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Anterior Segment > Lumps & Bumps: Epidermis, Epidermal Melanocytes & Dermis > Flashcards

Lumps & Bumps: Epidermis, Epidermal Melanocytes & Dermis Flashcards

1
Q

what is caused by hyperplasia of squamous epithelium

A

squamous papilloma

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2
Q

gradual onset & slow growth of a flesh colored growth with cerebriform surface is characteristic of

A

squamous papilloma

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3
Q

what is the potential for malignant transformation in squamous papilloma

A

minimal potential

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4
Q

what is caused by proliferation of keratinocytes (predominant cell type in epidermis)

A

seborrheic keratosis (basal cell papilloma)

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5
Q

“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)

A

seborrheic keratosis (basal cell papilloma)

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6
Q

what is the malignant potential for seborrheic keratosis

A

no malignant potential BUT it can present as part of a paraneoplastic syndrome

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7
Q

sudden appearance of multiple lesions of seborrheic keratosis indicates

A

can indicate cancer elsewhere in the body, especially the GI tract

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8
Q

what is caused by squamous papilloma caused by HPV type 6 or 11

A

verruca vulgaris

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9
Q

possible concomitant conjunctivitis & multiple lesions is characteristic of

A

verruca vulgaris

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10
Q

verruca vulgaris is more common in what population

A

children & young adults

immunocompromised are more susceptible to infection

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11
Q

what is the malignant potential for verruca vulgaris

A

minimal potential

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12
Q

what is caused by pox virus infection of the skin

A

molluscum contagiosum

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13
Q

typically asymptomatic, multiple pearly flesh-colored lesions with a small central dimple (but not always) & associated with chronic follicular conjunctivitis is characteristic of

A

molluscum contagiosum

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14
Q

what infection is more common in children & transmitted by direct contact or by STDs in adults

A

molluscum contagiosum

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15
Q

what 2 viral infections are self-resolving

A

molluscum contagiosum & herpes simplex dermatitis

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16
Q

when should you suspect someone with molluscum contagiosum is immunocompromised

A

when it is present in adults or severe bilateral involvement in children

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17
Q

what infection is caused by primary infection of the virus (usually) or reactivation of the virus (rarely)

A

herpes simplex dermatitis

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18
Q

prodromal facial & lid tingling that lasts ~24 hours, eyelid & periorbital vesicles with erythematous base is characteristic of

A

herpes simplex dermatitis

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19
Q

even though herpes simplex dermatitis is self-limiting, it resolves faster with oral antiviral therapy
what would you prescribe

A

acyclovir 400mg 5x/day x 7-10 days

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20
Q

what unilateral infection is caused by reactivation of the varicella zoster virus

A

herpes zoster dermatitis

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21
Q

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

A

herpes zoster dermatitis

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22
Q

what is the treatment for herpes zoster dermatitis

A

acyclovir 800mg 5x/day x 10 days

erythromycin or bacitracin ung BID for 1-2 weeks

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23
Q

verruca vulgaris, molluscum contagiosum, herpes simplex dermatitis & herpes zoster dermatitis are what kind of infection

A

viral infections of the epidermis

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24
Q

what is a type of SCC that is a fast-growing lesion with a keratin-filled central ulcer

A

keratoacanthoma

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25
Q

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
A

keratoacanthoma

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26
Q

what is the management for keratoacanthoma

A

falls within the spectrum of SCC → definitive treatment is indicated → complete surgical excision

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27
Q

what is the likelihood of recurrence of keratoacanthoma after surgical excision

A

recurrence is rare

28
Q

when there are multiple keratoacanthoma lesions what does it become & what can it be associated with

A

it becomes a paraneoplastic syndrome that can be associated with colon cancer

29
Q

what is the most common pre-cancerous lesion caused by proliferation of atypical keratinocytes

A

actinic keratosis

30
Q

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
A

actinic keratosis

31
Q

what happens if actinic keratosis is left untreated

A

it can progress to SCC (has highest potential for malignant transformation)

32
Q

when do you need a biopsy for actinic keratosis

A

painful, ulcerated, or bleeding lesions

hyperkeratotic lesions unresponsive to standard therapy

33
Q

keratoacanthoma & actinic keratosis are _____ of the epidermis & which one has the highest potential for malignant transformation

A

pre-malignant tumors, actinic keratosis has high potential for malignant transformation

34
Q

what is a malignant tumor of keratinocytes

A

squamous cell carcinoma (SCC)

35
Q

how common is SCC eyelid malignancy

A

second most common (accounts for 2-10% of eyelid malignancies)

36
Q

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
A

squamous cell carcinoma (SCC)

37
Q

what percentage of SCC occur in the head & neck

A

55%

38
Q

how common is SCC on eyelids

A

relatively uncommon, but potentially fatal due to metastasis → predilection for lower lid & lid margin

39
Q

how to manage SCC

A
  • Mohs microsurgery/frozen section
  • radiotherapy, cryotherapy, intralesional chemotherapy
  • photodynamic therapy (in select cases)
40
Q

what is the recurrence rate for SCC

A

high recurrence rate

41
Q

what is the most common malignant tumor of the skin & eyelid (>90% of eyelid tumors)

A

basal cell carcinoma (BCC)

42
Q

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

A

basal cell carcinoma (BCC)

43
Q

BCC in what location is most difficult to manage & has the greatest risk of recurrence

A

medial canthus

44
Q

management for BCC

A

complete resection with frozen section proof of tumor-free margins

45
Q

how likely is recurrence in BCC after treatment & what happens if left untreated

A

rarely metastasizes in complete removal

becomes locally invasive & destructive if left untreated

46
Q

SCC & BCC are ____ tumors of the ______

A

malignant tumors of the epidermis

47
Q

what is a small brown macule from increased melanin in the epidermal basal layer (normal)

A

freckle

48
Q

what is a darkly pigmented lesion containing MODIFIED MELANOCYTES that can be congenital or acquired

A

melanocytic nevus

49
Q

which melanocytic nevi is uncommon

A

congenital

50
Q

which melanocytic nevi has an onset of 5-15 years, begins at basal layer & migrates to dermis in young adulthood

A

acquired

51
Q

characteristics:
- can be deeply pigmented or amelanotic (without pigment)
- may contain hair
- marginal nevus can extend onto the palpebral conjunctiva

A

melanocytic nevus

52
Q

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

A

oculodermal melanocystosis (nevus of Ota)

53
Q

characteristics:

  • cutaneous lesion is flat, tan to gray, follows first & second division of CN V
  • usually unilateral, but can be bilateral
A

oculodermal melanocystosis (nevus of Ota)

54
Q

how to manage oculodermal melanocystosis & how likely is it to become malignant

A

periodic DFE to rule out uveal melanoma

malignant transformation of melanocytes is rare

55
Q

freckles, melanocytic nevus, & oculodermal melanocystosis are what kind of tumors

A

benign epidermal melanocytic tumors

56
Q

what is caused by an acquired cutaneous pigmentation occuring on skin exposed areas

A

lentigo maligna (Hutchinson freckle)

57
Q

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
A

lentigo maligna (Hutchinson freckle)

58
Q

treatment for lentigo maligna

A

if left untreated → 30% of the cases evolve into eyelid melanoma 10-15 years after onset

progressive lesions are managed with wide surgical resection

59
Q

what kind of tumor is lentigo maligna

A

pre-malignant epidermal melanocytic tumor

60
Q

what is a tumor caused by proliferation of atypical melanocytes invading the dermis

A

primary malignant melanoma

61
Q

characteristics:

  • uncommon malignant tumors of eyelid → but usually occurs on lower lid
  • can metastasize after many years
A

primary malignant melanoma

62
Q

which type of eyelid melanoma in primary malignant melanoma has the worst prognosis

A

eyelid margin melanoma

63
Q

how to manage primary malignant melanoma

A
  • EARLY DETECTION is key factor in lowering mortality

- wide surgical excision & eyelid reconstruction

64
Q

primary malignant melanoma is what kind of epidermal melanocytic tumor

A

malignant melanocytic tumor

65
Q

what benign tumor is caused by aggregation of lipid-filled macrophages within the dermis

A

eyelid xanthelasma

66
Q

characteristics:
- usually bilateral & on medial aspects of eyelids
- single or multiple flat, yellow, placoid lesions that affect loose aspect of eyelids

A

eyelid xanthelasma

67
Q

how to manage eyelid xanthelasma

A

observation, order lipid panel to see if they have hyperlipidemia

Anterior Segment (37 decks)

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