Mar 7 - Common Skin Tumors/Carcinomas Flashcards
Cherry Hemangiomas
Common, benign growth of blood vessels. In infants, due to GLUT-1, will spontaneously involute over the years
When do cherry hemangiomas really require medical intervention?
When they are around the eyes, “beard area” (larynx involvement), or on the bottom lip (ulceration)
What common heart medication will shrink cherry hemangiomas?
beta-blockers (propanolol)
Port-Wine Stain
Vascular malformation (mut in the GNAQ gene), equally prevalent in men & women, manifests as a violaceous streak
Sturge-Weber Syndrome
Port-wine stain, but with brain and eye involvement - the earlier the error in development, the more severe the cognitive impairment
Klippel–Trénaunay Syndrome
Port-Wine stain covering an entire limb - indicative of improper blood and lymph vessel development. Can lead to tissue hypertrophy
One treatment common to both port-wine stains and cherry hemangiomas?
Pulsed-dye laser therapy
Nevus Sebaceus
A hairless plaque usually on the face or scalp that is present at birth. (almost looks like some bubble gum stuck in the hair) RAS gene issue
Sebaceus Hyperplasia
Benign, hairless papules from outgrowth of oil glands. Cosmetic issue only
Acrochordon
“Skin tags” - fatty outgrowth on the face, armpit. Tx = snip excision
Lipoma
Fat tumor, usually in older people or in infants on the bottom of the feet
Dermatofibroma
Essentially a large freckle that dimples in the middle when pinched due to its fibrous nature. Usually on the legs
Keloid scars - hypertrophic or hyperplastic?
Hypertrophic - with raised borders extending beyond the wound
Suborrheic keratosis
Benign keratin pits associated with hair follicles- “the barnacles of old age”
Leser-Trélat sign
Explosive growth of suborrheic keratoses (“barnacles”) which indicates other malignancies
Nevocellular Nevi
Acquired moles (genes or sunlight) most commonly on photoexposed areas. Normally benign, but observe for ABCDE
Three types of nevocellular nevi:
1) Intradermal Nevus
2) Junctional Nevus (most common)
3) Compound Nevus
Blue Nevus
Non-vascular hyperpigmented cells (moles) that are in the dermis rather than the epidermis - look blue on exam
Congenital Nevi
Mole that can be >20 cm at birth due to an error in embreyonic migratory error in the melanocytes. Generally do not turn malignant
Dysplastic Nevus
Atypical mole: fuzzy border / color change / >5 mm in size - not necessarily malignant but could indicate other malignancies.
FAMM Syndrome
Familial Atypical Moles and Melanoma Syndrome. Pt will have upwards of 50+ atypical moles
Neurofibromatosis (signs and symptoms)
Café-au-lait spots, Lisch nodules, optic glioma, Crowe’s sign (axillary freckling), neurofibromas
Basal cell carcinoma is from an abnormal _________ cell, but a melanoma is from an abnormal ________cell
BCC = keratinocytes Melanoma = melanocytes
BCC’s look like:
A rash that doesn’t heal properly- intermittent bleeding, almost pearly appearance
When is Moh’s surgery indicated?
When the abnormality is large, recurrent, or in a cosmetically sensitive area
Desmoplastic BCC
A BCC that infiltrates deeper into the skin - loss of function of the PATCH gene (smoothened gene now active)
A Tx for BCC?
Vismodegib - re-blocks the smoothened gene
or, 5-flurouracil, diclofenac
Actinic Keratosis
Precancer that can become a squamous cell carcinoma. Rough, gritty, atypical keratinocytes in the epidermis
Squamous Cell Carcinoma
Pearly white, fibrous abnormalities, esp in immunosuppressed patients / chronic UV damage. Metastasis is slow/rare except on lip
Bowen’s Disease
HPV-induced squamous cell carcinoma
Keratoacanthoma
Common, sharply demarcated, volcano-appearance skin tumor that grows rapidly but is unlikely to metastasize. Tx = excision
Most common cancer for ages 15-29?
Melanoma! Pretty damn common
The four sub-types of melanoma?
1) Superficial/Spreading
2) Nodular
3) Acral Intigenous
4) Lentigo-Maligna
Where do men vs women tend to get melanoma?
men = on the back women = back and legs
What is the Breslow depth?
Measuring from the top of the epidermis to the base of the growth. Use Clark’s levels for prognosis
So is tanning associated with increased skin cancer?
Yes. Don’t let anyone tell you differently - UV is a class 1 carcinogen
What is SPF and what does it protect from?
Sun Protection Factor - only blocks UV-B!
[If usually takes 5 mins to burn, SPF 15:
5x15 = 75 mins outside with protection]
You can successfully treat a melanoma Pt with vemurafinib if and only if:
They have a BRAF mutation
