
  • Surgical excision
  • ED&C
55
Q

Pyogenic granuloma can be mistaken for…

A

Amelanotic nodular melanoma

56
Q

The three types of hemangiomas are…

A
  • Cherry angioma
  • Capillary hemangioma
  • Strawberry angioma
57
Q

The MC tumor in babies is…

A

Hemangiomas

Vascular tumor, NOT a malformation

58
Q

Generally, hemangiomas are seen at weeks ….

A

2-4 weeks

Female preference

59
Q

Hemangiomas are typically found on the … (2)

A
  • Head
  • Neck

Compressible

60
Q

Which hemangioma subtype typically resolves on its own by years 5-10?

61
Q

The main concern with hemangiomas is…

A

Obstruction!

Vision, larynx, nose, mouth

Get an MRI, doppler/arteriography

62
Q

1st line tx of a hemangioma is…

A

Propranolol

Prednisone 2nd

Also call cardio to monitor

63
Q

Vitiligo is characterized by the absence of…

A

Melanocytes

64
Q

Half of all vitiligo cases begin between the ages of ….

65
Q

The only risk factor for vitiligo appears to be…

A

First degree relatives

Likely polygenic transmission

66
Q

What are the 3 proposed theories for vitiligo pathogensis?

A
  • Autoimmune
  • Neurogenic
  • Self-destruction
67
Q

What symptoms are associated with vitiligo?

A

None

Painless, not itchy

68
Q

T/F: New white macules can appear in someone with vitiligo via Koebnerization

A

TRUE

Areas of recent trauma

69
Q

The MC subtype of vitiligo is..

A

Generalized and symmetrical with a widespread distribution

Lip-tip pattern

70
Q

If histopathology was done of the macules in vitiligo, you would see…

Normally clinical dx

A

Normal skin with a lack of melanocytes.

71
Q

There are a few repigmentation methods for vitiligo, which include…

A
  • Intermittent high-potency topical CS for 2 months max
  • Topical photochemotherapy for small/single macules, taking 100+ treatments
  • Systemic photochemotherapy
  • Narrow-band UVB is TOC for older than 6
72
Q

The treatment of choice for repigmentation in vitiligo for children >6 (???) is ….

Not sure if he meant younger than 6

A

Narrow-band UVB

73
Q

Last resort tx for vitiligo pigmentation is…

A

Minigrafting

Refractory cases only

74
Q

If someone has vitligo universalis and practically has no pigmentation anywhere, we might suggest…

A

Bleaching their skin with hydroquinone (MEH)

Its like reverse tanning lotion

I think he said michael jackson used this

Dermatology (12 decks)

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