Malignant skin Flashcards
What is actinic keratosis?
lesions in areas of high sun exposure; yellowy scaling with “rough, dry sandpaper scaling” with erythema from chronic sun exposure, aging, with the potential to progress to SCCs
How do you treat actinic keratosis?
cryotherapy, if hard or bleeding, biopsy
can consider imiquimod too
What is the clinical presentation of basal cell carcinoma?
pearly papule “dome shaped” with rolled borders and superficial telangiectasias , usually on the upper lip and won’t heal
How do you manage basal cell carcinoma?
punch or shave biopsy and ED&C is most commonly used for removal, excision, if on face, MOHS surgery. Consider imiquimoid cream
What is the presentation of squamous cell carcinoma?
thick, adhered erythematous and elevated base with white crusty surface normally on the LOWER LIP
Where does SCC arise from often?
actinic keratosis
How do you treat SCC?
ED&C or for larger areas, excision with wide margins; MOHS surgery for face. Consider metastasis if on lips to lymphnodes, followed by 5-FU injections
What is keratoacanthoma SCC?
ulcerated, swollen SCC with rapid onset pink dome shaped lesion with keratotic plug and a “volcano appearance”
What is the treatment of keratoacanthoma SCC?
always excised, Mohs surgery, or ED&C to ensure complete removal
What is Bowen’s disease?
“SCC in situ”, scarry, red scaly patch, superficial and gradually growing. Usually caused by sun exposed areas, like legs of women and ears/scalp of men
How do you treat Bowen’s disease?
ED&C, cryosurgery, excision or 5-FU
What is Paget’s disease?
breast malignancy in nipple with extended area of redness and serous fluid, forming a crust
How do you manage Paget’s disease?
surgical cone excision
What should you be looking for in atypical nevi for malignancy?
cell disarrangement and atypical shapes, ABCDEFs, ugly duckling, biopsy
What is the presentation of superficial spreading melanoma?
haphazard color combos, newly pigmented barely raised plaques on trunk of men and legs of women
Ask: Hx of serious sunburns? Family?
What are candidates for punch biopsy?
> 1mm needing to measure Breslow level
How do you treat melanoma?
complete, wide local excision; may have to refer to oncology depending on severity
In patients with melanoma, what is your responsibility?
Initial FBSE at time of diagnosis and:
<1mm: FBSE every 3 months for 1 year and 6 months for year 2 and then annually for life
>1mm: FBSE every 3 months for 2 years, every 6 months for 3 years, then annually.
always check lymphnodes and recheck primary site
What is a nodular melanoma?
head, neck, trunk arising quickly, colored dark brown, red brown, red black, polypoid, mostly in males
What is the presentation of lentigo maligna melanoma?
mostly on face but any sun exposed areas: striking variations of macular browns and black with haphazard blue or gray spots
What is acral lentiginous melanoma?
flat dark colors on palms, soles, distal phalanges, or mucous membranes. +Hutchinson’s sign = sudden appearance of pigmented band on proximal nail fold
What is amelanotic melanoma?
“Skin colored” red, pink, or erythematous papule with erythema and asymmetrical borders and faint line at periphery.
3Rs: red, recent, and raised?
How do you differentiate amelanotic melanoma and BCC?
BCC has a caved in middle appearance while amelanotic have the 3 Rs: red, raised, and recent
What is congenital melanoma?
small black-blue papules or nodules or larger firmer palpable masses - can be spread mother to fetus, and excision is needed when possible
