Malignant skin

Question 1

What is actinic keratosis?

Answer 1

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

Question 2

How do you treat actinic keratosis?

Answer 2

cryotherapy, if hard or bleeding, biopsy

can consider imiquimod too

Question 3

What is the clinical presentation of basal cell carcinoma?

Answer 3

pearly papule “dome shaped” with rolled borders and superficial telangiectasias , usually on the upper lip and won’t heal

Question 4

How do you manage basal cell carcinoma?

Answer 4

punch or shave biopsy and ED&C is most commonly used for removal, excision, if on face, MOHS surgery. Consider imiquimoid cream

Question 5

What is the presentation of squamous cell carcinoma?

Answer 5

thick, adhered erythematous and elevated base with white crusty surface normally on the LOWER LIP

Question 6

Where does SCC arise from often?

Answer 6

actinic keratosis

Question 7

How do you treat SCC?

Answer 7

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

Question 8

What is keratoacanthoma SCC?

Answer 8

ulcerated, swollen SCC with rapid onset pink dome shaped lesion with keratotic plug and a “volcano appearance”

Question 9

What is the treatment of keratoacanthoma SCC?

Answer 9

always excised, Mohs surgery, or ED&C to ensure complete removal

Question 10

What is Bowen’s disease?

Answer 10

“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

Question 11

How do you treat Bowen’s disease?

Answer 11

ED&C, cryosurgery, excision or 5-FU

Question 12

What is Paget’s disease?

Answer 12

breast malignancy in nipple with extended area of redness and serous fluid, forming a crust

Question 13

How do you manage Paget’s disease?

Answer 13

surgical cone excision

Question 14

What should you be looking for in atypical nevi for malignancy?

Answer 14

cell disarrangement and atypical shapes, ABCDEFs, ugly duckling, biopsy

Question 15

What is the presentation of superficial spreading melanoma?

Answer 15

haphazard color combos, newly pigmented barely raised plaques on trunk of men and legs of women
Ask: Hx of serious sunburns? Family?

Question 16

What are candidates for punch biopsy?

Answer 16

> 1mm needing to measure Breslow level

Question 17

How do you treat melanoma?

Answer 17

complete, wide local excision; may have to refer to oncology depending on severity

Question 18

In patients with melanoma, what is your responsibility?

Answer 18

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

Question 19

What is a nodular melanoma?

Answer 19

head, neck, trunk arising quickly, colored dark brown, red brown, red black, polypoid, mostly in males

Question 20

What is the presentation of lentigo maligna melanoma?

Answer 20

mostly on face but any sun exposed areas: striking variations of macular browns and black with haphazard blue or gray spots

Question 21

What is acral lentiginous melanoma?

Answer 21

flat dark colors on palms, soles, distal phalanges, or mucous membranes. +Hutchinson’s sign = sudden appearance of pigmented band on proximal nail fold

Question 22

What is amelanotic melanoma?

Answer 22

“Skin colored” red, pink, or erythematous papule with erythema and asymmetrical borders and faint line at periphery.
3Rs: red, recent, and raised?

Question 23

How do you differentiate amelanotic melanoma and BCC?

Answer 23

BCC has a caved in middle appearance while amelanotic have the 3 Rs: red, raised, and recent

Question 24

What is congenital melanoma?

Answer 24

small black-blue papules or nodules or larger firmer palpable masses - can be spread mother to fetus, and excision is needed when possible