Lumps & Bumps: Epidermis, Epidermal Melanocytes & Dermis Flashcards
what is caused by hyperplasia of squamous epithelium
squamous papilloma
gradual onset & slow growth of a flesh colored growth with cerebriform surface is characteristic of
squamous papilloma
what is the potential for malignant transformation in squamous papilloma
minimal potential
what is caused by proliferation of keratinocytes (predominant cell type in epidermis)
seborrheic keratosis (basal cell papilloma)
“button stuck on surface skin”
a solitary lesion 1-2cm in diameter, elevated with waxy surface & sharp demarcation with varying degrees of pigmentation that present on hair-bearing areas of skin (chest, face, back)
seborrheic keratosis (basal cell papilloma)
what is the malignant potential for seborrheic keratosis
no malignant potential BUT it can present as part of a paraneoplastic syndrome
sudden appearance of multiple lesions of seborrheic keratosis indicates
can indicate cancer elsewhere in the body, especially the GI tract
what is caused by squamous papilloma caused by HPV type 6 or 11
verruca vulgaris
possible concomitant conjunctivitis & multiple lesions is characteristic of
verruca vulgaris
verruca vulgaris is more common in what population
children & young adults
immunocompromised are more susceptible to infection
what is the malignant potential for verruca vulgaris
minimal potential
what is caused by pox virus infection of the skin
molluscum contagiosum
typically asymptomatic, multiple pearly flesh-colored lesions with a small central dimple (but not always) & associated with chronic follicular conjunctivitis is characteristic of
molluscum contagiosum
what infection is more common in children & transmitted by direct contact or by STDs in adults
molluscum contagiosum
what 2 viral infections are self-resolving
molluscum contagiosum & herpes simplex dermatitis
when should you suspect someone with molluscum contagiosum is immunocompromised
when it is present in adults or severe bilateral involvement in children
what infection is caused by primary infection of the virus (usually) or reactivation of the virus (rarely)
herpes simplex dermatitis
prodromal facial & lid tingling that lasts ~24 hours, eyelid & periorbital vesicles with erythematous base is characteristic of
herpes simplex dermatitis
even though herpes simplex dermatitis is self-limiting, it resolves faster with oral antiviral therapy
what would you prescribe
acyclovir 400mg 5x/day x 7-10 days
what unilateral infection is caused by reactivation of the varicella zoster virus
herpes zoster dermatitis
pain along the trigeminal nerve
3 phases:
1) pre-eruptive: generalized malaise, fever, headache; pain/burning/itching along affected dermatome
2) acute eruptive phase: vesiculopustular rash
3) chronic phase: post-herpetic neuralgia
these are all characteristics of what infection
herpes zoster dermatitis
what is the treatment for herpes zoster dermatitis
acyclovir 800mg 5x/day x 10 days
erythromycin or bacitracin ung BID for 1-2 weeks
verruca vulgaris, molluscum contagiosum, herpes simplex dermatitis & herpes zoster dermatitis are what kind of infection
viral infections of the epidermis
what is a type of SCC that is a fast-growing lesion with a keratin-filled central ulcer
keratoacanthoma
characteristics:
- develops on hair-bearing sun-exposed skin (5% on eyelids)
- elevated margins with a CENTRAL CRATER with rapid onset & growth
- usually a solitary lesion
- spontaneous regression
keratoacanthoma
what is the management for keratoacanthoma
falls within the spectrum of SCC → definitive treatment is indicated → complete surgical excision
what is the likelihood of recurrence of keratoacanthoma after surgical excision
recurrence is rare
when there are multiple keratoacanthoma lesions what does it become & what can it be associated with
it becomes a paraneoplastic syndrome that can be associated with colon cancer
what is the most common pre-cancerous lesion caused by proliferation of atypical keratinocytes
actinic keratosis
characteristics:
- multiple, erythematous, sessile (immobile) plaques that are pink in color, but can be pigmented
- lesions range from 1-10mm in diameter
- present on face, eyelids (rarely), dorsa of hands, & bald areas on head
actinic keratosis
what happens if actinic keratosis is left untreated
it can progress to SCC (has highest potential for malignant transformation)
when do you need a biopsy for actinic keratosis
painful, ulcerated, or bleeding lesions
hyperkeratotic lesions unresponsive to standard therapy
keratoacanthoma & actinic keratosis are _____ of the epidermis & which one has the highest potential for malignant transformation
pre-malignant tumors, actinic keratosis has high potential for malignant transformation
what is a malignant tumor of keratinocytes
squamous cell carcinoma (SCC)
how common is SCC eyelid malignancy
second most common (accounts for 2-10% of eyelid malignancies)
characteristics:
- aggressive course → aplastic cells extend beyond basement membrane (2-5% metastasize)
- greater tendency for aggressive local invasion & metastasis to regional lymph nodes
- can extend into orbit & brain via neuronal invasion
- lesions arising from actinic keratosis have more favorable prognosis
- can develop on any cutaneous surface & be irritating & bleed
squamous cell carcinoma (SCC)
what percentage of SCC occur in the head & neck
55%
how common is SCC on eyelids
relatively uncommon, but potentially fatal due to metastasis → predilection for lower lid & lid margin
how to manage SCC
- Mohs microsurgery/frozen section
- radiotherapy, cryotherapy, intralesional chemotherapy
- photodynamic therapy (in select cases)
what is the recurrence rate for SCC
high recurrence rate
what is the most common malignant tumor of the skin & eyelid (>90% of eyelid tumors)
basal cell carcinoma (BCC)
characteristics:
- 50-60% occur in lower eyelid
- 15-30% in medial canthus
- 15% in upper eyelid
- 5% in lateral canthus
usually painless, but invasive lesions can cause pain
occurs mainly in head & neck region
hallmark signs: PEARLY, waxy, rolled, TELANGIECTATIC borders with central ulceration
basal cell carcinoma (BCC)
BCC in what location is most difficult to manage & has the greatest risk of recurrence
medial canthus
management for BCC
complete resection with frozen section proof of tumor-free margins
how likely is recurrence in BCC after treatment & what happens if left untreated
rarely metastasizes in complete removal
becomes locally invasive & destructive if left untreated
SCC & BCC are ____ tumors of the ______
malignant tumors of the epidermis
what is a small brown macule from increased melanin in the epidermal basal layer (normal)
freckle
what is a darkly pigmented lesion containing MODIFIED MELANOCYTES that can be congenital or acquired
melanocytic nevus
which melanocytic nevi is uncommon
congenital
which melanocytic nevi has an onset of 5-15 years, begins at basal layer & migrates to dermis in young adulthood
acquired
characteristics:
- can be deeply pigmented or amelanotic (without pigment)
- may contain hair
- marginal nevus can extend onto the palpebral conjunctiva
melanocytic nevus
what is caused by congenital pigmentation of periocular skin, uveal tract, sclera & ipsilateral meninges
CNV & melanocytes originate from neural crest & incomplete migration of melanocytes to epidermis during embryonic development
oculodermal melanocystosis (nevus of Ota)
characteristics:
- cutaneous lesion is flat, tan to gray, follows first & second division of CN V
- usually unilateral, but can be bilateral
oculodermal melanocystosis (nevus of Ota)
how to manage oculodermal melanocystosis & how likely is it to become malignant
periodic DFE to rule out uveal melanoma
malignant transformation of melanocytes is rare
freckles, melanocytic nevus, & oculodermal melanocystosis are what kind of tumors
benign epidermal melanocytic tumors
what is caused by an acquired cutaneous pigmentation occuring on skin exposed areas
lentigo maligna (Hutchinson freckle)
characteristics:
- flat, well-circumscribed, irregular, tan-brown lesion & enlarges over the years
- much later onset than acquired nevus
- associated with primary acquired melanosis of the conjunctiva
lentigo maligna (Hutchinson freckle)
treatment for lentigo maligna
if left untreated → 30% of the cases evolve into eyelid melanoma 10-15 years after onset
progressive lesions are managed with wide surgical resection
what kind of tumor is lentigo maligna
pre-malignant epidermal melanocytic tumor
what is a tumor caused by proliferation of atypical melanocytes invading the dermis
primary malignant melanoma
characteristics:
- uncommon malignant tumors of eyelid → but usually occurs on lower lid
- can metastasize after many years
primary malignant melanoma
which type of eyelid melanoma in primary malignant melanoma has the worst prognosis
eyelid margin melanoma
how to manage primary malignant melanoma
- EARLY DETECTION is key factor in lowering mortality
- wide surgical excision & eyelid reconstruction
primary malignant melanoma is what kind of epidermal melanocytic tumor
malignant melanocytic tumor
what benign tumor is caused by aggregation of lipid-filled macrophages within the dermis
eyelid xanthelasma
characteristics:
- usually bilateral & on medial aspects of eyelids
- single or multiple flat, yellow, placoid lesions that affect loose aspect of eyelids
eyelid xanthelasma
how to manage eyelid xanthelasma
observation, order lipid panel to see if they have hyperlipidemia
